Some Types of Dementia

Alzheimer’s disease
Alzheimer’s accounts for 50 to 60 percent of the cases of dementia. It typically starts after age 50 and becomes more common as a person grows older. Death usually occurs six to 12 years after the onset of the disease. Scientists have narrowed the cause of early-onset Alzheimer’s to three separate chromosomes and the onset of the more typical, age-related Alzheimer’s to one chromosome. Alzheimer’s starts quietly – that is, there are few or no symptoms to indicate anything is wrong. Early warning signs include difficulty with language and remembering things recently learned (such as a person’s name or directions to a particular place). As the disease progresses, so do the symptoms. Judgment is impaired, and the person has difficulty performing simple tasks. Behavioral symptoms may persist throughout the disease. About 70 percent of patients with the disease experience delusions of some sort, while depression affects about 40 percent. The only drugs currently approved for treating Alzheimer’s disease are called acetylcholinesterase inhibitors. Other drugs are on their way to the market, but are only effective for the early and middle stages of the disease and only provide a modest improvement in function.

Vascular dementia, or stroke
Multiple strokes are the second most common cause of dementia after Alzheimer’s disease. Over time, the patient becomes neurologically impaired. Usually there is a contributing factor, such as a history of hypertension, heart disease, diabetes or cigarette smoking. Physical symptoms include weakness, tremors and difficulty walking. Memory suffers, depression is frequent, and personality changes may occur. Controlling the risk factors of stroke – such as hypertension, diabetes, being overweight, smoking – is critical.

Binswanger’s disease
A form of vascular dementia that affects tiny blood vessels deep inside the brain. Dementia comes gradually with this disease. Symptoms include memory problems, mood changes and poor judgment.

Parkinson’s with dementia
Parkinson’s affects about 1 million Americans. Dementia is obvious in about 40 percent of patients with the disease, while an additional 50 percent have subtle signs of dementia. Dementia is most common in Parkinson’s patients with noticeable posture problems and walking difficulties. It is least common in patients with the characteristic tremors.

Diffuse Lewy body disease
It’s still a form of dementia that accompanies Parkinson’s disease, although the mental degradation is similar to that found in Alzheimer’s patients. Patients often appear rigid in their movement. The disease usually appears after age 60. Lewy bodies are abnormal cells that are found in the brain. For information on a study involving patients with diffuse Lewy body disease, please see Dementia Studies. (link to Dementia Studies)

Toxic-metabolic dementia
Prescribed drugs can cause dementia in the elderly. Looking over the patient’s medication regimen may reveal a reversible cause of dementia. Almost any drug can cause problems with mental function, but drugs in the following categories are particularly likely to cause problems:

anticholinergic drugs
analgesics
antihypertensive agents
anticonvulsants
psychotropic agents.

Prescription drugs aside, alcohol can also cause dementia. An alcoholic loses his memory capability, his mental processes slow down and his attention span decreases.

Other causes of toxic-metabolic dementia include:

Korsakoff’s syndrome, or thiamine deficiency (more common in alcoholics)
Intoxication by industrial solvents and heavy metals after prolonged exposure
Nutritional deficiencies

Infectious dementia
A number of infectious agents can cause dementia in the elderly: fungi, parasites and viruses. Dementia can also occur with illnesses such as AIDS and Lyme disease.

Depression and Dementia
Certain patients with depression may show symptoms similar to dementia. The onset of dementia is gradual, and it’s reversible with the successful treatment of the mood disorder. Symptoms include a depressed mood, a slowing of mental processes and poor memory, as well as anxiety and agitation. Yet a patient’s memory usually isn’t affected.

Intervention

Dementia brings with it many forms of disability. Patients with memory loss tend to underreport their symptoms, so illness may be overlooked. Infection and dehydration are quite common, as are adverse reactions to medications (particularly medication interactions.) Patients may need supervision to prevent falls, medication errors or poor eating habits. Prevent social and sensory deprivation by spending time with the patient. Support groups, family counseling and legal and social services can educate and help caregivers.

Disease-specific treatment (see Medications)

Behavioral management
Doctors can treat changes in behavior caused by dementia. But it’s important to tailor the treatment to the individual, as his or her medical problems and medications need to be taken into account. If a patient’s behavior changes, check for infections and dehydration. It’s a good idea to maintain a routine, avoid unfamiliar places and relieve the patient’s pain. Ways to modify a patient’s behavior include being calm and gentle, using non-verbal communication, giving reassurance and acknowledging the patient’s concerns. Start medications at a low dose, and gradually increase to their optimal levels. Just remember that medications should be reviewed frequently and discontinued or reduced in dosage if necessary.

Treatment depends on the type of dementia a patient suffers from. In mild cases, where the behaviors don’t disturb the patient or the caregiver, then no treatment may be necessary. Otherwise, low-dose antipsychotics (link to Dementia Medications)may be helpful. For lasting agitation, irritability, aggression or violence, a low dose of an antipsychotic medication should be used. Patients that tend to move excessively – characterized by feeling restless, wandering, pacing or hiding objects – are best managed by providing a safe, contained environment. Also, regular exercise may reduce wandering.

See below for information on drugs to treat specific types of dementia.

Medications Used to Control Dementia

Anti-dementia

Donepezil: start with 5 mg/day; increase to 10 mg after three weeks
Side effects: nausea; diarrhea

Tacrine: start with 10 mg four times a day, slowly building up to 40 mg four times a day
Side effects: nausea; diarrhea; may be toxic to the liver

Antidepressants

Nefazodone: start with 100 – 400 mg/day in two divided doses
Side effects: headache; sedation; nausea; dry mouth

Nortriptyline: 25 – 75 mg/day. Be sure to have doctor check the patient’s blood plasma levels.
Side effects: sedation; hindrance to the parasympathetic nervous system (which controls actions like pupil dilation and heart rate); rigid movement

Paroxetine: start with 10 – 40 mg/day
Side effects: insomnia; nausea; anxiety

Sertraline: 50 – 200 mg/day
Side effects: insomnia; diarrhea; tremor

Trazodone: 50 – 250 mg at night
Side effects: sedation; mild rigidity

Antipsychotics

Haloperidol: 0.25 – 2 mg/day. Gradually increase this dose
Side effects: Parkinson disease symptoms; feeling sedated; falling; problems with physical movement

Perphenazine: 2 – 12 mg/day in two to three doses
Side effects same as those with Haloperidol

Risperidone: 0.5 – 2 mg/day in two doses
Side effects: sedation; Parkinson’s symptoms

Stroke Prevention

Aspirin: 325 mg every day
Side effects: excessive bleeding; stomach irritation

Ticlopidine: 250 mg twice a day. Blood tests required every two weeks for six weeks
Side effects: May cause a decrease in the number of neutrophils – a type of immune cell – in blood

Miscellaneous

Buspirone: 10 – 60 mg/day in divided doses
Side effects: dizziness; nausea; headache

Divalproex sodium: 125 – 750 mg/day in three divided doses
Side effects: nausea; sedation; liver toxicity (though rare)

Lorazepam: 0.5 – 2 mg every day in divided doses. Use only for mild dementia
Side effects: confusion; sedation; uninhibited behavior; problems with movement; anxiety if taking the drug is stopped

Propranolol: doses of 100 – 500 mg/day
Side effects: slowed heart beat (less than 60 beats/minute); low blood pressure

Zolpidem: 5 mg at night.
Side effects: daytime drowsiness; dizziness; headache