a general loss of cognitive abilities, including impairment of memory as well as one or more of the following: aphasia, apraxia, agnosia, or disturbed planning, organizing, and abstract thinking abilities. It does not include loss of intellectual functioning caused by clouding of consciousness
(as in delirium
, or other functional mental disorder (pseudodementia
). Causes include a large number of conditions, some reversible and some progressive, that result in widespread cerebral damage or dysfunction. The most common cause is Alzheimer's disease; others include cerebrovascular disease, central nervous system infection, brain trauma or tumors, vitamin deficiencies, anoxia, metabolic conditions, endocrine conditions, immune disorders, prion diseases, Wernicke-Korsakoff syndrome, normal-pressure hydrocephalus, Huntington's chorea, multiple sclerosis, and Parkinson's disease.
Binswanger's dementia a progressive dementia of presenile onset due to demyelination of the subcortical white matter of the brain, with sclerotic changes in the blood vessels supplying it.
boxer's dementia a syndrome more serious than boxer's traumatic encephalopathy, the result of cumulative injuries to the brain in boxers; characterized by forgetfulness, slowness in thinking, dysarthric speech, and slow, uncertain movements, especially of the legs.
epileptic dementia a progressive mental and intellectual deterioration that occurs in a small fraction of cases of epilepsy; it is thought by some to be caused by degeneration of neurons resulting from circulatory disturbances during seizures.
dementia prae´cox (obs.) schizophrenia.
substance-induced persisting dementia that resulting from exposure to or use or abuse of a substance, such as alcohol, sedatives, anxiolytics, anticonvulsants, lead, mercury, carbon monoxide, or organophosphate insecticides, but persisting long after exposure to the substance ends, usually with permanent and worsening deficits. Individual cases are named for the specific substance involved.
vascular dementia patchy deterioration of intellectual function resulting from damage by a significant cerebrovascular disorder.
dementia (di-men'cha) [L. dementia, madness]
A progressive, irreversible decline in mental function, marked by memory impairment and, often, deficits in reasoning, judgment, abstract thought, registration, comprehension, learning, task execution, and use of language. The cognitive impairments diminish a person's social, occupational, and intellectual abilities. In the U.S., 4.5 million people are afflicted by dementia. The prevalence is esp. high in the very elderly: about 20% to 40% of those over 85 are demented. Dementia is somewhat more common in women than in men. It must be distinguished by careful clinical examination from delirium, psychosis, depression, and the effects of medications. See: Alzheimer disease
; Huntington chorea
; Parkinson disease
The onset of primary dementia may be slow, taking months or years. Memory deficits, impaired abstract thinking, poor judgment, and clouding of consciousness and orientation are not present until the terminal stages; depression, agitation, sleeplessness, and paranoid ideation may be present. Patients become dependent for activities of daily living and typically die from complications of immobility in the terminal stage.
Dementia may result from many illnesses, including AIDS, chronic alcoholism, Alzheimer disease, vitamin B12 deficiency, carbon monoxide poisoning, cerebral anoxia, hypothyroidism, subdural hematoma, or multiple brain infarcts (vascular dementia).
Some medications, e.g., donepezil, nemantidine, and tacrine, improve cognitive function in some patients.
Demented patients deserve respectful and dignified care at all stages of their disease. Caregivers assist the demented with activities of daily living and with the cognitive and behavioral changes that accompany the disease. A variety of nursing interventions may reduce the risk of inadvertently precipitating behavioral symptoms. Health care professionals should reinforce the patient's abilities and successes rather than disabilities and failures. Caregivers can help the patient make optimal use of his or her abilities by reducing the adverse effects of other health conditions, sensory impairments, and cognitive defects while maximizing social and environmental factors that support functional capacity. Daily routines should be adjusted to focus on the person rather than the task, e.g., the comfort of bathing rather than the perceived need to bathe in a certain way at a certain time.
Interaction and communication strategies should be adjusted to ensure that the message delivered is the one perceived (obtain attention, make eye contact, speak directly to the individual, match nonverbal communication and gestures to the message, slow the pace of speech, use declarative sentences, use nouns instead of pronouns). Commands including the word “don’t” and questions beginning with “why” should be avoided. Tasks should be broken down into manageable steps. Reassurance and encouragement are provided to assist the patient to act more independently. Reality grounding is not necessary for such a patient; thus, if the patient asks to see his mother (who is dead), reminding him of her death may reinforce the pain of that loss. It may be better to redirect the conversation, asking the patient to talk about his mother, instead. Written agreements and reminders may not be as useful as they would be in the care of other patients, for a demented patient may not remember what has been negotiated and agreed upon in the past. The patient’s environment should be adjusted to provide needed safety. Finding the correct balance between doing too much or too little may be difficult for the caregiver, who should recognize that the balance may shift day to day and that patience and flexibility are more helpful. Caregivers must be aware that the patient will have moments of lucidity, which should be treasured but not considered evidence that the patient is exaggerating or feigning his or her disease to obtain attention. Family members who provide care must be aware that they, too, have emotional needs and can become angry, frustrated, and impatient and that they need help to learn to forgive themselves as well as the loved one they are caring for. Finally, such caregivers must learn how to accept help and should not fear to admit that they cannot carry the burden of care by themselves.
