Brief overview
- Major forms of dementia: Alzheimer’s disease (45-70% of all dementias), Vascular dementia (15-25%), Lewy body dementia (3-10%), Frontotemporal dementia (3-18%), Mixed forms (5-20%).
- Symptoms: In all forms of dementia, there is a long-term loss of mental capacity. Other symptoms and the exact course vary depending on the form of dementia.
- Affected: Mainly people over 65 years of age. Exception: frontotemporal dementia, which begins around the age of 50. Most dementia patients are women, because on average they live longer than men.
- Causes: Primary dementias (such as Alzheimer’s) are independent diseases in which nerve cells in the brain gradually die off – the exact reason for this is unknown. Secondary dementias may be the result of other diseases (such as alcohol addiction, metabolic disorders, inflammation) or medications.
- Treatment: medication, non-drug measures (such as occupational therapy, behavioral therapy, music therapy, etc.).
What is dementia?
The term dementia does not refer to a specific disease, but to the joint occurrence of certain symptoms (= syndrome), which can have a wide variety of causes. In total, the term covers more than 50 forms of the disease (such as Alzheimer’s disease and vascular dementia).
Common to all forms of dementia is the persistent or progressive impairment of memory, thinking and/or other brain functions. Often, other symptoms (such as in interpersonal behavior) are also present.
Primary and secondary dementia
The term “primary dementia” covers all forms of dementia that are independent clinical pictures. They originate in the brain, where more and more nerve cells die off.
The most common primary dementia (and generally the most common dementia) is Alzheimer’s disease. Vascular dementia follows in second place. Other primary forms of dementia include frontotemporal and Lewy body dementia.
There are also mixed forms of dementing disease processes, especially mixed forms of Alzheimer’s disease and vascular dementia.
Pseudodementia is not a “real” dementia and therefore does not belong to the primary or secondary forms of dementia. It is a symptom – usually of major depression.
Cortical and subcortical dementia
Another classification of the disease patterns is based on where the changes occur in the brain: Cortical dementia is associated with changes in the cerebral cortex (Latin: cortex cerebri). This is the case, for example, in Alzheimer’s disease and frontotemporal dementia.
Subcortical dementia, on the other hand, refers to dementia with changes below the cortex or in deeper layers of the brain. This includes, for example, subcortical arteriosclerotic encephalopathy (SAE), a form of vascular dementia.
Dementia syndrome
The term Dementia Syndrome is often equated with “dementia”. It is understood to mean a general intellectual decline, for example, memory and orientation disorders as well as speech disorders. Over time, the patient’s personality often changes as well.
Pseudodementia must be distinguished from dementia syndrome. This term covers temporary brain performance disorders that are feigned by an inhibition of thought and drive. Most frequently, pseudodementia develops in the context of severe depression. If the depression is treated properly, the symptoms of pseudodementia usually subside.
To learn more about dementia and pseudodementia, see the article Dementia Syndrome.
Senile dementia and senile dementia
Dementia syndrome
The term Dementia Syndrome is often equated with “dementia”. It is understood to mean a general intellectual decline, for example, memory and orientation disorders as well as speech disorders. Over time, the patient’s personality often changes as well.
Pseudodementia must be distinguished from dementia syndrome. This term covers temporary brain performance disorders that are feigned by an inhibition of thought and drive. Most frequently, pseudodementia develops in the context of severe depression. If the depression is treated properly, the symptoms of pseudodementia usually subside.
To learn more about dementia and pseudodementia, see the article Dementia Syndrome.
Senile dementia and senile dementia
Read more about symptoms, causes, diagnosis and treatment of this most common form of dementia in the article Alzheimer’s disease.
Vascular dementia
Vascular dementia is the result of circulatory disorders in the brain. It often shows similar dementia symptoms as Alzheimer’s disease. However, the exact clinical picture in vascular dementia depends on where in the patient’s brain the circulatory disorders occur and how pronounced they are.
Possible symptoms include problems with attentive listening, coherent speech and orientation. These dementia signs are also present in Alzheimer’s disease, but they often occur earlier and more severely in vascular dementia. In addition, memory may be preserved longer in Vascular Dementia.
Other possible signs of Vascular Dementia include gait disturbances, slowing down, bladder emptying disturbances, concentration problems, changes in character, and psychiatric symptoms such as depression.
Lewy Body Dementia
Lewy body dementia also manifests with dementia symptoms similar to those of Alzheimer’s disease. However, many patients show hallucinations (sensory illusions) in the early stages of the disease. In return, memory is usually preserved longer than in Alzheimer’s disease.
