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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
Lithograph of a man diagnosed with dementia in the 1800s
SpecialtyNeurology, psychiatry
SymptomsDecreased ability to think and remember, emotional problems, problems with language, decreased motivation, general decline in cognitive abilities[2]
ComplicationsMalnutrition, aspiration pneumonia, inability to perform self-care tasks, personal safety challenges, akinetic mutism[3]
Usual onsetVaries, usually gradual[2]
DurationVaries, usually long term[2]
CausesAlzheimer's disease, vascular dementia, Lewy body disease, frontotemporal dementia, and others[2]
Risk factorsLack of education and socialization, family history
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]
TreatmentVaries, some types can be reversed, but supportive care is given to people suffering from irreversible forms of dementia.[2]
MedicationVaries depending on the type, most medications have a small benefit[8]
PrognosisVaries, life expectancy usually shortened
Frequency55 million (2021)[2]
Deaths2.4 million (2016)[9]

Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects 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 of dementia 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, their caregivers, and their 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 might be caused by the normal aging process.[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 a mild or major neurocognitive disorder with varying degrees of severity and many causative subtypes. The International Classification of Diseases (ICD-11) also classifies 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] It 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, 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] The coexistence of more than one type of dementia is known as mixed dementia.[15]

Many neurocognitive disorders may be caused by another medical condition or disorder, including 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, some leukodystrophies, and neurological disorders such as epilepsy and multiple sclerosis. Some of the neurocognitive deficits may sometimes show improvement with treatment of the causative medical condition.[17]

Diagnosis of dementia 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. Although the greatest risk factor for developing dementia is aging, dementia is not a normal part of the aging process; 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 (approximately one every three 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, but the overall benefit may be minor. There are many measures that can improve the quality of life of a person with dementia and their caregivers. Cognitive and behavioral interventions may be appropriate for treating the associated symptoms of depression.[20]

  1. ^ "Dementia". medlineplus.gov. Retrieved January 20, 2022.
  2. ^ a b c d e f g h i j "Dementia". who.int. Retrieved September 26, 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 January 20, 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 September 8, 2017.
  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". who.int. Retrieved April 4, 2024.
  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 January 20, 2022.
  15. ^ a b "What is mixed dementia". Dementia UK. Archived from the original on November 1, 2020. Retrieved December 13, 2020.
  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". ninds.nih.gov. Retrieved December 9, 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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