Dementia and Alzheimer's

Dementia results from damage to brain cells that affects how they communicate. Depending on which areas of the brain are affected, people may experience changes in memory, attention, planning, language, perception, mood or personality.

The main types include:

• Alzheimer's disease: the most common cause, typically starting with memory problems for recent events.
• Vascular dementia: caused by reduced blood flow to the brain, often after strokes or small vessel disease.
• Lewy body dementia: may involve fluctuating alertness, visual hallucinations, sleep disturbances and movement changes.
• Frontotemporal dementia: often begins earlier in life and can first affect behavior, personality or language.
• Mixed dementia: a combination, such as Alzheimer's and vascular changes.

Mild cognitive impairment (MCI) describes noticeable changes in memory or thinking that are greater than expected for age but don't significantly interfere with daily independence. MCI doesn't always progress to dementia, but it's a reason for monitoring and a healthy lifestyle.

Early signs of dementia can be subtle and vary by type. They may include:

• Memory loss that disrupts daily life, such as repeatedly asking the same questions or forgetting recent conversations
• Difficulty planning, solving problems or managing finances
• Trouble completing familiar tasks, like following a recipe or driving a known route
• Confusion about time or place
• Problems finding words or following conversations
• Misplacing things and being unable to retrace steps
• Poorer judgment, for example with money or safety
• Withdrawing from work or social activities
• Changes in mood or personality, such as apathy, anxiety, irritability or suspicion

Normal aging can bring occasional forgetfulness, like misplacing keys or briefly forgetting a name, but people usually remember later and remain independent. If changes are persistent, getting worse or noticed by others, it's worth seeing a doctor.

Age is the strongest risk factor, but dementia is not inevitable. Other risk factors include family history, high blood pressure, diabetes, smoking, physical inactivity, hearing loss, social isolation, depression and heavy alcohol use. Some of these are modifiable, which is why heart-healthy habits and staying socially and mentally active are often recommended.

Several conditions can cause memory and thinking problems that look like dementia but can be treated:

• Depression, which can affect concentration and memory, particularly in older adults
• Vitamin deficiencies or thyroid problems
• Medication side effects or interactions
• Infections, which can cause sudden confusion (delirium), especially in older people
• Sleep disorders
• Excessive alcohol use

Sudden confusion is a medical emergency and needs urgent assessment. This is one important reason why memory concerns should always be checked by a doctor rather than assumed to be dementia.

Dementia stages are often described as early (mild), middle (moderate) and late (severe):

• Early: memory lapses, difficulty with complex tasks, but largely independent.
• Middle: increasing confusion, needing help with daily activities, possible behavior changes such as agitation or wandering.
• Late: significant assistance needed with personal care, communication and mobility.

Progression varies widely between people and types of dementia.

There is no single dementia test. Diagnosis usually involves a primary care doctor and often specialists such as neurologists, geriatric psychiatrists or neuropsychologists. Assessment may include a medical history, cognitive screening questionnaires, physical examination, blood tests, brain imaging and detailed neuropsychological testing. Input from family members is very valuable. Online quizzes can't diagnose dementia, but they may help someone decide to seek an assessment.

Although most types of dementia can't currently be cured, treatment and support can make a real difference to quality of life:

• Medications: doctors may prescribe medicines to help with symptoms of some types of dementia or to address mood, sleep or behavioral symptoms. Newer treatments for early Alzheimer's are available in some places for selected patients and require specialist evaluation.
• Cognitive stimulation and rehabilitation: structured activities to maintain thinking skills and independence.
• Psychological support: therapy can help people adjust to the diagnosis and manage anxiety or depression. A psychologist or neuropsychologist can also help families understand changes.
• Practical support: occupational therapy, home adaptations and routines that reduce confusion.
• Planning ahead: legal and financial planning while the person can participate in decisions.

Carers often face significant stress. Caregiver support groups, respite care and counseling are important parts of dementia care, and seeking help is not a sign of failing.

See a doctor if you or someone close to you notices persistent memory or thinking changes that affect daily life, or if family and friends are concerned. Early assessment can identify treatable causes, allow access to treatment and support, and give time to plan.

Seek urgent medical help if confusion comes on suddenly, or if there are signs of stroke such as facial drooping, arm weakness or slurred speech; call 911 in the US or your local emergency number.

If a person with dementia or a caregiver feels hopeless or has thoughts of suicide, reach out right away: call or text 988 in the US, call Samaritans at 116 123 in the UK and Ireland, or call your local emergency number.