Dementia

What is Dementia?

Dementia is a condition that causes loss of memory, thought control, and judgment. Alzheimer disease is often the cause of dementia. Other common causes are loss of blood flow or nerve damage in the brain, and long-term alcohol or drug use. Dementia cannot be cured or prevented, but treatment may slow or reduce your symptoms.

In alcohol-related dementia, cognitive problems result from the toxic effects of alcohol on the liver and the brain and  from secondary damage to other organs that occur as a result of alcohol abuse, such as vitamin deficiency, malnutrition, and increased risk of stroke.

What increases my risk for dementia?

• A family history of dementia
• Diseases such as diabetes or high blood pressure
• A head injury, brain tumor, or stroke
• Toxins such as alcohol or cigarette smoke
• Lack of activity or exercise
• Viruses and bacteria that cause illnesses such as HIV and syphilis

What are the signs and symptoms of dementia?

Dementia may develop quickly over a few months or it may develop slowly over many years. Your memory and other mental abilities may decline steadily. They may stay the same for a time and then decline again. You may have any of the following:

• Loss of short-term memory, followed by loss of long-term memory
• Trouble remembering to go to the bathroom to urinate or have a bowel movement
• Anger, or violent behavior
• Depression, anxiety, or hallucinations (you see or hear things that are not real)

How is dementia diagnosed?

Your provider will ask you or someone close to you about your symptoms. You will be asked when your symptoms began, and if they have gotten worse with time. You may also be asked if you have any family members with dementia.

• Memory testing will be done regularly so healthcare providers can monitor memory changes over time. Healthcare providers will test your long-term memory by asking questions about how much you remember from the past. They will also test your short-term memory by asking you to remember new facts.
• Blood tests may be used to rule out any other conditions that could be causing your symptoms. Some temporary conditions may be similar to dementia but can be treated.
• An MRI or CT scan can help healthcare providers find damage to your brain caused by dementia. The pictures may also show an injury or blood flow problems. You may be given contrast liquid before the pictures are taken. Tell the provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the provider if you have any metal in or on your body.

What is neuropsychological testing?

In customers with suspected dementia, neuropsychological testing may be helpful to diagnosis dementia in customers with subtle or atypical findings and to distinguish between the different types of dementia. Neuropsychological testing can also determine the extent of the cognitive impairment and establish a baseline.

Although standardized mental status tests and more comprehensive instruments for evaluating cognition are reasonably accurate for diagnosing early dementia before functional impairment is severe, no single screening test is appropriate for all customers being evaluated for possible cognitive impairment. The choice of initial test should be population appropriate, with consideration of the individual customer’s age, race, and educational level.

The Mini-Mental State Examination is the most practical tool for detecting cognitive impairment of at least moderate severity. Brief screening instruments such as the memory impairment screen and the Clock Drawing Test are rapid but less sensitive tests. Other screening instruments can be added as needed for more comprehensive testing or special situations.

How is dementia treated?

The goal of treatment is to help you keep your current health for as long as possible. Treatment of dementia and Alzheimer disease requires a multidisciplinary and multi-modal approach that varies depending on the stage of illness and specific symptoms.

• Multidisciplinary approach: treatment of dementia and Alzheimer disease requires a multidisciplinary and multimodal approach that varies depending on the stage of illness and specific symptoms. Adequate education of all caregivers, attention to safety concerns, selection of appropriate environment of care, development and maintenance of daily activity structure, and general health maintenance are important considerations. Care should be taken so that customer dignity is preserved, customer limitations are minimized, and customer capabilities are maximized. Attention to the needs of the caregivers will assist in assuring these goals.
• Therapies and medicines: cognitive symptoms, neuropsychiatric symptoms such as psychosis, agitation or other behavioral problems, and depression are the major areas at which treatment is directed. In addition to customer improvement in cognition, behavior, and functional activities, relief of caregiver burden is another focus of treatment. A combination of therapy and medicines may be used based on your care plan.
• Psychosocial treatments: include various cognition, behavior, emotion, and stimulation-oriented approaches that may have some effect in restoring cognitive deficits, improving mood and socialization, reducing specific behavioral problems such as urinary incontinence and disruptive or aggressive conduct, and improving quality of life.

Where can you go for care?

At North Memorial Health, Mental Health Services providers evaluate individuals with suspected or demonstrated neurological problems in collaboration with primary care providers. These evidence based assessments can assist in deferentially diagnosing potential reasons for cognitive decline such as reversible causes of depression versus the early stages of a progressive dementia.

• Outpatient evaluations:  For adults (18 years of age or older) outpatient evaluations are available for a wide range of cognitive concerns, including those related to potential traumatic brain injury, progressive dementia disorders, substance-abuse, and stroke among others. The North Memorial Health care team provides results and recommendations from neuropsychological evaluation to the referring provider and customer for intervention planning.
• Inpatient services: Neuropsychological assessment is also available for inpatient consultation on the medical and psychiatric units at the at North Memorial Health Hospital in Robbinsdale. This inpatient service often includes brief cognitive screens to assist in making recommendations for discharge or assistance in determination of decision making capacity.

How can you manage your dementia?

The following may help you manage your dementia:

• Keep your mind and body active. Do activities that you love, such as art, gardening, or listening to music. Call or visit people often. This will keep your social skills sharp, and may help reduce depression.
• Take all of your medicines as directed. This will help control medical conditions, such as high blood pressure, high cholesterol, and diabetes.
• Write daily schedules and routines. Record medical appointments, times to take your medicines, meal times, or any other things to remember. Write down reminders to use the bathroom if you have trouble remembering. You may need to ask someone to write things down for you.
• Place clocks and calendars where you can see them. This will help you remember appointments and tasks.
• Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
• Eat healthy foods. Examples are fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish. Ask if you need to be on a special diet.

When should your seek immediate care?

• You have signs of delirium, such as extreme confusion, and seeing or hearing things that are not there.
• You become angry or violent, and cannot be calmed down.
• You faint and cannot be woken.

When should your contact your healthcare provider?

• You have a fever.
• You have increased confusion, behavior, or mood changes.
• You have questions or concerns about your condition or care.