Dementia: Your GoodRx Guide

Definition

Dementia is a general term that includes a group of similar conditions that affect the brain. These conditions tend to start in older age and affect someone’s memory, problem-solving skills, and ability to care for themselves. Alzheimer’s disease is the most well-known type of dementia, but it’s not the only type.  

All types of dementia affect brain function (cognition). This can lead to troubles with:

• Memory: People with dementia tend to be forgetful about recent events or conversations. As the condition progresses, they have trouble remembering how to do basic tasks or recognizing people and loved ones. 

• Activities of daily living (ADL): People with dementia may find it increasingly difficult to perform daily tasks or stay organized. They may miss important appointments or have trouble managing their finances. This progresses to trouble with more basic tasks like bathing and dressing.  

• Social interactions: Dementia also affects someone’s experience in social settings. This may lead to social withdrawal and isolation. This often goes in hand with significant personality changes and emotional reactions to events and people. 

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Types of dementia

There are several different types of dementia. And they all have slightly different causes and symptoms. The main types include:

• Alzheimer’s disease: Alzheimer’s is the most common type of dementia. It accounts for around 70% of all cases. The cause is related to abnormal protein deposits and tangles in nerve fibers in the brain.

• Lewy body dementia: This type of dementia is also caused by abnormal protein deposits in the brain called “Lewy bodies.” It often leads to hallucinations, sleep disturbance, and delirium-type symptoms.

• Parkinson’s dementia: Parkinson’s disease affects movement in its earlier stages. But in the later stages, it can also cause dementia. People with Parkinson’s also develop Lewy bodies in their brain, so this type of dementia looks similar to Lewy body dementia.

• Vascular dementia: This type of dementia occurs in those who have had a stroke or other cerebrovascular disease of the brain. 

• Frontotemporal lobar dementia: The cause of this is atrophy of the frontal and temporal lobes. It’s known for causing odd behaviors and personality changes. 

Dementia can be the result of brain injury from other conditions, such as:

• Traumatic brain injury (TBI)

• Huntington’s disease

• Prion disease

• Infections, such as HIV and syphilis

• Drug and alcohol use

Someone can also have more than one type of dementia at the same time. This is sometimes referred to as “mixed dementia.” 

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Risk factors

The causes of dementia vary between the different types. But there are some common factors that increase someone’s risk for developing any type of dementia:

• Age: Age over 65 is the single biggest risk factor for dementia. But dementia can happen in people younger than 65 — this is called “early-onset dementia.” 

• Sex: Parkinson’s dementia is more likely in males, and Alzheimer’s occurs at an increased rate in females.  

• Race: Black and Hispanic people have a higher risk for Alzheimer’s.

• Genetics: Some types of dementia are linked to certain genes. For example, several different genes increase the risk for Alzheimer’s. And someone inherits Huntington’s disease directly from their parents. 

• Cerebrovascular disease: Anything that affects blood flow in the brain can lead to increased dementia risk, like diabetes, high cholesterol, or high blood pressure.

• Mental health: Psychiatric disease, including depression, has been linked to increased risk for dementia. 

• Substance use: Alcohol and tobacco use have both been linked to increased dementia risk. Drug use can also do harm to brain tissue, leading to increased risk for dementia. 

• Social factors: Things such as socioeconomic status, education, social connectivity, and even air pollution have all been linked to higher community rates of dementia.  

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Symptoms

Dementia can be difficult to detect in its early stage. It starts with minor symptoms that become more obvious as time goes by. Some common signs are:

• Forgetfulness: Most people experience a degree of forgetfulness as they age, and this can be normal. But with dementia, this forgetfulness will steadily worsen as the disease progresses. 

• Disorientation: People with dementia may begin to have more trouble with directions and orientation, including when driving. In later stages, people with dementia may not recognize familiar surroundings, including their own home. 

• Self-care: People with dementia may forget to bathe or groom themselves on a regular basis. They may develop trouble using buttons, shoelaces, and zippers. 

• Executive dysfunction: Dementia may affect the higher brain functions, leading to trouble with more complex tasks. This may include activities such as planning, organizing, and decision-making. 

• Behavior changes: Dementia can cause someone to act in unexpected ways.Their personality may seem different. Sometimes they may be more or less emotional. Social settings can be more stressful for someone with dementia, so they may become more withdrawn and isolated. 

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Diagnosis

There’s no single test that can diagnose dementia. And it usually takes some time. This is because the timing and evolution of someone’s symptoms helps make the diagnosis. In the meantime, providers usually perform different tests to rule out other causes. 

Healthcare providers consider the following things when diagnosing dementia: 

• Personal and caregiver input: Your provider will want to hear about when the symptoms started and get feedback from someone else who has seen the changes.  

• Family history: Sharing any family history is important, as this can factor into your genetic risk for dementia. 

• Neurological evaluation: This may include a thorough physical exam and certain cognitive tests to assess brain health.  

• Blood tests: Your provider may order certain blood tests to rule out other causes of the symptoms. But there’s not a blood test that can diagnose dementia. 

• Radiology testing: To rule out other causes, your provider may order imaging of the brain, such as an MRI or CT scan. 

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Treatments

There are only a few medications for dementia. These are mostly used for Alzheiemer’s, but they’re sometimes used in other types of dementia. Medications include:

1. Cholinesterase inhibitors: These are the most prescribed class of dementia medications. They work by increasing levels of acetylcholine in the brain, which is a chemical that helps brain cells communicate with each other. Examples include donepezil (Aricept, Adlarity), rivastigmine (Exelon), and galantamine (Razadyne ER).

2. NMDA receptor antagonists: This medication blocks overstimulation of the NMDA receptor in the brain. It has modest benefits in more advanced stages of dementia. Memantine (Namenda, Namenda XR) is the only one in this class.

3. Monoclonal antibodies: These newer medications are designed to reduce amyloid plaque in the brain. Because they target the underlying cause of some dementias, they may have a role in curing or preventing the condition. Aducanumab (Aduhelm) is currently the only FDA-approved option in this class.

Some medications may also be used to treat the symptoms of dementia, though they’re not targeted at the disease itself. For example, antidepressants can target mood symptoms associated with dementia. 

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Prevention

Dementia is not always preventable. But there are some things you can do to lower dementia risk. The World Health Organization (WHO) recommends some lifestyle changes that could make a difference: 

• Follow a healthy diet — like the Mediterranean diet. 

• Exercise on a regular basis.

• Maintain a weight that is healthy for your body. 

• Avoid tobacco use, or quit smoking if you do use tobacco.

• Limit alcohol use. 

To protect blood flow in the brain, it’s also very important to keep your arteries healthy. This means maintaining healthy blood pressure, cholesterol, and blood sugar levels. This in turn leads to less development of plaque and other vascular changes that can compromise blood flow to the brain.   

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