It is a disease of the brain characterized by changes in thinking and severe enough to interfere with daily functioning and the quality of life.
A detailed and accurate history is required from caregivers who know the person well, as the person often lacks insight into the changes with their thinking. In addition to the changes noted with the “ABC’s”, the onset and course of those symptoms needs to be mapped out. Additional steps required for the physician to make a diagnosis of dementia involves performing a physical exam including cognitive testing, completing key blood tests and ordering diagnostic imaging. The benefits of early detection of dementia allows for future planning, safety considerations, modification of potential lifestyle and vascular risk factors and initiation of drug therapy for the dementia.
Alzheimer's Disease is the most common type of dementia. The onset is typically insidious and is progressive. Risk factors for this dementia include increasing age, family history of dementia / genetics, cardiovascular and health behaviors and female gender.
A combination of Alzheimer’s dementia and cerebrovascular disease is increasingly diagnosed based on physical exam and diagnostic imaging features. This is also known as vascular cognitive impairment. Individuals with this dementia may show executive dysfunction, impairment with attention and mood and slowed mental processing. Pure vascular dementia is diagnosed when there is a temporal relationship between a vascular event like a stroke and impaired cognition and function.
Dementia with Lewy Body presents with fluctuations in cognition, early and recurrant visual hallucinations, features of parkinsonism with rigidity, sleep disorder and sensitivity to certain drugs called neuroleptics.
Frontotemporal dementia is often seen with a younger population less than 65 year of age, early behavioral and personality changes and/or marked language difficulties. Neuroimaging is often helpful in diagnosing this type of dementia.
Help is available for dementia from family doctors, health care professionals and physicians specializing in the care of older adults. Additional support is available through the Alzheimer’s Society.
While there is no cure for dementia, it is important that vascular and lifestyle risk factors are modified if possible. Physical activity as well as social engagement are encouraged. Structure and routine are essential. Caregiver support and education is a key ingredient to coping and providing ongoing assistance to the person with dementia. Advance directives in the form of a personal directive and enduring power of attorney are encouraged if the person with cognitive impairment is capable of understanding the process. Safety with driving and usage of tools needs to be determined. Treatment for the varying dementias is similar using cholinesterase inhibitors except for frontotemporal dementia. Certain behaviours are treated with psychotropic medications based on severity of symptoms.
While the content of each Caregiver College Topic may be linked to a variety of other Topic areas, the following have been identified as a Key Linkage which you may be interested in also reviewing:
University of California, Memory & Aging Center