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 names Senility,[1] senile dementia

Lithography of a man diagnosed with dementia in the 1800s

Specialty Neurology, psychiatry

Symptoms Decreased ability to think and remember,

emotional problems, problems

with language, decreased motivation[2]

Complications poor nutrition, pneumonia, inability to

perform self-care tasks, personal safety

challenges, death.[3]
 Usual onset Gradual[2]

Duration Long term[2]

Causes Alzheimer's disease, vascular

disease, Lewy body

disease and frontotemporal lobar

degeneration.[2]

Diagnostic Cognitive testing (Mini-Mental State

method Examination)[4]

Differential Delirium, Hypothyroidism[5][6]

diagnosis

Prevention Early education, prevent high blood

pressure, prevent obesity, no smoking,

social engagement[7]

Treatment Supportive care[2]

Medication Acetylcholinesterase inhibitors (small

benefit)[8]

Frequency 55 million (2021)[2]

Deaths 2.4 million (2016)[9]

Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when
the brain is damaged by injury or disease.[2] The symptoms involve progressive impairments in
memory, thinking, and behavior, which negatively affects a person's ability to function and carry
out everyday activities. Aside from memory impairment and a disruption in thought patterns, the
most common symptoms include emotional problems, difficulties with language, and
decreased motivation. The symptoms may be described as occurring in a continuum over several
stages.[10][a] Consciousness is not affected. Dementia ultimately has a significant effect on the
individual, caregivers, and on 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 what is caused by normal aging.[12]
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] The Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition  (DSM-5), has re-described dementia as either
a mild or major neurocognitive disorder with varying degrees of severity and
many causative subtypes. The International Classification of Diseases (ICD-11) also classes
dementia as a neurocognitive disorder (NCD) with many forms or subclasses.[13] Dementia is listed
as an acquired brain syndrome, marked by a decline in cognitive function, and is contrasted
with neurodevelopmental disorders.[14] Dementia is also described as a spectrum of disorders with
causative subtypes of dementia based on a known disorder, 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; or Lewy body disease for dementia with Lewy bodies,
and prion diseases.[15] Subtypes of neurodegenerative dementias may also be based on the
underlying pathology of misfolded proteins such as synucleinopathies, and tauopathies.[15] More than
one type of dementia existing together is known as mixed dementia.[14]
Many neurocognitive disorders may be caused by another medical condition or disorder that
includes 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, and
some leukodystrophies, and neurological disorders such as epilepsy, and multiple sclerosis. Some
of the neurocognitive deficits may sometimes show improvement with treatment of the medical
condition.[16]
Diagnosis 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 to determine the dementia subtype. One commonly
used cognitive test is the Mini-Mental State Examination. The greatest risk factor for developing
dementia is aging, however dementia is not a normal part of aging. Many people aged 90 and above
show no signs of dementia.[17] 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.[18]
Dementia is currently the seventh leading cause of death worldwide and has 10 million new cases
reported every year (one every ~3 seconds).[2] There is no known cure for
dementia. Acetylcholinesterase inhibitors such as donepezil are often used and may be beneficial in
mild to moderate disorder. The overall benefit, however, may be minor. There are many measures
that can improve the quality of life of people with dementia and their caregivers. Cognitive and
behavioral interventions may be appropriate for treating associated symptoms of depression.[19]

Signs and symptoms[edit]

A drawing of a woman diagnosed with dementia

A drawing of an old man diagnosed with senile dementia

The signs and symptoms of dementia are termed as the neuropsychiatric symptoms, also known as
the behavioral and psychological symptoms of dementia.[20][21] Behavioral symptoms can
include agitation, restlessness, inappropriate behavior, sexual disinhibition, and aggression, which
can be verbal or physical.[22] These symptoms may result from impairments in cognitive inhibition.
[23]
 Psychological symptoms can include depression, hallucinations (most often visual),[24] and
delusions, apathy, and anxiety.[22][25] The most commonly affected areas include memory, visuospatial
function affecting perception and orientation, language, attention and problem solving. The rate at
which symptoms progress occurs on a continuum over several stages, and they vary across the
dementia subtypes.[26][10] Most types of dementia are slowly progressive with some deterioration of the
brain well established before signs of the disorder become apparent. Often there are other
conditions present such as high blood pressure, or diabetes, and there can sometimes be as many
as four of these comorbidities.[27]
People with dementia are also more likely to have problems with incontinence: they are three times
more likely to have urinary and four times more likely to have fecal incontinence compared to people
of similar ages.[28][29]
Dementia symptoms can vary widely from person to person. It affects memory, attention span,
communication, reasoning, judgement, problem solving and visual perception, etc. Signs that may
point to dementia include getting lost in a familiar neighborhood, using unusual words to refer to
familiar objects, forgetting the name of a close family member or friend, forgetting old memories, not
being able to complete tasks independently, etc.[30]

