Version May 2024
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DEMENTIA OVERVIEW — "Dementia" is a general term for when a person has developed difficulties with reasoning, judgment, and memory. People who have dementia usually have some memory loss as well as difficulty in at least one other area, such as:
●Speaking or writing coherently (or understanding what is said or written)
●Recognizing familiar surroundings
●Planning and carrying out complex or multi-step tasks
In order to be considered dementia these issues must be severe enough to interfere with a person's independence and daily activities.
Dementia can be caused by several diseases that affect the brain. The most common cause is Alzheimer disease. Alzheimer disease is present in approximately 60 to 80 percent of all cases of dementia; other degenerative and/or vascular diseases may be present as well, particularly as a person gets older. (See 'Mixed dementia' below.)
This article will discuss the main causes of dementia, focusing primarily on Alzheimer disease. It will also review the most common treatments and self-care strategies that can help people with dementia. It can be difficult and stressful living with dementia, or caring with someone who is. However, there are things you can do to make life more manageable, and resources for support are available.
CAUSES OF DEMENTIA — Dementia can be caused by several different brain disorders. These include:
Alzheimer disease — Alzheimer disease is the most common cause of dementia. Scientists have not yet determined exactly why or how it develops. However, they do know that Alzheimer disease produces specific changes in the brain. These changes include deposits (plaques) of a protein called "beta amyloid," loss of nerve cells (neurons) in important parts of the brain, and disorganized masses of protein fibers within the brain cells (these are known as "neurofibrillary tangles").
Vascular dementia — People with vascular dementia have damage to parts of the brain due to reduced blood flow. This can happen when the blood vessels in the brain get clogged with blood clots or fatty deposits. This form of dementia is more common among people who have had strokes or are at risk for strokes, especially those with longstanding high blood pressure and diabetes. It can occur together with Alzheimer disease.
Dementia with Lewy bodies — Dementia with Lewy bodies is a form of dementia caused by abnormal protein structures ("Lewy bodies") that form within brain cells. It causes symptoms characteristic of Parkinson disease, such as trembling, stiffness, and difficulty moving normally. This disorder also often causes hallucinations, which can be vivid and realistic.
Dementia with Lewy bodies can also cause people to act out their dreams during sleep. This can be frightening for partners and can lead to injury. This symptom, called "REM sleep behavior disorder," should be discussed with a health care provider, as it is treatable with medication.
Parkinson disease dementia — Dementia can also occur later in the course of Parkinson disease and has symptoms that are very similar to dementia with Lewy bodies. (See "Patient education: Parkinson disease symptoms and diagnosis (Beyond the Basics)".)
Frontotemporal dementia — Like Alzheimer disease, frontotemporal dementia (FTD) causes nerve cell loss in the brain, and also like Alzheimer disease, there are deposits of abnormal brain proteins but not beta-amyloid. FTD includes at least three different protein abnormalities that affect specific parts of the brain, primarily the frontal and temporal lobes. This type of dementia used to be called "Pick disease."
There are different types of FTD. When the nerve cell loss is primarily in the frontal lobes, personality changes and inappropriate social behaviors are common; this is often called "behavioral variant FTD." When the nerve cell loss is primarily in the temporal lobes, the most prominent symptoms involve using and understanding language in both speech and writing; this form of FTD is often called "primary progressive aphasia."
FTD usually arises at an earlier age than Alzheimer disease and is much less common than Alzheimer disease.
Mixed dementia — Among people at more advanced age (80 and older), there can be more than one cause of dementia, often both Alzheimer disease and vascular damage.
Other causes of dementia — Dementia can also be caused by cumulative damage to the brain over time. This can happen in people with chronic alcoholism or repeated head injuries (eg, from professional sports). Reports of dementia among professional football players who suffered multiple concussions led to the discovery of a condition now called "chronic traumatic encephalopathy" (CTE) that includes psychiatric and behavioral problems as well as cognitive impairment. Most patients with CTE will have other contributing disorders such as Alzheimer disease.
DEMENTIA RISK FACTORS — There is no way to predict with certainty who will develop dementia. Each form of dementia has its own risk factors, but most forms have several risk factors in common.
