Dementia

Symptoms

Dementia symptoms vary depending on the cause. Common symptoms include:

Cognitive changes

• Memory loss, which is usually noticed by someone else.
• Problems communicating or finding words.
• Trouble with visual and spatial abilities, such as getting lost while driving.
• Problems with reasoning or problem-solving.
• Trouble performing complex tasks.
• Trouble with planning and organizing.
• Poor coordination and control of movements.
• Confusion and disorientation.

Psychological changes

• Personality changes.
• Depression.
• Anxiety.
• Agitation.
• Behavior that doesn't fit the situation.
• Being suspicious, known as paranoia.
• Seeing things that aren't there, known as hallucinations.

When to see a doctor

See a healthcare professional if you or a loved one has trouble with memory or has other dementia symptoms. It's important to determine the cause. Some medical conditions that cause dementia symptoms can be treated.

Risk factors

Many factors can eventually contribute to dementia. Some factors, such as age, can't be changed, but you can address other factors to reduce your risk.

Risk factors that can't be changed

Being aware of these risk factors can help you understand your dementia risk.

• Age. The risk of dementia rises as you age, especially after age 65. However, dementia isn't a typical part of aging. Dementia also can occur in younger people.
• Family history. Having a family history of dementia puts you at greater risk of developing the condition. However, many people with a family history never develop symptoms, and many people without a family history do. There are tests to determine whether you have certain genetic changes that may increase your risk.
• Down syndrome. By middle age, many people with Down syndrome develop early-onset Alzheimer's disease.

Risk factors you can change

You might be able to manage the following risk factors for dementia.

• Lifestyle factors. Research has found that people at higher risk of dementia who followed a healthy lifestyle lowered their risk of cognitive decline. They ate a diet that included fish, fruits, vegetables and olive oil. They also exercised, had cognitive training and participated in social activities. While no specific diet is known to reduce dementia risk, research indicates that those who follow a Mediterranean style diet have better cognitive function. A Mediterranean diet focuses on fruits, vegetables, cereals, olive oil, nuts, and fish. The diet includes smaller amounts of dairy and meat.
• Drinking too much alcohol. Drinking large amounts of alcohol has long been known to cause brain changes. Several large studies and reviews have linked alcohol use disorders with an increased risk of dementia, particularly early-onset dementia.
• Cardiovascular risk factors. These include obesity, high blood pressure, high cholesterol and the buildup of fats in the artery walls, known as atherosclerosis. Having high levels of low-density lipoprotein (LDL), in particular, is a risk factor for cognitive decline and dementia. Diabetes and smoking also are cardiovascular risk factors. Having diabetes can increase the risk of dementia, especially if blood sugar isn't managed well. Smoking might increase the risk of developing dementia and blood vessel disease.
• Hearing loss or vision loss that is not treated. Having hearing loss is associated with a higher risk of dementia. The worse the hearing loss, the higher the risk. Research also suggests that vision loss can raise the risk of dementia, while treating vision loss can lower the risk.
• Depression. Depression in adulthood is a risk factor for dementia, particularly in midlife.
• Air pollution. Studies in animals have indicated that air pollution particulates can speed degeneration of the nervous system. And human studies have found that air pollution exposure — particularly from traffic exhaust and burning wood — is associated with greater dementia risk.
• Head trauma. People who've had severe head trauma have a greater risk of Alzheimer's disease. Several large studies found that the risk of dementia and Alzheimer's disease increased in people age 50 years or older who had a traumatic brain injury, also called TBI. The risk is higher in people with more-severe and multiple TBIs.
• Sleep conditions. People who have sleep apnea and other sleep disturbances might be at higher risk of getting dementia.
• Low levels of certain vitamins and nutrients. Low levels of vitamin D, vitamin B-6, vitamin B-12 and folate can increase the risk of dementia.
• Medicines that can worsen memory. These include sleep aids or allergy medicines that contain diphenhydramine (Benadryl, Unisom, others). They also include medicines you can get with or without a prescription to treat urinary urgency, such as oxybutynin (Oxytrol). Also limit sedatives. Talk with a healthcare professional about whether any of the medicines you take might make your memory worse.

