Diagnosing dementia and its type can be challenging. People have dementia when they have cognitive impairment and lose their ability to perform daily functions, such as taking their medication, paying bills and driving safely.
To diagnose the cause of the dementia, the doctor must recognize the pattern of the loss of skills and function and determine what a person is still able to do. More recently, biomarkers have become available to make a more accurate diagnosis of Alzheimer's disease.
Your doctor will review your medical history and symptoms and conduct a physical examination. He or she will likely ask someone close to you about your symptoms as well.
No single test can diagnose dementia, so doctors are likely to run a number of tests that can help pinpoint the problem.
Cognitive and neuropsychological tests
Doctors will evaluate your thinking (cognitive) function. A number of tests measure thinking skills, such as memory, orientation, reasoning and judgment, language skills, and attention.
Doctors evaluate your memory, language, visual perception, attention, problem-solving, movement, senses, balance, reflexes and other areas.
- CT or MRI. These scans can check for evidence of stroke or bleeding or tumor or hydrocephalus.
- PET scans. These can show patterns of brain activity and whether the amyloid protein, a hallmark of Alzheimer's disease, has been deposited in the brain.
Simple blood tests can detect physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland. Sometimes the spinal fluid is examined for infection, inflammation or markers of some degenerative diseases.
A mental health professional can determine whether depression or another mental health condition is contributing to your symptoms.
Most types of dementia can't be cured, but there are ways to manage your symptoms.
The following are used to temporarily improve dementia symptoms.
Cholinesterase inhibitors. These medications — including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a chemical messenger involved in memory and judgment.
Although primarily used to treat Alzheimer's disease, these medications might also be prescribed for other dementias, including vascular dementia, Parkinson's disease dementia and Lewy body dementia.
Side effects can include nausea, vomiting and diarrhea. Other possible side effects include slowed heart rate, fainting and sleep disturbances.
Memantine. Memantine (Namenda) works by regulating the activity of glutamate, another chemical messenger involved in brain functions, such as learning and memory. In some cases, memantine is prescribed with a cholinesterase inhibitor.
A common side effect of memantine is dizziness.
- Other medications. Your doctor might prescribe medications to treat other symptoms or conditions, such as depression, sleep disturbances, hallucinations, parkinsonism or agitation.
Several dementia symptoms and behavior problems might be treated initially using nondrug approaches, such as:
- Occupational therapy. An occupational therapist can show you how to make your home safer and teach coping behaviors. The purpose is to prevent accidents, such as falls; manage behavior; and prepare you for the dementia progression.
- Modifying the environment. Reducing clutter and noise can make it easier for someone with dementia to focus and function. You might need to hide objects that can threaten safety, such as knives and car keys. Monitoring systems can alert you if the person with dementia wanders.
- Simplifying tasks. Break tasks into easier steps and focus on success, not failure. Structure and routine also help reduce confusion in people with dementia.
Lifestyle and home remedies
Dementia symptoms and behavior problems will progress over time. Caregivers might try the following suggestions:
- Enhance communication. When talking with your loved one, maintain eye contact. Speak slowly in simple sentences, and don't rush the response. Present one idea or instruction at a time. Use gestures and cues, such as pointing to objects.
Encourage exercise. The main benefits of exercise in people with dementia include improved strength, balance and cardiovascular health. Exercise may also be helpful in managing symptoms such as restlessness. There is growing evidence that exercise also protects the brain from dementia, especially when combined with a healthy diet and treatment for risk factors for cardiovascular disease.
Some research also shows that physical activity might slow the progression of impaired thinking in people with Alzheimer's disease, and it can lessen symptoms of depression.
- Engage in activity. Plan activities the person with dementia enjoys and can do. Dancing, painting, gardening, cooking, singing and other activities can be fun, can help you connect with your loved one, and can help your loved one focus on what he or she can still do.
Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active family members. Leave night lights on in the bedroom, hall and bathroom to prevent disorientation.
Limiting caffeine, discouraging napping and offering opportunities for exercise during the day might ease nighttime restlessness.