In addition, many people with Lewy body dementia show symptoms of Parkinson’s disease. These include stiff movements, involuntary tremors and unstable posture. This is why those affected frequently sway and fall.
Another characteristic of this form of dementia is that the physical and mental condition of the patients sometimes fluctuates greatly. At times, those affected are enterprising and wide awake, then again confused, disoriented and introverted.
Read more about symptoms, causes, diagnosis and treatment of this form of dementia in the article Lewy body dementia.
Frontotemporal dementia
Due to the conspicuous and antisocial behavior of many patients, a mental disorder is often first suspected instead of dementia. Only in the advanced stage of Pick’s disease do typical dementia symptoms such as memory problems appear. In addition, the patients’ speech becomes impoverished.
Read more about symptoms, causes, diagnosis and treatment of this rarer form of dementia in the article Frontotemporal dementia.
Difference: Alzheimer’s disease & dementia of another type
“What’s the difference between Alzheimer’s & dementia?” This is a question that some sufferers and their relatives ask themselves, assuming that they are dealing with two different clinical pictures. In fact, however, Alzheimer’s is – as already mentioned above – only one form of dementia, and by far the most common. The correct question should therefore be what the difference is between Alzheimer’s and other forms of dementia – such as vascular dementia.
So much for the theory – but practice often looks somewhat different. Each dementia can progress differently from patient to patient, which makes it difficult to distinguish between the various forms of the disease. In addition, there are mixed forms, such as Alzheimer’s and vascular dementia. Those affected show characteristics of both forms of dementia, which is why a diagnosis is often difficult.
Read more about the similarities and differences between important forms of dementia in the article Difference between Alzheimer’s and dementia?
Dementia: Causes and risk factors
In most cases of dementia, it is a primary disease (primary dementia), i.e. an independent disease originating in the brain: In those affected, nerve cells gradually die and the connections between the nerve cells are lost. Doctors refer to this as neurodegenerative changes. The exact cause varies depending on the form of primary dementia and is often not fully understood.
Alzheimer’s dementia: Causes
It is not known exactly why the plaques form. Rarely – in about one percent of cases – the causes are genetic: changes in the genetic material (mutations) lead to plaque formation and the onset of the disease. Such mutations make Alzheimer’s dementia hereditary. In the vast majority of cases, however, it is not known exactly why someone has Alzheimer’s disease.
Vascular dementia: Causes
In vascular dementia, circulatory disorders in the brain lead to the death of nerve cells. For example, they may be the result of several small strokes (due to vascular occlusion) occurring simultaneously or at different times in one brain region (“multi-infarct dementia”). Sometimes vascular dementia also develops on the basis of a major cerebral hemorrhage, such as in hypertensive patients.
Less common causes of vascular dementia include vascular inflammation and genetic disorders.
Lewy body dementia: Causes
Frontotemporal dementia: Causes
In frontotemporal dementia, nerve cells in the frontal and temporal lobes of the cerebrum gradually die. Again, the cause is largely unknown. In some cases, the disease cases are genetic.
Secondary dementia: Causes
The rare secondary dementias are caused by other diseases or medications. For example, they can be triggered by alcohol addiction, thyroid disorders, liver disease, infections (e.g., HIV encephalitis, neuroborreliosis), or vitamin deficiency. Medications are also possible causes of dementia.
Risk factors for dementia
Advanced age and a corresponding genetic predisposition increase the risk of dementia. Other risk factors include high blood pressure, diabetes mellitus, cardiac arrhythmias, high cholesterol, depression, craniocerebral injury, smoking, excessive alcohol consumption and obesity.
Dementia: examinations and diagnosis
Forgetting things more often in old age is not necessarily a cause for concern. However, if your forgetfulness persists for months or even increases, you should see your family doctor. He or she can refer you to a specialist (neurological practice or memory outpatient clinic) if dementia is suspected.
Medical history interview
The doctor will first ask you about your symptoms and general health. He will also ask if you are taking any medications and if so, which ones. This is because many medications can temporarily or permanently worsen brain performance. During this medical history discussion, the doctor will also pay attention to how well you can concentrate on the conversation.
Often, the doctor also talks to close relatives. He asks them, for example, whether the patient is more restless or aggressive than before, is very active at night or has sensory delusions.
Cognitive dementia tests
Clock test
The clock test helps to detect dementia at an early stage. However, it is always combined with another test for this purpose: The result of the clock test alone is not sufficient for a diagnosis.
The procedure of the clock test is quite simple: You should write the numbers 1 to 12 in a circle, as they are arranged on a clock face. In addition, you should draw the hour and minute hands in such a way that a certain time results (for example, 11:10 a.m.).
