Dementia is a term used to describe intellectual decline due to brain dysfunction. Dementia is associated with changes in memory, language and other cognitive functions, in addition to changes in personality or behavior. This intellectual decline results in some loss of personal autonomy and independence. Patients may require supervision or assistance when performing daily activities such as managing medications, finances or work-related tasks.The causes of dementia are many; some are reversible, and others are progressive. The most common and well-understood cause of dementia is Alzheimer's disease. Other causes include stroke, Parkinson's disease and multiple sclerosis, as well as conditions such as vitamin B-12 deficiency and hypothyroidism.
Not all dementias can be diagnosed definitively, especially early on. Alzheimer's disease, for example, has no available diagnostic test. The course and mental and physical manifestations of different dementing diseases can vary dramatically.In most cases, an experienced neurologist makes the diagnosis based upon supportive evidence. The diagnosis of dementia, therefore, requires comprehensive interviews with patient and caregiver, neurological and mental status examinations, and depending on the findings, additional studies to help narrow down the possible causes. These studies may include brain imaging with MRI or CT scan, blood tests, brainwave assessment with EEG and spinal fluid analysis.
The goal of treatment is to improve or maintain good quality of life for the patient. The patient may be treated with specific medications to minimize symptoms over the course of an illness, including both cognitive and behavioral symptoms (e.g., depression or agitation). Personal safety issues, such as the organization of medications and finances, driving and fire hazards, should be addressed. Preparation for future loss of independent decision-making, including establishing power of attorney and health care proxy, should also be addressed.A multidisciplinary approach is most effective in addressing these and many other concerns. A team - including the primary physician, specialist (e.g., neurologist or psychiatrist), social worker, nurse and caregiver - working together, is most effective.
The Center for Cognitive Disorders is a multidisciplinary clinic devoted to the diagnosis and treatment of Alzheimer's disease and memory loss. Through collaboration, the Departments of Neurology, Geriatrics, Neuropsychology and Social Work treat patients, conduct research on cognitive disorders and train Lahey Hospital & Medical Center residents and medical students.Our behavioral neurology group includes Yuval Zabar, MD, and neuropsychologists Caitlin E. Macaulay, PhD, and Dana Penney, PhD.