Prevention

There's no sure way to prevent dementia, but there are steps you can take that might help. More research is needed, but it might help to do the following:

• Keep your mind active. Mentally stimulating activities might delay the onset of dementia and decrease its effects. Spend time reading, solving puzzles and playing word games.
• Be physically and socially active. Physical activity and social interaction might delay the onset of dementia and reduce its symptoms. Aim for 150 minutes of exercise a week.
• Quit smoking. Some studies have shown that smoking in middle age and beyond might increase the risk of dementia and blood vessel conditions. Quitting smoking might reduce the risk and improve health.
• Get enough vitamins. Some research suggests that people with low levels of vitamin D in their blood are more likely to develop Alzheimer's disease and other forms of dementia. You can increase your vitamin D levels with certain foods, supplements and sun exposure. More study is needed before an increase in vitamin D intake is recommended for preventing dementia. But it's a good idea to make sure you get adequate vitamin D. Taking a daily B-complex vitamin and vitamin C also might help.
• Manage cardiovascular risk factors. Treat high blood pressure, high cholesterol and diabetes. Pay attention to your levels of LDL cholesterol and get treatment if the levels are too high. High levels of LDL cholesterol in middle age raise the risk of dementia. Lose weight if you're overweight. High blood pressure might lead to a higher risk of some types of dementia. More research is needed to determine whether treating high blood pressure may reduce the risk of dementia.
• Take care of your mental health. See your healthcare professional if you have depression or anxiety.
• Maintain a healthy diet. A diet such as the Mediterranean diet might promote health and lower the risk of developing dementia. A Mediterranean diet is rich in fruits, vegetables, whole grains and omega-3 fatty acids, which are commonly found in certain fish and nuts. This type of diet also improves cardiovascular health, which may help lower dementia risk.
• Get good-quality sleep. Practice good sleep hygiene. Talk with a healthcare professional if you snore loudly or have times when you stop breathing or gasp during sleep.
• Treat hearing loss. People with hearing loss have a greater chance of developing a condition related to thinking known as cognitive decline. Early treatment of hearing loss, such as use of hearing aids, might help decrease the risk.
• Get regular eye exams and treat vision loss. Research suggests that not treating vision loss may be associated with a raised risk of dementia.

Treatment

Most types of dementia can't be cured, but there are ways to manage your symptoms.

Medications

The following medicines are used to temporarily improve dementia symptoms.

• Cholinesterase inhibitors. These medicines work by boosting levels of a chemical messenger involved in memory and judgment. They include donepezil (Aricept, Adlarity), rivastigmine (Exelon) and galantamine (Zunveyl).

  Although primarily used to treat Alzheimer's disease, these medicines also might be prescribed for other dementias. They might be prescribed for people with vascular dementia, Parkinson's disease dementia and Lewy body dementia.

  Side effects can include nausea, vomiting and diarrhea. Other possible side effects include slowed heart rate, fainting and trouble with sleep.

• Memantine (Namenda). Memantine works by regulating the activity of glutamate. Glutamate is another chemical messenger involved in brain functions such as learning and memory. Memantine is sometimes prescribed with a cholinesterase inhibitor. A common side effect of memantine is dizziness.
• Other medicines. You might take other medicines to treat symptoms or other conditions. You may need treatment for depression, trouble with sleep, hallucinations, agitation, and slow and stiff movements known as parkinsonism.

Two other medicines approved by the U.S. Food and Drug Administration (FDA) are lecanemab-irmb (Leqembi) and donanemab-azbt (Kisunla). They're approved for people with mild Alzheimer's disease and mild cognitive impairment due to Alzheimer's disease.

Clinical trials found that the medicines slowed declines in thinking and functioning in people with early Alzheimer's disease. The medicines prevent amyloid plaques in the brain from clumping.

Lecanemab is given as an IV infusion every two weeks for 18 months. Then it can be given every two or four weeks afterward. Side effects include infusion-related reactions such as fever, flu-like symptoms, nausea, vomiting, dizziness, changes in heart rate and shortness of breath.