- Keep a calendar. A calendar might help your loved one remember upcoming events, daily activities and medication schedules. Consider sharing a calendar with your loved one.
Plan for the future. Develop a plan with your loved one while he or she is able to participate that identifies goals for future care. Support groups, legal advisers, family members and others might be able to help.
You'll need to consider financial and legal issues, safety and daily living concerns, and long-term care options.
Several dietary supplements, herbal remedies and therapies have been studied for people with dementia. But at this time there is no convincing evidence for any of these.
Use caution when considering taking dietary supplements, vitamins or herbal remedies, especially if you're taking other medications. These remedies aren't regulated, and claims about their benefits aren't always based on scientific research.
While some studies suggest that vitamin E supplements may be helpful for Alzheimer's disease, the evidence is not convincing and large doses may pose risks. Vitamin E supplementation is not currently recommended, but including vitamin E in the diet through foods such as nuts is suggested to promote brain health.
The following techniques may help reduce agitation and promote relaxation in people with dementia.
- Music therapy, which involves listening to soothing music
- Light exercise
- Watching videos of family members
- Pet therapy, which involves use of animals, such as visits from dogs, to promote improved moods and behaviors in people with dementia
- Aromatherapy, which uses fragrant plant oils
- Massage therapy
- Art therapy, which involves creating art, focusing on the process rather than the outcome
Coping and support
Receiving a diagnosis of dementia can be devastating. Many details need to be considered to ensure that you and those around you are as prepared as possible for dealing with a condition that's unpredictable and progressive.
Care and support for the person with the disease
Here are some suggestions you can try to help yourself cope with the disease:
- Learn as much as you can about memory loss, dementia and Alzheimer's disease.
- Write about your feelings in a journal.
- Join a local support group.
- Get individual or family counseling.
- Talk to a member of your spiritual community or another person who can help you with your spiritual needs.
- Stay active and involved, volunteer, exercise, and participate in activities for people with memory loss.
- Spend time with friends and family.
- Participate in an online community of people who are having similar experiences.
- Find new ways to express yourself, such as through painting, singing or writing.
- Delegate help with decision-making to someone you trust.
Helping someone with dementia
You can help a person cope with the disease by listening, reassuring the person that he or she still can enjoy life, being supportive and positive, and doing your best to help the person retain dignity and self-respect.
Providing care for someone with dementia is physically and emotionally demanding. Feelings of anger and guilt, frustration and discouragement, worry, grief, and social isolation are common. If you're a caregiver for someone with dementia:
- Learn as much about the disease as you can and participate in caregiver education programs
- Find out about supportive services in your community, such as respite care or adult care, which can give you a break from caregiving at scheduled times during the week
- Ask friends or other family members for help
- Take care of your physical, emotional and spiritual health
- Ask questions of doctors, social workers and others involved in the care of your loved one
- Join a support group
Preparing for your appointment
Most likely, you'll first see your primary care provider if you have concerns about dementia. Or you might be referred to a doctor trained in nervous system conditions (neurologist).
Here's some information to help you get ready for your appointment.
What you can do
When you make the appointment, ask if there's anything that needs to be done in advance, such as fasting before certain tests. Make a list of:
- Symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment
- Key personal information, including any major stresses or recent life changes and family medical history
- All medications, vitamins or supplements you take, including the doses
- Questions to ask the doctor
Even in the early stages of dementia, it's good to take a family member, friend or caregiver along to help you remember the information you're given.
For dementia, basic questions to ask the doctor include:
- What is likely causing my symptoms?
- Are there other possible causes for my symptoms?
- What tests are necessary?
- Is the condition likely temporary or chronic?
- What's the best course of action?
- What alternatives are there to the primary approach being suggested?
- How can dementia and other health issues be managed together?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
The doctor is likely to ask questions, such as:
- When did your symptoms begin?
- Have symptoms been continuous or occasional?
- How severe are symptoms?
- What, if anything, seems to improve symptoms?
- What, if anything, appears to worsen symptoms?
- How have the symptoms interfered with your life?