Age — The biggest risk factor for dementia is age: dementia is rare in people younger than 60 years and becomes very common in people older than 80. For example, dementia affects approximately one in six people between 80 and 85 years old, one in three above 85 years, and almost half of people over age 90.
Family history — Some forms of dementia have a genetic component, meaning that they tend to run in families. Having a close family member with Alzheimer disease increases your chances of developing it. People with a first-degree relative (parent or sibling) with Alzheimer disease have a greater chance of developing the disorder. The risk is probably highest if the family member developed Alzheimer disease at a younger age (less than 70 years old) and is lower if the family member did not get Alzheimer disease until late in life. However, families that have a very strong genetic tendency toward Alzheimer disease are uncommon.
Scientists have discovered a particular gene, called APOE epsilon 4, that increases a person's risk of developing Alzheimer disease. But even among individuals with this gene, only approximately one-half develop Alzheimer disease by age 90, suggesting that other factors are also involved. Testing for this gene is not currently recommended unless you are involved in a research study. For more information on ongoing clinical trials related to Alzheimer disease, visit the National Institute on Aging at https://www.alzheimers.gov/clinical-trials.
Other factors — Studies indicate that high blood pressure, smoking, and diabetes may be risk factors for dementia. Experts are still not sure how treatment for these problems might influence your risk of developing dementia beyond their benefit of reducing stroke risk.
Lifestyle factors have also been implicated in dementia. For instance, people who remain physically active, socially connected, and mentally engaged seem less likely to develop dementia than people who do not. These activities may produce more cognitive (mental) reserve or resilience, delaying the emergence of symptoms until an older age.
DEMENTIA SYMPTOMS — Each form of dementia can cause difficulty with memory, language, reasoning, and judgment, but the symptoms are often very different from person to person. Symptoms also change over time.
The differences between one form of dementia and another may only be recognizable to skilled health care providers who have experience working with people with dementia. Sometimes family members notice changes but mistakenly attribute them to aging.
Since Alzheimer disease is the most common cause of dementia, and the symptoms of other forms of dementia often overlap, the sections below will focus on the symptoms of Alzheimer disease.
Is memory loss normal? — Many people worry that memory problems are related to early Alzheimer disease. However, some problems are normal and just related to aging, and do not signify a progressive dementia. Normal age-related changes often cause minor difficulties with immediate memory, for example, remembering a phone number or a set of directions for a short time. Temporary difficulty recalling proper names, even very familiar ones, is also common with aging. As people age normally, it is common to complain of less efficient and slower processing and learning of new information. Memory changes due to normal aging are usually mild and do not worsen greatly over time, nor should they interfere with a person's day-to-day functioning.
When symptoms of memory difficulty are associated with minor functional effects at work or home, and a person shows mild impairments on specific memory tests, this is referred to as mild cognitive impairment (MCI). Because MCI may progress to dementia over time, people with this condition should have a more careful assessment and closer monitoring for signs of a decline in their ability to function. Some people with MCI may have a transient or treatable disorder that remains unchanged for long periods, has a fluctuating course, or actually improves over time, all depending on the specific cause.
Early changes — The earliest symptoms of Alzheimer disease are gradual and often subtle. Many people and their families first notice difficulty recalling recent events or information. This often emerges as a tendency to repeat stories or questions or to request or require repetition of material to be able to remember. If you find yourself telling an older family member or friend "I told you that earlier" or "You have told me that more than once," you might begin to suspect Alzheimer disease. Other changes can include one or more of the following:
●Difficulties with language (eg, not being able to find the right words for things)
●Difficulty with concentration and reasoning
●Problems with complex tasks like paying bills, cooking, or balancing a checkbook
●Getting lost in a familiar place
Late changes — As Alzheimer disease progresses, a person's ability to think clearly continues to decline, and any or all of the changes listed above may be more disruptive. In addition, personality and behavioral symptoms can become quite troublesome. These can include:
●Increased anger or hostility, sometimes aggressive behavior; alternatively, some people become depressed or exhibit little interest in their surroundings (called "apathy")
●Sleep problems
●Hallucinations and/or delusions
●Disorientation
●Needing help with basic tasks (such as eating, bathing, and dressing)
●Incontinence (difficulty controlling the bladder and/or bowels)
The number of symptoms, the functions that are impaired, and the speed with which symptoms progress can vary widely from one person to the next. In some people, severe dementia occurs within five years of the diagnosis; for others, the progression can take more than 10 years. Most people with Alzheimer disease do not die from the disease itself, but rather from a secondary illness such as pneumonia, bladder infection, or complications of a fall.
