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Dementia

This article is about the cognitive disorder. For other uses, see Dementia (disambiguation).

"Senile" and "Demented" redirect here. For other uses, see Senile (disambiguation) and Demented (disambiguation).
Dementia
Other namesSenility,[1] senile dementia
Lithography of a man diagnosed with dementia in the 1800s
SpecialtyNeurology, psychiatry
SymptomsDecreased ability to think and remember, emotional problems, problems with language, decreased motivation[2]
ComplicationsPoor nutrition, pneumonia, inability to perform self-care tasks, personal safety challenges[3]
Usual onsetGradual[2]
DurationLong term[2]
CausesAlzheimer's disease, vascular disease, Lewy body disease and frontotemporal lobar degeneration[2]
Diagnostic methodCognitive testing (mini–mental state examination)[4]
Differential diagnosisDelirium, hypothyroidism[5][6]
PreventionEarly education, prevent high blood pressure, prevent obesity, no smoking, social engagement[7]
TreatmentSupportive care[2]
MedicationAcetylcholinesterase inhibitors (small benefit)[8]
Frequency55 million (2021)[2]
Deaths2.4 million (2016)[9]

Dementia is a syndrome associated with many neurodegenerative diseases (most commonly Alzheimer's), which is characterized by a general decline in cognitive abilities that impacts a person's ability to perform everyday activities. This typically involves problems with memory, thinking, behavior, and motor control.[10] Aside from memory impairment and a disruption in thought patterns, the most common symptoms include emotional problems, difficulties with language, and decreased motivation.[2] The symptoms may be described as occurring in a continuum over several stages.[11][a] Dementia ultimately has a significant effect on the individual, caregivers, and on social relationships in general.[2] A diagnosis of dementia requires the observation of a change from a person's usual mental functioning and a greater cognitive decline than what is caused by normal aging.[13]

Several diseases and injuries to the brain such as a stroke can give rise to dementia. However, the most common cause is Alzheimer's disease, a neurodegenerative disorder.[2] The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has re-described dementia as either a mild or major neurocognitive disorder with varying degrees of severity and many causative subtypes. The International Classification of Diseases (ICD-11) also classes dementia as a neurocognitive disorder (NCD) with many forms or subclasses.[14] Dementia is listed as an acquired brain syndrome, marked by a decline in cognitive function, and is contrasted with neurodevelopmental disorders.[15] Dementia is also described as a spectrum of disorders with causative subtypes of dementia based on a known disorder, such as Parkinson's disease, for Parkinson's disease dementia; Huntington's disease, for Huntington's disease dementia; vascular disease, for vascular dementia; HIV infection, causing HIV dementia; frontotemporal lobar degeneration for frontotemporal dementia; or Lewy body disease for dementia with Lewy bodies, and prion diseases.[16] Subtypes of neurodegenerative dementias may also be based on the underlying pathology of misfolded proteins such as synucleinopathies, and tauopathies.[16] More than one type of dementia existing together is known as mixed dementia.[15]

Many neurocognitive disorders may be caused by another medical condition or disorder that includes brain tumours, and subdural hematoma; endocrine disorders such as hypothyroidism, and hypoglycemia; nutritional deficiencies including thiamine, and niacin; infections, immune disorders, liver or kidney failure, metabolic disorders such as Kufs disease, and some leukodystrophies, and neurological disorders such as epilepsy, and multiple sclerosis. Some of the neurocognitive deficits may sometimes show improvement with treatment of the medical condition.[17]

Diagnosis is usually based on history of the illness and cognitive testing with imaging. Blood tests may be taken to rule out other possible causes that may be reversible, such as hypothyroidism (an underactive thyroid), and to determine the dementia subtype. One commonly used cognitive test is the mini–mental state examination. The greatest risk factor for developing dementia is aging, however dementia is not a normal part of aging. Many people aged 90 and above show no signs of dementia.[18] Several risk factors for dementia, such as smoking and obesity, are preventable by lifestyle changes. Screening the general older population for the disorder is not seen to affect the outcome.[19]

Dementia is currently the seventh leading cause of death worldwide and has 10 million new cases reported every year (one every ~3 seconds).[2] There is no known cure for dementia. Acetylcholinesterase inhibitors such as donepezil are often used and may be beneficial in mild to moderate disorder. The overall benefit, however, may be minor. There are many measures that can improve the quality of life of people with dementia and their caregivers. Cognitive and behavioral interventions may be appropriate for treating associated symptoms of depression.[20]

  1. ^ "Dementia". medlineplus.gov. Retrieved 20 January 2022.
  2. ^ a b c d e f g h i j "Dementia". www.who.int. Retrieved 26 September 2022.
  3. ^ "Dementia". mayoclinic.org. Mayo Clinic. Retrieved June 5, 2022.
  4. ^ Cite error: The named reference Creavin was invoked but never defined (see the help page).
  5. ^ "Differential diagnosis dementia". NICE. Retrieved 20 January 2022.
  6. ^ Hales RE (2008). The American Psychiatric Publishing Textbook of Psychiatry. American Psychiatric Pub. p. 311. ISBN 978-1-58562-257-3. Archived from the original on 2017-09-08.
  7. ^ Cite error: The named reference Lancet2020 was invoked but never defined (see the help page).
  8. ^ Cite error: The named reference Comm2012 was invoked but never defined (see the help page).
  9. ^ Nichols E, Szoeke CE, Vollset SE, Abbasi N, Abd-Allah F, Abdela J, et al. (GBD 2016 Dementia Collaborators) (January 2019). "Global, regional, and national burden of Alzheimer's disease and other dementias, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016". The Lancet. Neurology. 18 (1): 88–106. doi:10.1016/S1474-4422(18)30403-4. PMC 6291454. PMID 30497964.
  10. ^ "Dementia". www.who.int. Retrieved 2024-04-04.
  11. ^ Cite error: The named reference Bathini was invoked but never defined (see the help page).
  12. ^ McKeith IG, Ferman TJ, Thomas AJ, et al. (April 2020). "Research criteria for the diagnosis of prodromal dementia with Lewy bodies". Neurology (Review). 94 (17): 743–755. doi:10.1212/WNL.0000000000009323. PMC 7274845. PMID 32241955.
  13. ^ Budson A, Solomon P (2011). Memory loss : a practical guide for clinicians. [Edinburgh?]: Elsevier Saunders. ISBN 978-1-4160-3597-8.
  14. ^ "ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Retrieved 20 January 2022.
  15. ^ a b "What is mixed dementia". Dementia UK. Archived from the original on 2020-11-01. Retrieved 2020-12-13.
  16. ^ a b Wilson H, Pagano G, Politis M (March 2019). "Dementia spectrum disorders: lessons learnt from decades with PET research". J Neural Transm (Vienna). 126 (3): 233–251. doi:10.1007/s00702-019-01975-4. PMC 6449308. PMID 30762136.
  17. ^ American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). Washington, DC: American Psychiatric Association. pp. 591–603. ISBN 978-0-89042-554-1.
  18. ^ "The Dementias: Hope Through Research | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved 9 December 2022.
  19. ^ Cite error: The named reference Lin was invoked but never defined (see the help page).
  20. ^ Orgeta V, Leung P, Del-Pino-Casado R, Qazi A, Orrell M, Spector AE, Methley AM (April 2022). "Psychological treatments for depression and anxiety in dementia and mild cognitive impairment". The Cochrane Database of Systematic Reviews. 2022 (4): CD009125. doi:10.1002/14651858.CD009125.pub3. PMC 9035877. PMID 35466396.


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