Donanemab is given as an IV infusion every four weeks. Side effects of the medicine may include flu-like symptoms, nausea, vomiting, headache and changes in blood pressure. Rarely, donanemab can cause a life-threatening allergic reaction and swelling.

Also, people taking lecanemab or donanemab may have swelling in the brain or may get small bleeds in the brain. Rarely, brain swelling can be serious enough to cause seizures and other symptoms. Also in rare instances, bleeding in the brain can cause death. The FDA recommends getting a brain MRI before starting treatment. The FDA also recommends periodic brain MRIs during treatment to look for or check symptoms of brain swelling or bleeding.

People who carry a certain form of a gene known as APOE e4 appear to have a higher risk of these serious complications. The FDA recommends testing for this gene before starting treatment.

If you take a blood thinner or have other risk factors for brain bleeding, talk with your healthcare professional before taking lecanemab or donanemab. Blood-thinning medicines may increase the risk of bleeds in the brain. These medicines include clot-busting medicines given to people with strokelike symptoms.

More research is being done on the potential risks of taking lecanemab and donanemab. Other research is looking at how effective the medicines may be for people at risk of Alzheimer's disease, including people who have a first-degree relative, such as a parent or sibling, with the disease.

Therapies

Therapies can help improve several dementia symptoms and behavior changes. These treatments may include:

• Occupational therapy. An occupational therapist can show you how to make your home safer and teach coping behaviors. The purpose is to prevent accidents, such as falls. The therapy also helps you manage behavior and prepare you for when the dementia progresses.
• Changes to the environment. Reducing clutter and noise can make it easier for someone with dementia to focus and function. You might need to hide objects that can threaten safety, such as knives and car keys. Monitoring systems can alert you if the person with dementia tries to wander.
• Simpler tasks. Breaking tasks into easier steps and focusing on success, not failure, can be helpful. Structure and routine help reduce confusion in people with dementia.

Alternative medicine

Several dietary supplements, herbal remedies and therapies have been studied for people with dementia. But there's no convincing evidence that these treatments are effective.

Use caution when considering taking dietary supplements, vitamins or herbal remedies, especially if you're taking other medicines. Supplements, vitamins and herbs aren't regulated. Claims about their benefits aren't always based on scientific research.

While some studies suggest that vitamin E supplements may be helpful for Alzheimer's disease, study results have been mixed. Also, high doses of vitamin E can pose risks. Taking vitamin E supplements is generally not recommended. However, including foods high in vitamin E, such as nuts, in your diet is recommended.

Other therapies

The following techniques may help reduce agitation and promote relaxation in people with dementia.

• Music therapy, which involves listening to soothing music.
• Light exercise.
• Watching videos of family members.
• Pet therapy, which can include visits from dogs or other animals to promote improved mood and behavior.
• Aromatherapy, which uses fragrant plant oils.
• Massage therapy.
• Art therapy, which involves creating art, focusing on the process rather than the outcome.

Preparing for an appointment

See a healthcare professional if you have concerns about dementia. You might be referred to a doctor trained in nervous system conditions, known as a neurologist.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything that needs to be done in advance, such as fasting before certain tests. Make a list of:

• Symptoms, including any that may not seem related to the reason for which you scheduled the appointment, and when they began.
• Key personal information, including any major stresses or recent life changes and family medical history.
• All medicines, vitamins and supplements you take, including the doses.
• Questions to ask the health professional.

Even in the early stages of dementia, it's good to take a family member, friend or caregiver along to help you remember the information you're given.

For dementia, basic questions to ask a healthcare professional include:

• What is likely causing my symptoms?
• Are there other possible causes for my symptoms?
• What tests are necessary?
• Is the condition likely temporary or chronic?
• What's the best course of action?
• What alternatives are there to the primary approach being suggested?
• How can dementia and other health issues be managed together?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

You're likely to be asked questions such as:

• When did your symptoms begin?
• Have symptoms been constant or do they come and go?
• How bad are your symptoms?
• What, if anything, seems to make symptoms better?
• What, if anything, appears to worsen symptoms?
• How have the symptoms interfered with your life?