During the evaluation, the doctor checks, for example, whether the numbers and hands are drawn in correctly and the digits are clearly legible. From errors and deviations, he can conclude that dementia may be present. For example, people with incipient dementia often place the minute hand incorrectly, but the hour hand correctly.
You can read more about this test procedure in the article Watch test.
MMST
At the end of the test, all the points scored are added together. The severity of dementia is estimated on the basis of the result. With regard to Alzheimer’s – by far the most common form of dementia – a distinction is made between the following dementia stages:
- MMST 20 to 26 points: mild Alzheimer’s dementia
- MMST 10 to 19 points: moderate/moderate Alzheimer’s dementia
- MMST < 10 points: severe Alzheimer's dementia
To learn more about the process and scoring of the “Mini-Mental Status Test”, see the article MMST.
DemTect
The abbreviation DemTect stands for “Dementia Detection”. The approximately ten-minute test checks various cognitive abilities such as memory. Ten terms are read out to you (dog, lamp, plate, etc.), which you then have to repeat. The order does not matter. The test counts how many of the terms you were able to remember.
Points are awarded for each task. At the end of the test, you add up all the points. The overall result can be used to estimate whether and to what extent your cognitive performance is impaired.
Read more about this test procedure in the article DemTect
Physical examination
A physical examination is important to rule out other diseases as the cause of the suspected dementia symptoms. It also helps to determine your physical condition. For example, the doctor measures your blood pressure, checks your muscle reflexes and how your pupils react to light.
Lab tests
In some cases, more extensive laboratory tests are necessary, for example if the dementia patient is remarkably young or the symptoms progress very quickly. Then the doctor orders, for example, a drug screening, urine tests and/or a test for Lyme disease, syphilis and HIV.
If the medical history and the previous examinations give rise to the suspicion of an inflammatory brain disease, a sample of the cerebrospinal fluid (CSF) should be taken from the lumbar spine (lumbar puncture) and analyzed in the laboratory. This may provide clues to Alzheimer’s disease: Characteristic changes in the concentration of certain proteins (amyloid protein and tau protein) in the CSF are highly likely to indicate Alzheimer’s disease.
Imaging methods
Computer tomography (CT) and magnetic resonance imaging (MRI, also known as magnetic resonance imaging) are the main methods used. Sometimes, however, other examinations are also performed. These include, for example, an ultrasound examination of the neck vessels if vascular dementia is suspected. In unclear cases of Lewy body dementia, a nuclear medicine examination may be useful (positron emission tomography = PET, single photon emission computed tomography = SPECT).
Genetic examination
If there is a suspicion that the dementia is hereditary, the patient should be offered genetic counseling and testing. The result of the genetic test has no influence on the therapy. However, some patients would like to know exactly whether they actually carry a disease-causing gene or not.
Dementia: Treatment
Dementia therapy consists of drug treatment and non-drug measures. An individually tailored therapy plan is created for each patient. The patient’s personality and wishes should be taken into account, especially when choosing the non-drug measures. The chances of successful treatment are greater the earlier therapy is started.
Dementia drugs (antidementives)
So-called antidementia drugs are the main drugs used in dementia therapy. They influence various messenger substances in the brain. In this way, they can maintain the mental capacity of patients. However, antidementives usually only work for a limited time.
Antidementia drugs have been tested primarily in the treatment of Alzheimer’s disease. Approved representatives are acetylcholinesterase inhibitors and the glutamate antagonist (NMDA antagonist) memantine.
Acetylcholinesterase inhibitors are also often used for other forms of the disease, such as Lewy body dementia and mixed forms.
The glutamate antagonist memantine blocks the docking sites for the nerve messenger glutamate in the brain. The concentration of glutamate can be increased in Alzheimer’s disease, for example, which destroys the nerve cells in the long term. Memantines (neuroprotection) protect against this irreversible nerve damage. They are used in the middle and late stages of Alzheimer’s disease.
Preparations based on the medicinal plant Ginkgo biloba are also often recommended for dementia. They are considered to have a weaker effect, but can be used as a supplement.
Other drugs for dementia
When people learn that they have dementia, they often develop a depressive mood. The demise of brain cells themselves can also be responsible for depression. In such cases, the doctor may prescribe antidepressants. They have a mood-lifting and drive-enhancing effect.
In vascular dementia, risk factors and underlying diseases that can lead to further vascular damage should be treated. This includes, for example, the administration of antihypertensives for high blood pressure and lipid-lowering agents for elevated blood lipid levels (such as elevated cholesterol).