AIDS-dementia complex See: AIDS-dementia complex
A form of toxic dementia in which there is loss of memory and problem-solving ability after many years of alcohol abuse.
dementia of the Alzheimer type Abbreviation: DAT
See: Alzheimer disease
Sudden loss of cognitive or intellectual function as a result of a large or bloody stroke or a brain tumor.
Binswanger dementiaBinswanger disease.
A neurological disturbance in patients who have been on dialysis for several years. There are speech difficulties, myoclonus, dementia, seizures, and, eventually, death. The causative agent is presumed to be aluminum in the dialysate.
An infrequent complication of epilepsy, presumed to result from injury to neurons during uncontrolled seizures.
A general term for any of four types of dementia: 1. frontotemporal lobar degeneration; 2. Pick’s disease; 3. primary progressive aphasia; or 4. semantic dementia. Symptoms include personality changes, apathy, compulsive or repetitive behavior, lack of social inhibition, and deterioration in language use.
Heller dementiaRegressive autism.
HIV-associated dementia See: AIDS-dementia complex
dementia with Lewy bodies
A common neurodegenerative disease characterized by gradual and progressive loss of intellectual abilities combined with a movement disorder that resembles Parkinson disease. Those affected often have marked fluctuations in their ability to stay alert and awake and also visual hallucinations. The disease is characterized pathologically by deposits of Lewy bodies. The dementia is treated symptomatically.
Dementia in which elements of both Alzheimer disease and vascular dementia are found.
Dementia resulting from multiple small strokes. After Alzheimer disease, it is the most common form of dementia in the U.S. It has a distinctive natural history. Unlike Alzheimer disease, which develops insidiously, the cognitive deficits of multi-infarct dementia appear suddenly, in stepwise fashion. The disease is rare before middle age and is most common in patients with hypertension, diabetes mellitus, or other risk factors for generalized atherosclerosis. Brain imaging in patients with this form of dementia shows multiple lacunar infarctions. Synonym: vascular dementia
An obsolete term for tertiary syphilis.
An obsolete term for tertiary syphilis.
Dementia following a severe febrile illness.
Dementia beginning in middle age, usually resulting from cerebral arteriosclerosis or Alzheimer disease. The symptoms are apathy, loss of memory, and disturbances of speech and gait.
Dementia associated with Alzheimer disease.
Traumatic dementia, i.e., encephalopathy or an organic brain syndrome caused by closed head injury. It is sometimes referred to colloquially as “boxer's brain.”
Any of a group of brain disorders marked by nearly complete losses in the understanding of word meanings, spelling, and the identification or recognition of facts, faces, or objects. The disease is marked pathologically by local atrophy in the neocortex of the temporal lobe of the brain.
senile dementia of the Alzheimer type Abbreviation: SDAT
subcortical vascular dementiaBinswanger disease.
Dementia caused by tertiary syphilis.
Dementia caused by exposure to neurotoxins such as lead, mercury, arsenic, alcohol, or cocaine.
vascular dementia Abbreviation: VaD
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Patient discussion about dementia of the Alzheimer type
Q. My father is 84 and he was diagnosed with Alzheimer’s disease. I would like to share with all of you a common question that I hear a lot regarding Alzheimer. My father is 84 and he was diagnosed with Alzheimer’s disease. Is there anything I can do to affect how long I stay mentally sharp or is it solely determined by my genes?
A. This is a question that I hear a lot and the answer is Yes. What we do also counts. It is not just genetics. While there is currently no medication that cures Alzheimer’s disease, there is quite a bit of science that shows that although our genes count, our brain health is not completely predetermined. Research shows us that certain behaviors and life style support brain health and prolong mental acuity. Important contributors to brain health are being socially active, physically active, and cognitively active. We need to continue to challenge our mind even when we are no longer in school or are retired. We need to keep a healthy nutrition, make sure we get adequate sleep, and engage in enjoyable activities and life style that help reduce stress levels. Being happy and feeling good about ourselves is also important.
Q. How can alzheimer's disease be slowed down? My father has alzheimer's disease, but only not for a long time. Is it still possible to stop it from progressing? how to do it? He is still ok, recognizing everybody just not remember many things.
A. There are several drugs (including choline esterase inhibitors etc.) using to slow down mild-moderate Alzheimer’s disease, although these medications can't totally prevent the progression of the disease. Vitamin E is also generally recommended to Alzheimer disease patients. However, these drugs must be prescribed by a doctor so consulting one may be wise.
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Q. how do you know if you have early onset of alzheimers? i'm 47. i do have extreme tremors at times and memory l i was told this could be what i have by a psychiatrist. What else can cause me to have these symptoms at my age and how do i know?
A. any time ;)More discussions about dementia of the Alzheimer type