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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Other namesSenility[1] and senile dementia (outdated)
1896 lithograph of a man diagnosed with "senile dementia", a now outdated term
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 factorsSeveral across the life course (e.g. less education, hearing loss, vision loss, physical inactivity, obesity, high cholesterol, hypertension, diabetes, smoking, excessive alcohol consumption, social isolation, air pollution, traumatic brain injury, depression)[4]
Diagnostic methodClinical assessment, cognitive testing (mini–mental state examination)[5] and imaging.
Differential diagnosisDelirium, depression, hypothyroidism[6][7]
PreventionAddressing risk factors throughout the life course, e.g. preventing, reducing or treating hearing and vision loss, depression, head injury and vascular risk factors (e.g. cholesterol, diabetes), decreasing smoking, and maintaining physical activity and cognitive stimulation[4]
TreatmentVaries but supportive care is given[2]
MedicationVaries depending on the type and stage, most medications have a small benefit[8]
PrognosisVaries, dementia is a life limiting condition and life expectancy is usually shortened
Frequency57 million (2021)[2]
Deaths1.62nbsp;million dementia-related deaths (2019) estimated to increase to 4.91 million by 2050[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.[10] This typically involves problems with memory, thinking, behavior, and motor control.[11] 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.[12][a] Dementia is a life-limiting condition, having 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.[14]

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] Dementia is a neurocognitive disorder with varying degrees of severity (mild to major) and many forms or subtypes.[15] Dementia is an acquired brain syndrome, marked by a decline in cognitive function, and is contrasted with neurodevelopmental disorders.[16] It has also been described as a spectrum of disorders with subtypes of dementia based which known disorder caused its development, 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.[17] Subtypes of neurodegenerative dementias may also be based on the underlying pathology of misfolded proteins, such as synucleinopathies and tauopathies.[17] The coexistence of more than one type of dementia is known as mixed dementia.[16]

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.[18]

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 imaging can be used to help determine the dementia subtype and exclude other causes. One of the cognitive tests used is the mini–mental state examination.[19]

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.[19] 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.[20]

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 in some dementia subtypes and may be beneficial in mild to moderate stages, 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.[21]

  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. ^ a b Cite error: The named reference :0 was invoked but never defined (see the help page).
  5. ^ Cite error: The named reference Creavin was invoked but never defined (see the help page).
  6. ^ "Differential diagnosis dementia". NICE. Retrieved January 20, 2022.
  7. ^ 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.
  8. ^ Cite error: The named reference Comm2012 was invoked but never defined (see the help page).
  9. ^ Cite error: The named reference :13 was invoked but never defined (see the help page).
  10. ^ "What Is Dementia? Symptoms, Types, and Diagnosis". National Institute on Aging. December 8, 2022. Retrieved March 8, 2025.
  11. ^ "Dementia". who.int. Retrieved April 4, 2024.
  12. ^ Cite error: The named reference Bathini was invoked but never defined (see the help page).
  13. ^ 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.
  14. ^ Budson A, Solomon P (2011). Memory loss : a practical guide for clinicians. [Edinburgh?]: Elsevier Saunders. ISBN 978-1-4160-3597-8.
  15. ^ "ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Retrieved January 20, 2022.
  16. ^ a b "What is mixed dementia". Dementia UK. Archived from the original on November 1, 2020. Retrieved December 13, 2020.
  17. ^ 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.
  18. ^ 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.
  19. ^ a b "The Dementias: Hope Through Research | National Institute of Neurological Disorders and Stroke". ninds.nih.gov. Retrieved December 9, 2022.
  20. ^ Cite error: The named reference Lin was invoked but never defined (see the help page).
  21. ^ 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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