Case Evaluation

Types of Brain Injuries: Dementia

Dementia

What is dementia?

We all forget things as we get older. Many older people have a slight loss of memory that does not affect their daily lives. But memory loss that gets worse may mean that you have dementia.

Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships. They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems, such as agitation, delusions, and hallucinations. While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia.

Doctors diagnose dementia only if two or more brain functions - such as memory and language skills -- are significantly impaired without loss of consciousness.  Some of the diseases that can cause symptoms of dementia are Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia, Huntington’s disease, and Creutzfeldt-Jakob disease.  Doctors have identified other conditions that can cause dementia or dementia-like symptoms including reactions to medications, metabolic problems and endocrine abnormalities, nutritional deficiencies, infections, poisoning, brain tumors, anoxia or hypoxia (conditions in which the brain’s oxygen supply is either reduced or cut off entirely), and heart and lung problems. 

Although it is common in very elderly individuals, dementia is not a normal part of the aging process. Your chances of having dementia rise as you get older. But this does not mean that everyone will get it. Many older adults never get it. By age 85, about 35 out of 100 people have it. That means that 65 out of 100 people this age do not have dementia.

What causes dementia?

Dementia is caused by damage to or changes in the brain. Things that can cause dementia include:

  • Strokes, tumors, or head injuries. After Alzheimer's disease, strokes are the most common cause of dementia. This type of dementia is called vascular dementia.
  • Diseases, such as Parkinson's disease, dementia with Lewy bodies, and frontotemporal dementia.

In a few cases, dementia is caused by a problem that can be treated. Examples include having an underactive thyroid gland (hypothyroidism), not getting enough vitamin B12, and fluid buildup in the brain (normal-pressure hydrocephalus). In these cases, treating the problem may cure the dementia.

In some people, depression can cause memory loss that seems like dementia. Depression can be treated.

As you age, medicines may affect you more. Taking some medicines together may cause symptoms that look like dementia. Be sure your doctor knows about all of the medicines you take. This means all prescription medicines and all over-the-counter medicines, herbs, vitamins, and supplements.

What are the symptoms?

Usually the first symptom is memory loss. Often the person who has a memory problem does not notice it, but family and friends do. As dementia gets worse:

  • You may have more trouble doing things that take planning, like making a list and going shopping.
  • You may have trouble using or understanding words.
  • You may get lost in places you know well.

Over time, people with dementia may begin to act very different. They may become scared and strike out at others, or they may become clingy and childlike. They may stop brushing their teeth or bathing.

Later, they cannot take care of themselves. They may not know where they are. They may not know their loved ones when they see them.

How is dementia diagnosed?

There is no single test for dementia. To diagnose it, your doctor will:

Do a physical exam:

  • Ask questions about recent and past illnesses and life events. The doctor will want to talk to a close family member to check details.
  • Ask you to do some simple things that test your memory and other mental skills. Your doctor may ask you to tell what day and year it is, repeat a series of words, or draw a clock face.

The doctor may do tests to look for a cause that can be treated. For example, you might have blood tests to check your thyroid or to look for an infection. You might also have a test that shows a picture of your brain, like an MRI and a CT scan.

These tests can help your doctor find a tumor or brain injury. They can also show if there has been shrinking in parts of the brain. This can be a sign of dementia.

How is it treated?

There are medicines you can take for dementia. They cannot cure it, but they can slow it down for a while and make it easier to live with.

As dementia gets worse, a person may get depressed or angry and upset. Medicines can help.

If a stroke caused the dementia, there are things you can do to reduce the chance of another stroke. Stay at a healthy weight, exercise, and keep your blood pressure and cholesterol at normal levels. If you have diabetes, keep your blood sugar in your target range.

Keeping both your mind and your body active is a good idea for anyone. So is not smoking.

How can I help my loved one with dementia?

There are many things you can do to help your loved one be safe at home. For example, get rid of throw rugs, and put handrails in bathrooms to help prevent falls. Post reminder notes around the house. Put a list of important phone numbers by the telephone. You also can help your loved one stay active. Play cards or board games, and take walks.

Work with your loved one to make decisions about the future before dementia gets worse. It is important to write a living will and a durable power of attorney. A living will states the types of medical care your loved one wants. A durable power of attorney lets your loved one pick someone to be the health care agent. This person makes care decisions once your loved one cannot.

Watching a loved one slip away can be sad and scary. Caring for someone with dementia can leave you feeling drained. Be sure to take care of yourself and to give yourself breaks. Ask family members to share the load, or get other help.

Your loved one will need more and more care as dementia gets worse. In time, he or she may need help to eat, get dressed, or use the bathroom. You may be able to give this care at home, or you may want to think about using a nursing home. A nursing home can give this kind of care 24 hours a day. The time may come when a nursing home is the best choice.

You are not alone. Many people have loved ones with dementia. Ask your doctor about local support groups, or search the Internet for online support groups. Help is available.

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