Dementia is not a disease; instead, it is a syndrome — a set of symptoms — that occurs when neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die.
Eventually this leads to a loss of cognitive ability that is significant enough to disrupt a person’s daily life.
Dementia ranges in severity from mild to severe. People who are in the final stages become completely incapable of caring for themselves and require around-the-clock help with the most basic aspects of daily living.
Up to half of all men and women who are 85 and older (sometimes called the oldest old) have some form of dementia, yet experts do not consider it a normal part of aging. Many people live into their nineties with their cognitive abilities intact.
The National Institute on Aging defines dementia in two parts:
- Having two or more core functions that are impaired. These functions include memory, language skills, visual perception, and the ability to focus and pay attention. Also included are cognitive skills such as the ability to reason and solve problems.
- A loss of brain function severe enough that a person cannot do normal everyday tasks.
Some people with dementia may be unable to control their emotions, or they may exhibit personality changes.
They may grapple with hallucinations (seeing or experiencing things that don’t exist) and delusions (convictions not grounded in reality). (1)
Are Dementia and Alzheimer’s the Same?
Dementia and Alzheimer’s disease are not the same thing.
Alzheimer’s accounts for 60 to 80 percent of all dementia cases. It is a slowly progressive brain disease marked by the accumulation of fragments of the protein beta-amyloid (plaques) outside neurons in the brain and twisted strands of the protein tau (tangles) inside neurons.
Early in the course of the disease, people with Alzheimer’s may have difficulty remembering recent conversations, names, or events, and they may experience apathy and depression.
While Alzheimer’s is the most common dementia, it is not the only kind.
The second most prevalent form of dementia, for instance, is vascular dementia, which occurs when blocked arteries stop blood flow to the brain, depriving brain cells of the oxygen and nutrients they need to function.
While memory loss is one of the first signs of Alzheimer’s, people with vascular dementia may initially have impaired judgment or unusual difficulty with planning, organizing, and making decisions.
In the past, physicians used a diagnosis of Alzheimer’s to rule out vascular dementia and vice versa. But now experts believe that the two dementias often coexist, an example of a condition called mixed dementia.
Autopsy studies of people with Alzheimer’s reveal that about half also had other forms of dementia, most commonly vascular dementia. (2)
A Tell-Tale Sign of Dementia: Proteins in the Brain
Dementia is caused by damage to brain cells. Researchers are working to better understand why and how this happens. Their hope is that their efforts will lead to a cure — none exists yet — or a treatment that does more than relieve symptoms for a short time.
Scientists have observed an association between certain kinds of dementia and high levels of proteins in the brain, as with Alzheimer’s disease.
Lewy body dementia, the third most common form of dementia, is associated with abnormal deposits of a protein called alpha-synuclein.
In a healthy brain, alpha-synuclein helps neurons communicate. But when alpha-synuclein begins to clump inside neurons, forming so-called Lewy bodies, brain function is impaired, impacting thinking, movement, behavior, and mood. (3)
A Syndrome With Many Causes — Some Preventable
Genes, which are passed down from parents to their offspring, are believed to play a role in almost every type of dementia.
Yet except in rare cases of a single-gene mutation, people don’t inherit dementia directly. Instead, their odds depend on some combination of genetic, environmental, and lifestyle factors.
According to the United Kingdom group the Alzheimer’s Society, most people can significantly lower their dementia risk by staying physically active, eating a healthy diet, drinking alcohol in moderation (if at all), and not smoking.
Certain kinds of dementia, however, appear to be more seriously affected by genetics. About 10 to 15 percent of people with a form of dementia called frontotemporal disorders (also known as frontotemporal dementia) have a strong family history. (4)
How Many People Suffer From Dementia?
An estimated 14 percent of people age 71 and older live with dementia. Of these, more women are affected than men — 16 percent versus 11 percent.
Unfortunately, dementia often goes unreported and undiagnosed, with only about half of people with dementia identified by physicians.
The number of people living with dementia is expected to increase significantly due to the aging of the baby boomers and advances in medicine. By 2030, an estimated 20 percent of people in the United States will be age 65 and older, up from 14 percent in 2012.
Dementia’s toll — personal, medical, and societal — is already high, and with these changing demographics, it is expected to go much higher.
For 2017, the total cost of healthcare and long-term care for people with dementia was estimated at $259 billion. That amount is projected to shoot up to $1.1 trillion in 2050 (in 2017 dollars). (2)
Medication Can Stabilize the Symptoms, Not Cure Dementia
When it comes to the progressive diseases that cause dementia, there is currently no cure and no way to significantly slow or reverse damage to the brain.
However, certain medications can lessen or stabilize some of the symptoms of dementia at least for a while. Many have been approved by the Food and Drug Administration (FDA) to treat Alzheimer’s disease, with clinical evidence that they can also help people with other forms of dementia.
