Dementia is a general term for problems with memory, thinking and social functioning that are serious enough to interfere with daily life. Many different diseases can cause dementia. Although dementia mostly affects older adults, it is not a normal part of aging. It can deeply affect every part of a person’s life, and the lives of the people who care for them.
How Common Is Dementia?
Dementia is very common. Alzheimer’s disease is the most common cause, accounting for a majority of cases. The risk rises sharply with age, and Alzheimer’s affects roughly 1 in 9 people over age 65 (1). As the population ages, the number of people living with dementia worldwide is expected to keep rising dramatically. Alzheimer’s disease and other dementias cost the U.S. healthcare system hundreds of billions of dollars each year, not counting the billions of hours of unpaid care provided by family and friends (2).
What Are the Symptoms of Dementia?
Dementia can cause many different symptoms, depending on its cause. The most common symptoms involve thinking and emotions.
Thinking symptoms include memory loss, which is often noticed first by a spouse or close family member. People may have trouble finding words or expressing their thoughts.
Problem solving, reasoning, attention and focus can all be affected, and it can become hard to complete tasks. People may have trouble finding their way, and can get lost or disoriented, even while driving.
Planning and organization can become difficult, and coordination and movement may be affected. Balance can also worsen, and the risk of falls increases as dementia progresses.
Emotional and behavioral symptoms can include depression, anxiety and agitation. Personality changes can lead to socially inappropriate behavior, paranoia and hallucinations. Confusion and disorientation become more common as dementia progresses (3).
If someone has sudden confusion, a sudden change in alertness, or new weakness or trouble speaking, seek medical care right away. These can be signs of a stroke, infection or other urgent problem rather than dementia.
What Causes Dementia?
Most dementias are caused by neurodegeneration, the gradual damage and death of nerve cells and their connections in the brain. Symptoms depend on which areas of the brain are affected.
Most dementias likely involve several contributing factors. Genetics can play a role, and diet, lifestyle, exercise, sleep, head injury and other factors may contribute as well.
Alzheimer’s disease. Alzheimer’s is the most common form of dementia. It is a protein buildup disorder. A protein called beta-amyloid clumps together into plaques between nerve cells, and a protein called tau forms tangles inside nerve cells. Over time, these plaques and tangles damage nerve cells and cause them to die (4).
Vascular dementia. Vascular dementia results from damage to the blood vessels that supply the brain. This can cause a series of small strokes or damage to the brain’s white matter, leading to shrinkage in the affected areas. It often causes trouble with planning, organization, concentration and problem solving (5).
Lewy body dementia. This is another protein buildup disorder, related to Parkinson’s disease. It involves a protein called alpha-synuclein, which clumps into Lewy bodies. It can cause problems with attention and focus, visual hallucinations, and movement symptoms like tremor, slow movement, shuffling walk and stiffness (6).
Frontotemporal dementia. This involves the breakdown of nerve cells in the frontal and temporal lobes. It can cause personality changes, trouble controlling behavior, poor judgment and reasoning, difficulty speaking or understanding language, and memory problems (7).
Mixed dementia. Many people have more than one cause of dementia at the same time.
What Are the Risk Factors for Dementia?
Many factors raise the risk of dementia. The risk increases with age, especially after 65, but not everyone develops dementia as they age. A family history also raises the risk, though many people with a family history never develop dementia, and many people without one do.
Lack of exercise, a poor diet, heavy alcohol use, high blood pressure, high cholesterol and obesity all raise the risk. Diabetes and sleep problems are also major risk factors later in life (8).
How Is Dementia Diagnosed?
Dementia is diagnosed by a physician, often with help from specialists. It can be hard to diagnose early, and it is often not diagnosed until later in its course. No single test can diagnose dementia, and input from family members is often needed to get an accurate picture.
Warning signs of Alzheimer’s disease include memory loss, difficulty with familiar tasks, problems with language, confusion about time and place, poor judgment, trouble with abstract thinking, misplacing things, changes in mood or behavior, personality changes and loss of initiative (9).
Cognitive and neuropsychological tests can measure memory, reasoning, judgment, orientation, language and attention. A neurological exam can show problems with sensation, movement, coordination, balance, walking and vision.
Brain imaging such as MRI and CT can show signs of blood vessel damage and rule out other causes of symptoms, such as a tumor or fluid buildup in the brain. PET scans can show protein buildup and patterns of reduced brain activity (10).
How Is Dementia Usually Treated?
Medications are a main part of dementia care. Some act on brain chemicals, such as acetylcholine, to help with memory, or glutamate. Other medications may be used for agitation, depression or sleep problems (11). For people in the early stages of Alzheimer’s disease, newer medications that target amyloid may modestly slow decline. Most medications help with symptoms or slow decline for a limited time rather than stopping the disease.
