My own research into many sites, information is pieced together
Dementia is a group of symptoms involving progressive impairment of all aspects of brain function. Disorders that cause dementia are usually disorders that impair the vascular (blood vessel) or neurologic structures of the brain (organic brain syndrome). A few causes of dementia are treatable. Treatable causes include normal pressure hydrocephalus, brain tumors, and dementia due to metabolic causes. However, many of the disorders associated with dementia are progressive, irreversible, degenerative conditions.
Dementia may be diagnosed when there is impairment of two or more brain functions, including language, memory, visual-spatial perception, emotional behavior or personality, and cognitive skills (such as calculation, abstraction, or judgment). Dementia usually appears first as forgetfulness. Other symptoms may be apparent only on neurologic examination or cognitive testing. Loss of functioning progresses slowly from decreased problem solving and language skills, to difficulty with ordinary daily activities, to severe memory loss and complete disorientation with withdrawal from social interaction.
Progressive loss of memory
Inability to concentrate
Decrease in problem solving skills and judgment capability
Fluctuating mental status, hyperactive to limited alertness
Altered sensation or perception
Impaired recognition (agnosia)
Altered sleep patterns
Need for increased sleep
Disturbance or change of sleep-wake cycle
Motor system impairment
Impaired skilled motor function (apraxia)
Person, place, time
Inability to interpret environmental cues
Specific disorders of problem solving or learning
Inability to generalize
Loss of abstract thinking
Impaired calculating ability
Inability to learn
Absent or impaired language ability (aphasia)
Inability to comprehend speech
Inability to read (alexia)
Inability to write (agraphia)
Inability to speak, without muscle paralysis
Inability to form words
Inability to name objects (anomia)
Inappropriate speech, use of jargon or wrong words
Inability to repeat a phrase
Persistent repetition of phrases
Poor temper control
No observable mood (flat affect)
Inappropriate mood or behavior
Withdrawal from social interaction
Inability to function or interact in social or personal situations
Inability to maintain employment
Decreased ability to care for oneself
Decreased interest in daily living activities
The goal of treatment is to control the symptoms of dementia. Treatment varies with the specific disorder. Hospitalization may be required for a short time. The underlying causes should be identified and treated, including treatment for reversible organic lesions (such as tumors).
Stopping or changing medications that worsen confusion, or that are not essential to the care of the person, may improve cognitive function. Medications that contribute to confusion include anticholinergics, analgesics, cimetidine, central nervous system depressants, lidocaine, and other medications.
Disorders that contribute to confusion should be treated. These include heart failure, decreased oxygen (hypoxia), thyroid disorders, anemia, nutritional disorders, infections, and psychiatric conditions such as depression. Correction of coexisting medical and psychiatric disorders often greatly improves mental functioning.
Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person or to others. These are usually given in very low doses, with adjustment as required.
Medications that may be considered for use include:Anti-psychotics, given at night
Beta blockers if dementia is related to central nervous system lesions
Serotonin-affecting drugs (lithium, trazodone, buspirone, clonazepam)
Dopamine blockers (such as haloperidol)
Carbamazepine, particularly in senile dementia, Alzheimer's type
Fluoxetine, imipramine, may help to stabilize mood
Cerebral vasodilators (variable results reported)
Stimulant drugs (such as methylphenidate), may improve mood
Ergotoxine alkaloids, may improve mood and self care without altering cognitive function
The provision of a safe environment, control of aggressive or agitated behavior, and the ability to meet physiologic needs may require monitoring and assistance in the home or in an institutionalized setting. This may include in-home care, boarding homes, adult day care, or convalescent homes.
In any care setting, there should be familiar objects and people. Lights that are left on at night may reduce disorientation. The schedule of activities should be simple. Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.
The outcome varies. Acute disorders that cause delirium may coexist with chronic disorders causing dementia. Chronic brain syndromes are often progressive and usually result in decreased quality of life and decreased life span.