Patients with Lewy body dementia, for instance, may find some relief from using cholinesterase inhibitors, currently used to treat symptoms of Alzheimer’s such as memory loss, confusion, and problems with thinking and reasoning. (5)
There are currently more than 250 clinical trials in the United States examining dementia. Investigators working with people online and at centers around the country are studying both pharmaceutical and nonpharmaceutical interventions.
Participants in these clinical trials, including those with dementia and those at risk, can gain access to potential treatments before they are in widespread use while also helping find a cure for future generations. (6)
Dementia Causes and Risk Factors
Dementia occurs when neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. Researchers are still working to understand why this happens and are investigating the role that genetics, lifestyle, and environment all play.
Vascular dementia has been linked to damaged arteries that block the flow of blood to the brain, depriving brain cells of the oxygen and nutrients they need to function. The severity of the blockage and its location in the brain will determine the impact on thinking and reasoning. Risk factors include atherosclerosis (hardening of the arteries), high cholesterol, high blood pressure, and diabetes, among others; smoking also raises risk.
For Lewy body dementia, in which abnormal clumps of protein called Lewy bodies impede normal brain function, other diseases such as Parkinson’s appear to raise risk. Scientists believe that a family history of this dementia may also be a factor.
At this point in time, the main risk factor that scientists have been able to identify for frontotemporal disorders (also called frontotemporal dementia) is family history. However, researchers have found molecular and genetic similarities between the underlying brain condition, frontotemporal degeneration, and amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease. Exploring those similarities may help scientists better understand and treat both illnesses.
Can You Prevent Dementia?
People who have a parent or sibling with dementia may feel doomed by their genetics. However, while researchers believe that genetics matter, they also hold that (with the exception of rare diseases caused by specific mutations) other variables come into play. Researchers are actively investigating lifestyle and environmental factors that may increase or decrease one’s risk of developing dementia.
To prevent vascular dementia, for instance, the best way to protect the brain appears to be to protect the heart. This includes not smoking; exercising (with a doctor’s approval); keeping blood pressure, cholesterol, and sugar levels within recommended limits; and following a healthy diet that’s low in red meat and high in fruits and vegetables.
Scientists are actively investigating other lifestyle factors that can affect dementia risk. There is ongoing research on social engagement that analyzes factors like marital status and emotional connectedness. Some evidence supports an association between high levels of social engagement and decreased dementia risk.
Among other areas of study is the link between sleep and dementia, with one small study associating every minute of lost REM sleep with a 9 percent increase in dementia risk.
What Are the Signs and Symptoms of Dementia?
Dementia is an impairment in core functions (such as memory, language skills, visual perception, the ability to focus and pay attention, and cognitive skills such the ability to reason and solve problems) that is severe enough to affect a person’s ability to do normal everyday tasks.
While short-term memory loss is an early sign of dementia, particularly Alzheimer’s, different types of dementia may have different symptoms.
When vascular dementia develops after multiple small strokes, for instance, people may have difficulty with judgment and planning or may become increasingly unable to focus mentally.
With Lewy body dementia, people may experience visual hallucinations — imagining they see things that aren’t there, for instance. Or they may alternate (day to day or even hour to hour) between periods of alertness and confusion.
Some people with frontotemporal dementia exhibit extreme changes in behavior and personality. They may begin making wildly inappropriate comments in social situations, for instance, or show a startling lack of inhibition.
Finding a physician who can correctly identify the type of dementia is the first step to getting the right kind of treatment and support.
Diagnosing Dementia: How Is It Done?
Diagnosing dementia isn’t difficult; identifying the underlying brain disorder can be. The challenge is that symptoms of different types of dementia may overlap, or people can have multiple types of dementia at the same time (a condition called mixed dementia).
Getting the right diagnosis, however, is critical to getting the best treatment. Usually, a specialist like a neurologist is best equipped to do the job, although other specialists like a geriatric psychiatrist, a neuropsychologist, or a geriatrician may play a part.
The first task is ruling out treatable or reversible conditions with symptoms that can mimic dementia, such as depression or a thyroid problem. Physicians take a detailed medical history, conduct a physical exam and a neuropsychological assessment, and order lab tests.
Neuropsychological assessments help doctors see cognitive patterns that indicate the presence of a particular brain disorder. Difficulty creating a strategy to solve a hypothetical problem, for instance, is a sign of vascular dementia.
Physicians may also examine the brain for visible abnormalities by using scans such as MRI, CT, and PET.
What Are the Stages of Dementia?
People with dementia will always see their symptoms worsen over time, but not every person with the same type of dementia will decline at the same rate or experience the same symptoms at the same stage. Certain symptoms may never appear; stages may overlap; symptoms may appear, then disappear — each person is unique.
Outlining the stages of dementia, however, can be useful for people considering their future caregiving needs, hoping to enlist in clinical trials, or otherwise planning ahead.
Understanding the earliest stages of dementia can also help people make sense of puzzling brain glitches. In fact, researchers now identify a condition called mild cognitive impairment as a precursor to dementia for some people. This condition — which involves lapses in memory, language, thinking, and judgment that are noticeable to the person affected but not severe enough to impact everyday functioning — affects 15 to 20 percent of people age 65 and over.