Over time, people with dementia have trouble doing their regular daily activities, which can lead to safety issues. (See 'Safety and lifestyle issues for people with dementia' below.)
DEMENTIA DIAGNOSIS — To diagnose dementia and identify the type of dementia, health care providers typically rely on the information they can gather by interacting with the person and speaking with their family members. The provider will typically perform memory and other cognitive (thinking) tests to assess the person's degree of difficulty with different types of problems. The results of these tests can then be monitored over time to observe whether functioning stays the same or declines.
Blood tests are usually done to find out if a chemical or hormonal imbalance or vitamin deficiency is contributing to the person's difficulties. Brain scans (usually magnetic resonance imaging [MRI]) are often performed in people with dementia to look for other problems. Sometimes the MRI can also help health care providers identify the type of dementia, since different types can have characteristic brain changes. A lumbar puncture (also called a "spinal tap") is less commonly done to help identify the type of dementia. A positron emission tomography (PET) scan (another form of brain scan) can show the abnormal protein deposits seen in some people who have Alzheimer disease. This test has been more commonly performed in research studies but may also be used to confirm Alzheimer disease before newer medications are prescribed.
SAFETY AND LIFESTYLE ISSUES FOR PEOPLE WITH DEMENTIA — A major issue for caregivers is making sure the person with dementia stays safe. Because many people with dementia do not realize that their mental functioning is impaired, they try to continue their day-to-day activities as usual. This can lead to physical danger, and caregivers must help to avoid situations that can threaten the safety of the person or others.
The following information applies specifically to people with Alzheimer disease, but much of it is also relevant to people with other forms of dementia.
Medications — People with Alzheimer disease often have trouble remembering to take medications they are prescribed for other conditions, or they become confused about which medications to take. They are also at increased risk for potentially dangerous side effects from certain medications. Sedatives and certain other drugs (such as some antihistamines and antidepressants) may carry risk of increasing cognitive impairment. It is important to develop a plan for medication monitoring and safety. People with dementia often need help taking their medications. It's a good idea to throw away old pill bottles and other medications that are no longer needed.
Driving — Driving is often one of the first safety issues that arises in people with Alzheimer disease. In people with Alzheimer disease, the risk of having a car accident is significantly increased, especially as the disease progresses. It is best to discuss the issue of driving early, before the symptoms become advanced. Over time, everyone living long enough with dementia will reach a point where driving is too dangerous.
Losing the ability to drive can be hard to accept because it represents independence for many people. It can also be challenging if the person does not completely appreciate their impairments in mental functioning or reaction time. In particular, driving at night may carry extra risk. Many people with mild but worrisome impairments will insist that they can safely drive locally or in the daytime. That may be true for the present time; however, people may forget that they have agreed to limitations. In addition, their ability to drive safely, even with restrictions, will deteriorate over time.
A roadside driving test is often recommended if there is disagreement or uncertainty about a person's ability to drive. However, if a person with newly diagnosed, mild Alzheimer disease is deemed still able to drive, they will need to be reassessed every six months, with the understanding that driving will eventually no longer be possible. There may be important insurance implications of continued driving when medical records document advice to stop driving.
Cooking — Cooking is another area that can lead to serious safety concerns and may require help or supervision. Symptoms such as distractibility, forgetfulness, and difficulty following directions can lead to burns, fires, or other injuries. The use of gas cooking appliance raises a particular concern. A family member may have to ask the utility company to disconnect gas stoves if there is potential for accident or injury. Newer induction electric stoves do not change color when on, and may carry an inadvertent burn risk if a person forgets what they are doing.
