Dementia

ConditionsDementia

Dementia refers to a group of brain disorders characterized by progressive memory loss, cognitive functions such as decision making ability, and changes in personality.

Dementia is defined by a decline in brain function above and beyond the typical age-related loss of short term memory and slowing of processing speed.

The first goal when assessing patients with a complaint of memory loss or cognitive decline is to aggressively assess for reversible causes of memory loss. One addressable diagnosis that must be considered is normal pressure hydrocephalus, a condition of cerebrospinal fluid accumulation that results in memory loss and a decline in cognitive function, urinary incontinence, and gait instability. A full evaluation of a patient with memory loss must additionally include assessment for vascular disease and stroke. Nutritional deficiencies, infectious causes, endocrine conditions, and psychiatric conditions such as depression and anxiety are additionally screened for during a careful evaluation, and up to 25% of patients presenting with memory loss conditions are found to have a reversible condition when appropriate screening is undertaken. In addition to an expert examination, laboratory testing, and typical structural MRI, advanced MRI and careful neuropsychological testing are often essential tools used to differentiate reversible and non-reversible dementias.

Once reversible dementias are excluded, efforts turn to treatment of symptoms in patients with neurodegenerative disease. Alzheimer’s disease is a type of neurodegenerative disease that is characterized by a slow onset of short term memory loss and that progresses to involve other cognitive declines. Frontotemporal dementia is a separate type of neurodegenerative disease that is characterized as early personality changes that progress to involve memory, and Lewy body dementia often presents with movement abnormalities and visual disturbances.  Prescription medications are used in the treatment of memory loss in patients with Alzheimer’s-type dementia, and nutritional and holistic treatments are often included in the ongoing treatment of patients with neurodegenerative diseases. Clinical research studies are in progress at the Pacific Neuroscience Institute that focus on the underlying protein abnormalities that underlie these neurodegenerative conditions, directly treat the brain circuits involved with memory loss, and target the general loss of cortical brain function with medical treatments.