Dementia

Signs and Symptoms

Alzheimer disease

• Increasing memory loss
• Difficulty with language (not being able to find the right words)
• Not being able to think abstractly
• Disorientation (getting lost in familiar places)
• Not recognizing friends or family
• Inability to do familiar tasks (such as cooking)
• Loss of judgment and decision-making abilities
• Personality changes

Vascular dementia

• Mental confusion
• Having trouble walking; falling frequently
• Memory loss
• Difficulty with language
• Becoming agitated
• Urinary frequency or incontinence

What Causes It?

Dementia usually occurs in elderly people, although it is not considered a normal effect of aging. Some kinds of vascular dementia may be mistaken for Alzheimer disease, and the two often occur together.

Other causes of dementia include:

• Vascular disease (blockage of a blood vessel to the brain)
• Traumatic brain injury
• Parkinson, Huntington, Creutzfeldt-Jakob, and other diseases
• Brain tumor
• Vitamin B deficiencies
• Drug or alcohol abuse, medications, or exposure to toxic substances
• A history of severe hypoglycemic episodes among people with type 2 diabetes
• Delirium
• Stroke

What to Expect at Your Doctor's Office

Your doctor will go over your symptoms and do a physical examination. However, since there is no test to diagnose dementia, your doctor will rely greatly on interviews with you and your family, especially to discover noticeable declines in mental and physical abilities.

Depression is sometimes mistaken for dementia in older people. So your doctor should ask questions to rule that out. If your doctor suspects vascular dementia, your doctor may order an MRI (magnetic resonance imaging) or CT (computed tomography) scan to look at your brain.

Treatment Options

There is no cure for either vascular dementia or Alzheimer disease. But medications may help slow the progression of these diseases. It is important for both the person with dementia and the person's caregiver to have a strong support system in place to deal with the emotional challenges of the disease.

Treatments are aimed at lessening the symptoms and slowing the progression of the disease. Treatment may include a combination of drug and psychiatric or behavioral therapies. If you are elderly, your doctor may pay close attention to the medications you take because some drugs may cause confusion or delirium in older people. Exercise, both physical and mental, can slow the progress of dementia. In addition, preliminary studies suggest aromatherapy (using aromas and scents), listening to or playing music, and using art therapy, may help improve symptoms.

Drug Therapies

The following drugs have been approved to treat Alzheimer disease. They are also often used to treat vascular dementia. However, not everyone responds to these medications. Research is continuing to find better drugs to treat Alzheimer disease and other forms of dementia.

Cholinesterase inhibitors. These drugs increase the amount of a brain chemical called acetylcholine, a messenger chemical that is involved in memory and judgment. Side effects can include nausea, fatigue, and diarrhea. This class of drugs includes:

• Donepezil (Aricept)
• Rivastigmine (Excelon)
• Galantamine (Razadyne)

Memantine (Namenda). This drug works by regulating glutamate, a chemical messenger involved in information storage and retrieval in the brain. Side effects can include headache, constipation, confusion, and dizziness.

Complementary and Alternative Therapies

Alternative therapies may help treat dementia. If you are deficient in some nutrients, taking a supplement or getting more of that nutrient in your diet may help slow the progression of the disease. Practitioners use many of the nutrients and herbs listed because of their supposed effects of increasing blood flow to the brain. Not surprisingly, many of them have a blood-thinning effect and therefore can interfere or accentuate the effects of blood-thinning medications. Use dementia therapies, pharmaceutical or natural, under the supervision of a qualified doctor. If you are pregnant, or thinking of becoming pregnant, do not use any complementary and alternative therapies (CAM) unless directed to do so by your physician.