Wandering — As dementia progresses, some people with Alzheimer disease begin to wander. Because restlessness, distractibility, and memory problems are common, a person who wanders may easily become lost. Identification bracelets can help ensure that a lost wanderer gets home. The Alzheimer's Association provides a "Wandering Support" program that provides ID tags and 24-hour assistance to patients who are preregistered for this program. There are many "locator" applications that allow the person with dementia to wear or carry a GPS device that a family member can track with their cell phone.
Regular exercise may decrease the restlessness that can lead to wandering. Exercise is also just good practice to maintain strength, good sleep, and overall health. If wandering continues, wearable alarm systems are available that alert caretakers when the person leaves the home.
Falls — Falls with secondary injuries are one of the most important causes of additional disability in people with all types of dementia, including Alzheimer disease. Patients with other forms of dementia (vascular, dementia with Lewy bodies, Parkinson disease) have significant balance and gait impairments, which increase the risk of falls. Commonly used medications can increase risk of falls and injuries. Hip fracture is a particular concern in older people, as it can lead to serious complications and sometimes even death.
To reduce the risk of falls, potential tripping hazards such as loose electrical cords, slippery rugs, and clutter should be removed. Inadvertent hoarding may develop and pose a safety risk. If the person lives alone, family members or elder services should perform safety inspections of the living space periodically. Medication lists should also be reviewed with your doctor to identify those that might increase the risk of falling. Regular exercise, especially early in the course of dementia, and use of assistive devices like canes can also help with balance.
DEMENTIA TREATMENT — The treatment approach depends in part on the type of dementia a person has. People with vascular dementia should focus on getting their blood pressure and cholesterol under control to reduce the risk of further damage to the brain. People with dementia related to Parkinson disease, meanwhile, sometimes need medications used to manage their disease. (See "Patient education: Parkinson disease treatment options — medications (Beyond the Basics)".)
It's important to be certain that hearing loss and visual problems are corrected to the extent possible, as these may contribute to misunderstanding and memory problems.
Medications for Alzheimer disease — Many people with Alzheimer disease will have the option of trying a medication. A trial of medication is usually begun for a period of a few to several weeks while the person is monitored for side effects and response. A health care provider should periodically review all medications to see if they are providing any benefit.
It is important to have realistic expectations about the potential benefits of medication therapy in Alzheimer disease. None of these medications cure the disease, and the reality is that over time the person will continue to worsen. When medication does have an effect, the goal is not to stop progression of the disease, but to improve quality of life for the person and their family to the extent possible.
Treatment to slow or delay progression — There is currently no cure for Alzheimer disease. However, experts are studying treatments in the hope of finding a way to slow the progression of the mental and functional decline, along with scientific efforts to prevent or delay onset.
Memantine (brand names: Namenda, Ebixa) is a medicine that may limit or slow damage caused by Alzheimer disease. Dizziness is the most common side effect, and aggression and hallucinations may worsen in some people. It is usually used along with a cholinesterase inhibitor in patients with moderate or advanced dementia.
In 2021, after years of attempts to find medications that reduce the amyloid protein associated with Alzheimer disease, a medication called aducanumab (brand name: Aduhelm) was approved in the United States for the treatment of people with mild Alzheimer disease. It works by reducing the amount of amyloid deposits (plaques) in the brain. In some people, this might help slow the progression of disease, although it cannot reverse memory loss that has already occurred. It is given intravenously (by IV) every four weeks. Possible side effects include swelling and bleeding in the brain. This medication was controversial when it was approved by US Food and Drug Administration (FDA) because it is not clear whether and to what degree it helps with the symptoms of Alzheimer disease; it also comes with side effects, requires close monitoring, and is costly. In 2023, another medication in this class of drugs, lecanemab (brand name: Leqembi), was also approved by the FDA. And a third medication, donanemab, may be next in line for approval. While these are considered breakthrough results after years of failed trials, all three medications have only slight, "modest" beneficial effects that may not be evident to the patient, and all have downsides: They are expensive, require intensive monitoring, and have side effects including death.
There are also a number of medications that may help to control some of the symptoms of Alzheimer disease (such as memory loss and behavioral problems); these are discussed more below.