Each of the four main types of dementia — Alzheimer’s, vascular dementia, Lewy body dementia, and frontotemporal disorders — has early symptoms that can be telling. Unlike the short-term memory loss of Alzheimer’s, for instance, vascular dementia may reveal itself as difficulty making plans or decisions.
In their advanced stages, however, symptoms of different dementias all tend to become more like Alzheimer’s, with short-term memory loss, agitation, and aggression becoming more common.
Are There Treatments for Dementia?
Currently, there is no cure for dementia, but people can find relief from symptoms through different medications or nondrug methods.
Nonpharmaceutical approaches are generally the best place to start. These might include individual sessions with a mental health counselor to deal with feelings of stress or grief. Support group meetings with other people coping with dementia can also boost mental health, which may improve physical health.
When medications are in order, the type of dementia will dictate the drug. Doctors may prescribe blood pressure medication to people with vascular dementia, for instance, to prevent additional damage to blood vessels and keep as much oxygen going to the brain as possible.
People with Lewy body dementia may receive cholinesterase inhibitors, a category of drugs the FDA has approved for people with Alzheimer’s that can also relieve the cognitive symptoms of Lewy body dementia.
People with frontotemporal disorders are particularly difficult to treat with drugs because they can have adverse and even dangerous reactions to medications. Certain antidepressants, however, may help curb social disinhibitions or impulsivity.
Life With Dementia
Even while researchers search for better treatments, people with dementia can improve their quality of life by focusing on their overall well-being and taking steps to reduce stress.
People with dementia can protect their physical health by exercising (with a doctor’s okay), eating well, and taking part in activities that stimulate the brain.
To boost psychological health, relationships are key. Having close friends who can provide emotional support and staying active in a larger social group can lift a person's feelings of well-being and self-worth.
People with dementia can nourish their spiritual health by taking part in meaningful activities, whether that means outings with family and friends or quiet, meditative moments alone pursuing a hobby like yoga.
Caregivers can improve quality of life for people with dementia by knowing the best ways to communicate and having strategies to overcome cognitive or behavioral challenges. For instance, presenting complex tasks a step at a time will lead to a greater chance of success and foster feelings of confidence.
The well-being of caregivers is also a concern, given the enormous amount of stress they may experience. To prevent burnout, caregivers need to make their own physical and mental health a priority. A number of dementia organizations can connect caregivers with face-to-face and online support groups that can help lighten the emotional load.
Lewy Body Dementia in Detail
When media mogul Ted Turner announced during a TV interview in late September 2018 that he had Lewy body dementia, it was likely the first time that many viewers heard of this disease. Turner himself was a little hazy on the details of his diagnosis.
“It’s a mild case of what people have as Alzheimer’s. It’s similar to that but not nearly as bad,” Turner told the journalist Ted Koppel.
In fact, similar to Alzheimer’s disease and other types of dementia, Lewy body dementia causes a severe loss of cognitive ability that interferes with a person’s everyday activities.
Risk factors for Lewy body dementia include older age, having Parkinson’s disease, and having a condition called REM (rapid eye movement) sleep behavior disorder, which causes people to physically act out vivid, sometimes violent, dreams in their sleep.
Unlike in Alzheimer’s disease, memory loss may not be among the first symptoms of Lewy body dementia, although it may develop as the disease progresses. Common symptoms of Lewy body dementia include hallucinations, alternating periods of alertness and confusion, and movement disorders that affect walking.
Many of the medications used for Alzheimer’s disease can also be used to treat Lewy body dementia, but there is no cure for this potentially life-shortening disease.
The Right Resources Can Help You Live Better With Dementia
Dementia is often misunderstood and stigmatized, isolating people with the syndrome and caregivers at a time when they are in vital need of support.
Numerous nonprofit groups are committed to raising dementia awareness, sharing information about brain disorders and the best treatments for each kind, and advocating for better medical care, more research, and more empathy. There are groups that help with the specific demands of life with dementia, offering assistance to people who need help accessing support services, for instance, or paying for prescription drugs.
Federally funded organizations like the National Institute on Aging and initiatives like Alzheimers.gov are important resources. They can connect people with dementia and their caregivers to medical and social services and clinical trials that offer cutting-edge treatments not yet widely available.
Those struggling to cope with the emotional challenges of dementia can also connect with peers both in person and online. Bloggers who share their daily struggles and triumphs with dementia are another source of invaluable emotional support.
Editorial Sources and Fact-Checking
- What Is Dementia? National Institute on Aging. May 17, 2017.
- 2017 Alzheimer’s Disease Facts and Figures. Alzheimer’s Association.
- What Is Lewy Body Dementia? National Institute on Aging. May 17, 2017.
- Genetics of Dementia. Alzheimer’s Society.
- Treatment Options. Lewy Body Dementia Association.
- Why Participate in a Clinical Trial. Alzheimer’s Association.