Dementia is a group of conditions that involve loss of cognitive function (which usually includes memory loss, but may also involve change in thinking and personality). Not all dementia is Alzheimer’s. It is critical that the evaluation first establishes whether the person is undergoing the changes in brain function that we see with normal aging, or whether there is an accelerated process. Next, the doctor will search for treatable causes. If those are not found, the patient (and often the caregiver), after careful counseling, can pursue special tests which may give a more likely diagnosis.
Alzheimer’s may appear as difficulty remembering recently learned information, by forgetting the names of things, and by losing things. Initially, these lapses are almost impossible to distinguish from normal brain aging. As the condition progresses the person may have difficulty carrying out complex tasks such as paying bills; in some instances agitation, sleep disturbance and confusion dominate.
Some of the treatable types of cognitive impairment can include thyroid disease, vitamin deficiencies, hydrocephalus (“water on the brain,”), kidney or liver failure, and brain infections. A decline in concentration and memory can be symptoms of depression. The same factors which can cause heart attack and stroke--high blood pressure, high cholesterol, and diabetes--can cause or worsen dementia. Medications including prescription medications can interfere with cognitive performance. There are other neurodegenerative diseases, such as frontotemporal dementia, or corticobasal degeneration.
There are two principal reasons to pursue a diagnosis:
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