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Dementia describes a group of symptoms that are caused by changes in brain function. Dementia symptoms may include asking the same questions repeatedly; becoming lost in familiar places; being unable to follow directions; getting disoriented about time, people, and places; and neglecting personal safety, hygiene, and nutrition. People with dementia lose their abilities at different rates.

Dementia is caused by many conditions. Some conditions that cause dementia can be reversed, and others cannot. The two most common forms of dementia in older people are Alzheimer’s disease and multi-infarct dementia (sometimes called vascular dementia). These types of dementia are irreversible, which means they cannot be cured. (Symptoms associated with dementia can often be treated, however.)

Some conditions may mimic dementia, but are actually reversible conditions. Reversible conditions with symptoms of dementia can be caused by a high fever, dehydration, vitamin deficiency and poor nutrition, bad reactions to medicines, problems with the thyroid gland, or a minor head injury. Medical conditions like these can be serious and should be treated by a doctor as soon as possible.

Sometimes older people have emotional problems that can be mistaken for dementia. Feeling sad, lonely, worried, or bored may be more common for older people facing retirement or coping with the death of a spouse, relative, or friend. Adapting to these changes leaves some people feeling confused or forgetful. Emotional problems can be eased by supportive friends and family, or by professional help from a doctor or therapist.

http://psychcentral.com/lib/2006/what-is-dementia/

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What Kind of Care Does a Person with Dementia Need?

People with moderate and advanced dementia typically need round-the-clock care and supervision to prevent them from harming themselves or others. They also may need assistance with daily activities such as eating, bathing, and dressing. Meeting these needs takes patience, understanding, and careful thought by the person's caregivers.

A typical home environment can present many dangers and obstacles to a person with dementia, but simple changes can overcome many of these problems. For example, sharp knives, dangerous chemicals, tools, and other hazards should be removed or locked away. Other safety measures include installing bed and bathroom safety rails, removing locks from bedroom and bathroom doors, and lowering the hot water temperature to 120°F (48. 9°C) or less to reduce the risk of accidental scalding. People with dementia also should wear some form of identification at all times in case they wander away or become lost. Caregivers can help prevent unsupervised wandering by adding locks or alarms to outside doors.

People with dementia often develop behavior problems because of frustration with specific situations. Understanding and modifying or preventing the situations that trigger these behaviors may help to make life more pleasant for the person with dementia as well as his or her caregivers. For instance, the person may be confused or frustrated by the level of activity or noise in the surrounding environment. Reducing unnecessary activity and noise (such as limiting the number of visitors and turning off the television when it's not in use) may make it easier for the person to understand requests and perform simple tasks. Confusion also may be reduced by simplifying home decorations, removing clutter, keeping familiar objects nearby, and following a predictable routine throughout the day. Calendars and clocks also may help patients orient themselves.

People with dementia should be encouraged to continue their normal leisure activities as long as they are safe and do not cause frustration. Activities such as crafts, games, and music can provide important mental stimulation and improve mood. Some studies have suggested that participating in exercise and intellectually stimulating activities may slow the decline of cognitive function in some people.

Many studies have found that driving is unsafe for people with dementia. They often get lost and they may have problems remembering or following rules of the road. They also may have difficulty processing information quickly and dealing with unexpected circumstances. Even a second of confusion while driving can lead to an accident. Driving with impaired cognitive functions can also endanger others. Some experts have suggested that regular screening for changes in cognition might help to reduce the number of driving accidents among elderly people, and some states now require that doctors report people with AD to their state motor vehicle department. However, in many cases, it is up to the person's family and friends to ensure that the person does not drive.

The emotional and physical burden of caring for someone with dementia can be overwhelming. Support groups can often help caregivers deal with these demands and they can also offer helpful information about the disease and its treatment. It is important that caregivers occasionally have time off from round-the-clock nursing demands. Some communities provide respite facilities or adult day care centers that will care for dementia patients for a period of time, giving the primary caregivers a break. Eventually, many patients with dementia require the services of a full-time nursing home.

http://www.medicinenet.com/dementia/page10.htm#tocn

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Pharmacotherapy in Dementia Treatment


    * Cholinesterase inhibitors such as donepezil (Aricept), galantamine (Reminyl), or rivastigmine (Exelon). These drugs were developed to treat Alzheimer's disease, but they may be tried in other dementias to improve or maintain mental function. Studies indicate that this class of drugs holds promise for the treatment of people with vascular dementia. Both donepezil and galantamine have been shown to improve mental function with few side effects.7 Rivastigmine may help people with dementia with Lewy bodies, but side effects such as nausea, vomiting, and weight loss are common.8 At present, cholinesterase inhibitors can slow but not stop the progress of dementia. It is not clear how long these medicines will work. They may only stop the progress of dementia for a short time.

    * Memantine (Namenda). This new type of medicine can slow the late stages of Alzheimer's disease. It may also benefit those with mild to moderate vascular dementia.8 More studies are under way.

    * Antidepressants to treat depression. They must be used carefully because they can cause delirium in people with dementia. Antidepressants that have the fewest side effects in people with dementia are SSRIs, such as fluoxetine (Prozac, for example) and citalopram (Celexa).9

    * Medicines to ease anxiety, agitation, aggression, and hallucinations, which can become worse as dementia progresses. Some of these medicines, called antipsychotic drugs, are not approved by the FDA for the treatment of dementia. Studies of people with psychosis due to dementia who were treated with these medicines, including Zyprexa and Risperdal, found an increased risk of death.10, 11 Discuss this risk with your doctor before using these medicines.

http://www.webmd.com/alzheimers/tc/dementia-treatment-overview?page=2

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