Dementia is a loss of brain function that occurs with certain diseases.

It affects memory, thinking, language, judgment, and behavior. Causes, incidence, and risk factors Most types of dementia are nonreversible (degenerative). Nonreversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer's disease is the most common type of dementia. Lewy body disease is a leading cause of dementia in elderly adults. People with this condition have abnormal protein structures in certain areas of the brain. Dementia also can be due to many small strokes. This is called vascular dementia. The following medical conditions also can lead to dementia: Huntington's disease Multiple sclerosis Infections that can affect the brain, such as HIV /AIDS and Lyme disease Parkinson's disease Pick's disease Progressive supranuclear palsy

Changes in blood sugar, sodium, and calcium levels Low vitamin B12 levels Normal pressure hydrocephalus Use of certain medications, including cimetadine and some cholesterol-lowering medications. Dementia usually occurs in older age. It is rare in people under age 60. The risk for dementia increases as a person gets older. Symptoms Dementia symptoms include difficulty with many areas of mental function, including:

Language Memory Perception Emotional behavior or personality Cognitive skills (such as calculation, abstract thinking, or judgment) The early symptoms of dementia can include: Difficulty performing tasks that take some thought, but that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines Getting lost on familiar routes Language problems, such as trouble finding the name of familiar objects Losing interest in things you previously enjoyed, flat mood Misplacing items Personality changes and loss of social skills, which can lead to inappropriate behaviors

Some causes of dementia may be stopped or reversed if they are found soon enough, including: Brain injury Brain tumors Chronic alcohol abuse

As the dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of yourself. The symptoms may include: Change in sleep patterns, often waking up at night Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, or driving Forgetting details about current events Forgetting events in your own life history, losing awareness of who you are Having hallucinations, arguments, striking out, and violent behavior Having delusions, depression, agitation More difficulty reading or writing Poor judgment and loss of ability to recognize danger Using the wrong word, not pronouncing words correctly, speaking in confusing sentences Withdrawing from social contact People with severe dementia can no longer: Perform basic activities of daily living, such as eating, dressing, and bathing Recognize family members Understand language Other symptoms that may occur with dementia: Incontinence Swallowing problems

To maintain mental functioning for as long as possible when dementia cannot be reversed To prevent worsening of vascular dementia from future small strokes in people with high blood pressure and high cholesterol

To manage depression, insomnia, hallucinations, agitation, and aggression Acetylcholinesterase inhibitors Acetylcholinesterase (AChE) inhibitors like tacrine (Cognex), donepezil (Aricept), galantamine/ galanthamine (Reminyl), and rivastigmine (Exelon) are approved by the (FDA) for treatment of Alzheimer disease. They may be useful for other similar diseases causing dementia (for example, Parkinsons Dse.). Unfortunately, improvement is neither dramatic nor permanent. How AChE inhibitors work: AChE inhibitors delay the breakdown of acetylcholine, a brain chemical needed for nerve cells to communicate. They may be useful for mild-to-moderate Alzheimer disease. Once AChE inhibitors are started, they should be continued indefinitely. Stopping the medication may cause an abrupt, and possibly severe, cognitive and behavioral decline that may not be resolved by restarting the AChE inhibitor.

Anti Dementia Drugs Doctors use medicines to treat dementia in the following ways: To correct an underlying condition causing dementia, such as thyroid replacement for hypothyroidism, vitamins for lack of vitamin B12, or antibiotics for infections

Who should not use these medications: People with the following conditions should not use AChE inhibitors: Allergy to AChE inhibitors Liver disease

Use: AChE inhibitors come in tablets or capsules. The daily dose depends on the particular drug prescribed. Drug or food interactions: Certain drugs like cimetidine (Tagamet), ketoconazole (Nizoral), ritonavir (Norvir), paroxetine (Paxil), and erythromycin (E-Mycin) may increase AChE inhibitor toxicity. Certain drugs known as anticholinergics (antihistamines, bladder-control drugs) may decrease AChE inhibitors effectiveness.

Investigational Drugs Amyloid deposit inhibitors: Clioquinoline, an antibiotic, may help reduce amyloid deposits in the brains of persons with Alzheimer disease Treatment for Coexisting Behavioral Changes Antipsychotic drugs: Haloperidol (Haldol), risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel) are frequently prescribed to help manage psychosis and agitation. Treatment of dementia-associated psychosis or agitation is intended to decrease psychotic symptoms (for example, paranoia, delusions, hallucinations), screaming, combativeness, and/or violence. The therapeutic goal is increased comfort and safety of patients, families, and caregivers. Antidepressant drugs: Depression is frequently associated with dementia and generally worsens the degree of cognitive and behavioral impairment. . They must be used with caution, because they can cause delirium in people with dementia. Antidepressants that have the fewest side effects in people with dementia are the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, for example) and citalopram (Celexa). Antianxiety drugs: Many patients with dementia experience anxiety symptoms. Although benzodiazepines like diazepam (Valium) have been used for treating anxiety in other situations, they are often avoided because they may increase agitation in persons with dementia or are too sedating. Buspirone (Buspar) is often initially tried for mildto-moderate anxiety.

How NMDA blockers work: NMDA blockers guard against overexcitement of NMDA receptors by the brain chemical glutamate. Overexcitement of NMDA receptors by abnormally high brain levels of glutamate is thought to be responsible for decreased nerve cell function and, eventually, nerve cell death. NMDA blockers may also be helpful in other neurodegenerative conditions, such as Huntington disease, AIDS-related dementia, and vascular dementia. Who should not use these medications: People with allergy to NMDA blockers should not take them. Use: Tablets may be swallowed with or without food.

Drug or food interactions: Drugs that alter urine acidity, like sodium bicarbonate or acetazolamide (Diamox), may cause memantine to accumulate in the body. Side effects: Common adverse effects include dizziness (7%), headache (6%), and constipation (5%).

Other Therapeutic Interventions Data continue to emerge regarding other potential interventions that may treat dementia or decrease the risk of developing it. Observations of the following interventions are preliminary and are considered uncertain regarding their benefit in preventing or delaying disease progression. Selegiline (Eldepryl): Some studies have reported that selegiline, a drug used in the treatment of Parkinson disease, may improve behavior, functional performance, and cognitive function. Mood enhancement may play a role in the apparent improvement in cognition. Estrogens: In women, estrogens may enhance nerve cell function after menopause. Antioxidants: High doses of vitamin E (1000 units twice daily) may be beneficial in delaying functional deterioration in vascular dementia. Such high doses of vitamin E can cause bleeding problems in some people. The addition of vitamin C may enhance the beneficial effects.

Complications Complications depend on the cause of the dementia, but may include the following: Abuse by an overstressed caregiver Increased infections anywhere in the body Loss of ability to function or care for self Loss of ability to interact Reduced lifespan Side effects of medications used to treat the disorder

Anti-inflammatory agents: Nonsteroidal anti-inflammatory drugs (NSAIDs) include agents like ibuprofen (Motrin, Advil) and naproxen (Aleve). NSAIDs may decrease inflammatory changes that are common in Alzheimer disease, or they may inhibit platelets, thereby protecting blood flow in the brain. Statins: The Canadian Study of Health and Aging noticed that people using statins (for example, atorvastatin [Lipitor], pravastatin [Pravachol], or simvastatin [Zocor]) to lower cholesterol showed lower odds of developing Alzheimer disease.