Introduction

Dementia is the loss of mental abilities and most commonly occurs late in life. Of all persons over age 65, 5-8% are demented. This percentage increases considerably with age. Twenty-five to 50% of people over 85 are affected.

General Information

The most common form of dementia, Alzheimer’s disease, accounts for 50-75% of all cases of dementia. Another 20-30% is due to blood vessel disease ("multi-infarct dementia" or "mini-strokes"). The remaining cases result from a variety of less common disorders.

The affected person sometimes recognizes the first signs of dementia. Often family or friends first detect the problem. Typical early symptoms include memory loss, and difficulty performing complex tasks. A person may mislay items, become lost while driving, get confused in the middle of a conversation or lose a prior ability to balance a checkbook. As the condition progresses the deficits become more pronounced and interfere further with daily activities.

Depending on the cause of dementia, the natural course may vary. In the case of Alzheimer’s disease, the time between first obvious symptoms, through gradual loss of cognitive abilities, to death ranges from 7 to 10 years. Vascular dementia which usually results from the blockage of small blood vessels in the brain, often has a more erratic course, at times with stepwise exacerbation that parallels the destruction of different parts of the brain.

As the dementia progresses, the person may require increasing care by friends, family members or institutions.

Unfortunately these problems are often quite frustrating for the afflicted person and alarming to her family. The frustrations can lead to her becoming irritable or demanding, particularly if she doesn’t remember that she has a problem. She may resent being told that she can’t do things she has "always" done.

At times dementia can produce a degree of paranoia, since the affected individual sees those whom she relies on "taking over" her control. She may attribute the disappearance of mislaid items to her care provider stealing her possessions or money.

Despite these changes, people with moderately severe dementia can often engage in many usual activities, particularly if they are not expected to function at a very high level. Readily manageable activities might include attending a backyard barbecue or picnic; helping to repot houseplants, drying the dishes or being taken for a ride in the country.

Many people retain a considerable degree of social skills. For example laughing at a joke (often because everyone else is laughing, not because she understands it). She may carry on a conversation, but respond in stereotyped and vague ways with empty phrases ("My, my! Isn’t that something! You know, it’s just like that.")

While some rare forms of dementia don’t progress (e.g. dementia resulting from a head injury), the course is usually a relentless decline in functioning. When dementia becomes severe, a person may require much help with personal care, such as toileting, bathing, dressing and feeding. Finally the person becomes totally dependent on his caregivers, loses the use of language and is largely unaware of his bodily functioning or his environment.

Medical Treatments for Dementia

Depending on the cause of the dementia, there are different treatments available. For example if the cause of dementia were severe hypothyroidism, the treatment would be thyroid hormone replacement.

Until the past few years there was little that could be done to alter the course of Alzheimer’s disease. Currently there are a few medications that have been shown to afford (at most) a modest transient benefit. The cholinesterase inhibitors (Aricept® (donepezil) and Cognex® (tacrine) help some individuals.

Caring For a Demented Person

Because of the intensity of care that may be required, it is often difficult for even a loving family to provide all the "around the clock" care that a demented relative may need. If friends or family wish to provide these services it is very important for them to be aware not only of the demented person’s needs, but also of their own needs. It is not uncommon for a spouse or children to feel that they have an impossible choice between being utterly overwhelmed (if they try to provide all the care) or feeling they are betraying their relative (if they send them to a nursing home). This often leads to the care provider becoming exhausted. Because of this it is often helpful to investigate local resources to help the care provider.

Here are some helpful resources:

More Information

The following links contain more information on this subject.

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