Behavioral therapy
The diagnosis of dementia triggers uncertainty, anxiety, depression or aggression in many people. A psychologist or psychotherapist can help those affected to cope better with their illness as part of behavioral therapy. Thus, behavioral therapy is particularly suitable for patients in early stages of dementia.
Cognitive training
Autobiographical work
In early to moderate stages of dementia, autobiographical work can be useful: In conversations (individual or group therapy), the patient should use photos, books, and personal objects to recall and recount past positive experiences. This autobiographical work keeps a dementia patient’s memories of his or her past life alive and strengthens the patient’s sense of identity.
Reality orientation
In reality orientation, patients train to orient themselves spatially and temporally and to better classify people and situations. Time orientation can be supported with clocks, calendars and pictures of the seasons. To help patients find their way around spatially (in their home, for example), the various living rooms (bathroom, kitchen, bedroom, etc.) can be marked with different colors.
Music therapy
The purpose of music therapy in dementia is based on the fact that music can evoke positive memories and feelings. In early stages of dementia, patients – individually or together – can play an instrument themselves (drum, triangle, glockenspiel, etc.) or sing. In advanced dementia, at least listening to familiar melodies can calm a patient or ease their pain.
Occupational therapy
To help patients in early to moderate stages of dementia manage everyday activities such as shopping, cooking or reading the newspaper for as long as possible, they should practice these activities regularly with a therapist.
In moderate to severe stages of the disease, dancing, massage and touch stimuli can encourage physical activity. This can give patients pleasure and improve their sense of well-being.
Milieu therapy
Care planning: dementia
Sooner or later, dementia patients will need help with everyday tasks, such as dressing, washing, shopping, cooking and eating. Patients and their relatives should therefore address the issue as early as possible and take care of planning future care.
Important questions that need to be clarified include: Can and does the dementia patient want to stay in his own home? What help does he need in his everyday life? Who can provide this help? What outpatient care services are available? If care at home is not possible, what alternatives are available?
You can read everything important about topics such as care in the family, outpatient caregivers and nursing homes in the article Care Planning: Dementia.
Dealing with dementia
Dealing with dementia requires above all patience and understanding – both from the patient himself and from the relatives and caregivers. In addition, much can be done to slow down mental decline. This includes regularly exercising existing cognitive abilities, for example by reading or solving crossword puzzles. Other hobbies such as knitting, dancing or building model airplanes should also be continued – with necessary adjustments (such as easier knitting patterns or simpler dances) if necessary.
Last but not least, dementia patients also benefit from a balanced diet, regular exercise and a structured daily routine.
Read more tips for everyday life with dementia in the article Dealing with dementia.
Help with dementia
Anyone who wants to sensibly convert their own home for an elderly person or dementia sufferer can turn to the Bundesarbeitsgemeinschaft Wohnungsanpassung e.V. for tips and information. If a move to a retirement or nursing home is necessary, Heimverzeichnis.de offers help in finding a suitable facility.
You can find out more about these and other contact points for dementia patients and their relatives in the article Help with dementia.
Dementia: course of the disease and prognosis
In any form of dementia, mental capacity is lost in the long term. The patient’s personality is also irreversibly affected.
In individual cases, however, the course of dementia can vary greatly from patient to patient. It depends above all on the type of disease. For example, vascular dementia often appears suddenly and worsens in episodes. In most cases, however, dementia begins insidiously and progresses slowly.
The behaviors of dementia patients also vary greatly. Some patients become increasingly aggressive, others remain friendly and calm. Some patients remain physically fit for a long time, others become bedridden.
Overall, the course of dementia can vary greatly from person to person. It is also difficult to predict.
Influencing the course of dementia
Dementia cannot be cured. However, the quality of life of dementia patients can be significantly improved with activation, occupation and human attention. In addition, the right therapy (medication and non-drug measures) can help to temporarily halt or at least slow down the course of dementia.
Dementia: Prevention
Many factors favor a dementia-like illness. If it is possible to avoid or at least reduce these risk factors, this helps to prevent dementia.
The brain and the rest of the body benefit from regular exercise at any age. Physical activity stimulates blood flow and metabolism in the brain. As a result, the nerve cells are more active and network better. Sport and exercise in everyday life also lower blood pressure and cholesterol levels and prevent obesity, diabetes, heart attacks, strokes and depression. In addition, regular exercise keeps the blood vessels healthy, which protects against vascular dementia. But physical activation is not only suitable for prevention: dementia patients also benefit from it.
Brain training” is also recommended: Just like the muscles, the brain should also be regularly challenged. Cultural activities, mathematical puzzles or creative hobbies, for example, are suitable for this. Such mental activity in work and leisure can reduce the risk of dementia.