Stages[edit]
The course of dementia is often described in four stages that show a pattern of progressive cognitive
and functional impairment. However, the use of numeric scales allows for more detailed
descriptions. These scales include the Global Deterioration Scale for Assessment of Primary
Degenerative Dementia (GDS or Reisberg Scale), the Functional Assessment Staging Test (FAST),
and the Clinical Dementia Rating (CDR).[31] Using the GDS, which more accurately identifies each
stage of the disease progression, a more detailed course is described in seven stages – two of
which are broken down further into five and six degrees. Stage 7(f) is the final stage.[32][33]

Pre-dementia[edit]
Pre-dementia states include pre-clinical and prodromal stages. The prodromal stages includes (1)
mild cognitive impairment (MCI), (2) delirium-onset, and psychiatric-onset presentations.[34]
Pre-clinical[edit]
Sensory dysfunction is claimed for this stage which may precede the first clinical signs of dementia
by up to ten years.[10] Most notably the sense of smell is lost.[10][35] The loss of the sense of smell is
associated with depression and loss of appetite leading to poor nutrition.[36] It is suggested that this
dysfunction may come about because the olfactory epithelium is exposed to the environment. The
lack of blood–brain barrier protection here means that toxic elements can enter and cause damage
to the chemosensory networks.[10]
Prodromal[edit]
Pre-dementia states considered as prodromal are mild cognitive impairment (MCI), and mild
behavioral impairment (MBI).[37][38][39]
Kynurenine is a metabolite of tryptophan that regulates microbiome signalling, immune cell
response, and neuronal excitation. A disruption in the kynurenine pathway may be associated with
the neuropsychiatric symptoms and cognitive prognosis in mild dementia.[40][41]
In this stage signs and symptoms may be subtle. Often, the early signs become apparent when
looking back.[42] 70% of those diagnosed with MCI later progress to dementia.[12] In MCI, changes in
the person's brain have been happening for a long time, but symptoms are just beginning to appear.
These problems, however, are not severe enough to affect daily function. If and when they do, the
diagnosis becomes dementia. They may have some memory trouble and trouble finding words, but
they solve everyday problems and competently handle their life affairs.[43] During this stage, it is ideal
to ensure that advance care planning has occurred in order to protect the wishes of the person.
Advance directives which are specific to dementia exist,[44] which can be particularly helpful in
addressing the decisions related to feeding which come with the progression of the illness.
Mild cognitive impairment has been relisted in both DSM-5, and ICD-11, as mild neurocognitive
disorders – milder forms of the major neurocognitive disorder (dementia) subtypes.[45]

Early[edit]
In the early stage of dementia, symptoms become noticeable to other people. In addition, the
symptoms begin to interfere with daily activities, and will register a score on a Mini-Mental State
Examination (MMSE). MMSE scores are set at 24 to 30 for a normal cognitive rating and lower
scores reflect severity of symptoms. The symptoms are dependent on the type of dementia. More
complicated chores and tasks around the house or at work become more difficult. The person can
usually still take care of themselves but may forget things like taking pills or doing laundry and may
need prompting or reminders.[46]
The symptoms of early dementia usually include memory difficulty, but can also include some word-
finding problems, and problems with executive functions of planning and organization.[47] Managing
finances may prove difficult. Other signs might be getting lost in new places, repeating things, and
personality changes.[48]
In some types of dementia, such as dementia with Lewy bodies and frontotemporal dementia,
personality changes and difficulty with organization and planning may be the first signs.[49]

Middle