Nutrition and Supplements

• Phosphatidylserine, a substance that occurs naturally in the brain and shows promise in several studies. This supplement may increase levels of brain chemicals involved with memory. DO NOT take phosphatidylserine if you are taking anticoagulants (blood thinners), and use caution when combining it with ginkgo for the same reason. Quality among phosphatidylserine supplements differs. More expensive brands tend to be better than cheaper brands. Phosphatidylserine can interact with some medications, including those typically used to treat Alzheimer disease, glaucoma and other conditions. Talk to your doctor.
• Antioxidants may protect against the development of dementia. They may even slow the progression of dementia. In some studies, but not all, vitamin E, combined with Aricept, helped slow cognitive decline in people with Alzheimer disease. Another antioxidant, coenzyme Q10 (CoQ10), may also help the brain get more oxygen. CoQ10 can increase the clotting tendency of the blood. Check with your doctor to make sure it is suitable for you. The skins of dark berries also provide valuable antioxidants. Many naturally-oriented doctors recommend eating half a cup of frozen blueberries daily. Some nutritionally-oriented doctors believe that freezing improves absorption of the antioxidants in the skin.
• B Vitamins. Biotin, B1, B2, B6, B12, folic acid. These vitamins facilitate the making of several neurotransmitters (chemical messengers) necessary for proper brain function. No scientific evidence shows a direct benefit, but B12 and folic acid lower the levels of an amino acid in the blood that is often elevated in Alzheimer patients. Injections of B12 may have the best results.
• Zinc is often deficient in elderly people, and correcting real deficiencies may help improve memory. Excessive amounts of zinc may suppress the immune system and throw off the balance of certain minerals in the body.
• L-arginine. Evidence suggests that this amino acid may help in vascular dementia by increasing blood flow to the brain. Arginine may worsen herpes infections, and can interfere with some medications, including Viagra, medications that increase blood flow to the heart, such as Nitrates, as well as antihypertension medicines.
• Essential fatty acids, such as those found in alpha linoleic acid (ALA), borage oil, and evening primrose oil. These omega-3 fatty acids may help reduce the risk of Alzheimer disease. Dietary changes include eating fewer animal fats and more fish. Supplementing with omega-3 fatty acids can have many health benefits, but it can also increase the risk of bleeding, particularly in people who are taking blood-thinning medications, including warfarin (Coumadin), aspirin, and others.
• Melatonin. Studies suggest that melatonin, particularly when combined with physical exercise, protects against behavioral and psychological symptoms of dementia, including anxiety, a lack of exploration, and depression. It also protects the brain against cognitive impairment and oxidative stress. Melatonin interacts with several medications. Speak with your physician.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider. Always tell your doctor about any herbs you may be taking.

• Ginkgo (Ginkgo biloba) shows the best evidence for treating early Alzheimer disease and vascular dementia. If you are taking blood-thinning medication, or have a history of seizures, use ginkgo only under the supervision of your doctor.
• Huperzine A, a chemical made from the plant Huperzia serrata, may improve memory in both vascular and Alzheimer dementia, according to several studies in China. However, more studies are needed to know for sure. DO NOT take huperzine A if you have liver disease, epilepsy, asthma or lung issues, ulcers or problems with the urinary tract, or if you are about to have anesthesia. Huperzine can potentially interact with several medications. Speak with your physician.
• Lemon balm (Melissa officinalis). One study showed that 60 drops of this herb daily helped improve cognitive function in people with mild-to-moderate Alzheimer disease. Lemon balm can interact with sedative medications.
• Bacopa (Bacopa monnieri) leaf extract, called Brahmi, is used in Ayurvedic or Indian medicine to improve brain function and learning. However, no scientific studies have investigated how bacopa might affect symptoms of dementia. One study found that taking 300 mg of bacopa per day for 12 weeks seemed to improve cognition in healthy people. Bacopa can potentially decrease heart and lung function, as well as slow the heart rate and potentially lead to gastrointestinal congestion. Speak with your physician.
• Smelling lavender may be effective in terms of alleviating agitation associated with dementia. Lavender is not used internally, but rather as an aromatherapy agent.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider remedies, based on their knowledge and experience, for treating dementia. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Some of the most common remedies used for dementia are listed below.

• Alumina. For dullness of mind, vagueness, slow answers to questions.
• Argentum nitricum. For dementia with irritability, especially with lack of control over impulses.
• Cicuta. For dementia after head injuries, especially with convulsions.
• Helleborus. For stupefaction, when a person answers questions slowly and stares vacantly.
• Silica. For mental deterioration with anxiety over small details.

Following Up

People with dementia usually require continuous care and monitoring by both a health care provider and family members.

Special Considerations

Caregiver and patient education focusing on knowledge of the disease, health, and the patient's well being results in better patient care. Caregivers must also closely monitor patients to make sure they are taking medications appropriately.

Supporting Research

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