Speech and occupational therapy are also commonly used to help manage symptoms and create safe home environments.
How the NeuroRescue Program Can Help
We cannot cure dementia or stop its progression. Our goal is to support thinking, balance, safety and daily function, and to help address factors that may be contributing to decline. Our care works alongside your physicians, never in place of them. Please don’t change any medication without talking with the prescriber.
Lifestyle. Research supports a number of healthy lifestyle changes for brain health. Exercise can improve sleep, and sleep is when the brain clears out waste products through a system called the glymphatic system. One study by Shih and colleagues found that people with Alzheimer’s who walked more slept better, and that those who walked with family members slept better than those who walked with others (12).
Diet may also help. Research generally supports eating patterns that limit inflammation and blood sugar spikes, such as Mediterranean-style diets. Some research, mostly in animals, suggests that intermittent fasting may support cell repair and the cell’s cleanup process, called autophagy (13). Because weight loss can be a concern for people with dementia, any major diet change should be discussed with your physician.
Eye movements. Alzheimer’s disease affects eye movements, especially saccades, the quick jumps the eyes make from one target to another. In an anti-saccade, a person must look away from a new target instead of toward it.
Saccades are generated in part by an area of the frontal lobe called the frontal eye fields. When neurodegeneration affects the frontal lobe, it can affect both saccades and many thinking skills that rely on frontal lobe pathways.
Anti-saccades depend on the dorsolateral prefrontal cortex, which is involved in many executive functions, including staying focused. Anti-saccades require holding back the urge to look at the target and choosing to look the other way. This area also helps regulate emotions.
Research shows that people with Alzheimer’s disease are less accurate on anti-saccade tests than people without it, and similar findings are seen in mild cognitive impairment. People with Alzheimer’s also have slower reaction times and take longer to start saccades and anti-saccades (14).
Memory saccades test working memory. A series of dots appears and disappears in random positions while the person looks at each one, then the person must recall where a particular dot appeared. Studies show that people with frontotemporal dementia have more difficulty with anti-saccades and memory saccades, which both require higher-level thinking (15).
When dementia affects the back of the brain, eye movement problems can be even more pronounced. In one study, people with posterior cortical atrophy made shorter saccades, especially to distant targets, and the time needed to reach targets was linked to damage in the parietal and occipital lobes. People with typical Alzheimer’s disease and posterior cortical atrophy also showed more unwanted eye movements when trying to hold their gaze steady, and both groups had more difficulty following moving targets smoothly (16).
We use targeted exercises aimed at improving the speed and accuracy of saccades, anti-saccades and related eye movements. One study found that training saccades and anti-saccades was linked to improvements in executive function and attention control (17).
Light therapy. Small studies have found that LED light therapy was linked to improvements in thinking, sleep, anxiety, angry outbursts and wandering in people with Alzheimer’s disease (18), and to improvements in executive function and sense of smell (19). Research on laser light therapy, much of it in animals, suggests it may reduce brain inflammation, improve blood flow and support nerve cell health (20).
Cognitive training. We use computerized cognitive training to exercise attention, memory and other thinking skills. A 2017 review of studies in older adults found that computerized cognitive training led to moderate improvements in overall thinking skills in people with mild cognitive impairment, though the benefits were less clear for people who already had dementia (21).
Transcranial magnetic stimulation. TMS has been studied for improving thinking and executive function in dementia (22), and it is an established treatment for depression (23). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it’s appropriate for you.
Balance and vestibular rehabilitation. Falls are always a concern with dementia. Studies have found reduced inner ear balance function in people with dementia, which suggests that vestibular rehabilitation may help reduce fall risk and supports a link between vestibular problems and cognitive decline (24).
Virtual reality. Studies suggest that exercises in a virtual reality environment may help improve navigation and orientation in people with spatial memory problems (25).
Metabolic factors. When appropriate, we look at metabolic and nutritional factors such as inflammation, blood sugar and nutrient levels. Some research suggests that addressing these factors may help support thinking in some people (26).
Recovery between sessions. Some programs include mild hyperbaric therapy as a structured recovery option between more demanding therapy sessions.
Every NeuroRescue Program is different, with therapies chosen based on testing and your specific situation.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline, and we welcome family members or caregivers to join and share what they’ve noticed. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at supporting function and endurance in the systems that need it. Our testing also helps us decide when to push and when to let you rest.
We can’t bring back nerve cells that have been lost. What we can do is work with the pathways that remain, helping them work as efficiently as possible and work better together. Our goal is to help you stay as active, safe and independent as possible, for as long as possible.
Your Next Step
Living with any form of dementia is challenging. While we cannot cure dementia, many symptoms can be managed, and function and quality of life can often be supported. To find out if the NeuroRescue Program is right for you or your loved one, contact one of our patient care coordinators to schedule a Discovery Day.