Treatment of memory problems — There are several medicines currently available for treating the memory problems associated with Alzheimer disease; they are also used in people with other forms of dementia. Three of these medications are cholinesterase inhibitors:
●Donepezil (brand name: Aricept)
●Rivastigmine (brand name: Exelon)
●Galantamine (brand name: Razadyne)
These medications allow more of a chemical called acetylcholine to be active in the brain, making up for drops in acetylcholine levels that happen in Alzheimer disease. Cholinesterase inhibitors can cause side effects such as nausea, vomiting, and diarrhea in some people. They also seem to cause weight loss in many people. In some cases, these medicines can cause a slow heart rate and even fainting spells; if you or someone you are caring for has such a spell, it's important to discuss this with a health care provider. When taken at bedtime, cholinesterase inhibitors can cause very vivid dreams.
Unfortunately, few people will experience measurable benefit. If there is no improvement in symptoms or side effects are bothersome, the medication should be stopped. Sometimes the person's symptoms will worsen after treatment is stopped; if this happens, the medication may be started again.
Treatment of behavioral symptoms — The behavioral symptoms of Alzheimer disease are often more troubling than the cognitive (mental) symptoms. Even in mild cases, agitation, anxiety, and irritability can occur, and generally worsen as Alzheimer disease advances. This can be stressful for the person as well as for their family and caregivers. A combination of medications and behavioral therapy may be helpful. Non-medication therapies are preferred, as virtually all medications used for behavioral symptoms can increase confusion and many are associated with serious side effects and even an increased risk of death.
Depression — Depression is common, especially in the early phases of dementia. It may be treated with behavioral therapy and/or with medications. The key is to recognize that depression may be playing a role in the person's symptoms. If depression is causing distress, it is worth treating. Potentially helpful medicines include a group of medicines known as selective serotonin reuptake inhibitors, or SSRIs, which are usually preferred over other choices in patients with dementia. Widely used SSRIs include fluoxetine (brand name: Prozac), sertraline (brand name: Zoloft), paroxetine (sample brand names: Brisdelle, Paxil), citalopram (brand name: Celexa), and escitalopram (brand names: Lexapro, Cipralex). (See "Patient education: Depression treatment options for adults (Beyond the Basics)".)
A variety of behavioral therapies are often helpful, do not have the side effects often seen with medications, and may be recommended for depression. Behavioral therapy involves changing the person's environment (eg, regular exercise, avoiding triggers that cause sadness, socializing with others, engaging in pleasant activities that a person enjoys). Caregiver education and coordination of ongoing care are generally among the most effective approaches to address behavioral challenges in persons living with dementia.
Agitation and aggression — One of the most difficult issues for caregivers and people with Alzheimer disease is aggressive behavior. Fortunately, this behavior is not common. However, many family members are reluctant to report aggressive behavior. In some cases, the behavior becomes physically abusive as dementia progresses.
Agitation and aggression can be caused by a number of factors, including:
●Confusion, misunderstanding, or disorientation (doctors use the term "delirium" as a general term to describe a state of confusion in which a person does not think or behave normally)
●Frightening or paranoid delusions or hallucinations
●Depression or anxiety
●Sleep disorders, such as reduced sleep or altered sleep/wake cycles
●Certain medical conditions that can cause delirium, such as urinary tract infection or pneumonia
●Being in physical pain or discomfort
●Side effects of certain medications
Delusions (ie, believing something that is not real or true) are common in patients with dementia, occurring in up to 30 percent of those with advanced disease. Paranoid delusions are particularly distressing to both the patients and the caregivers: these often include beliefs that someone has invaded the house, that family members have been replaced by impostors, that spouses have been unfaithful, or that personal possessions have been stolen. Medications used to treat delusions in psychiatric disorders are rarely useful in dementia.
Family members should discuss any concerns about aggressive behavior with a health care provider and arrange for help if necessary. The best treatment for these symptoms depends upon what triggers them. As an example, a person who becomes aggressive during periods of confusion might best be treated by talking through the problem, while someone who becomes aggressive during delusions might require medication. Often, behavior improves once an underlying medical condition is treated. Caregivers can learn strategies to help lessen the number of triggers and confrontations. (See 'For caregivers' below.)
Sleep problems — Sleep disorders can be treated with either medicine or behavior changes or both: for example, limiting daytime naps, increasing physical activity, avoiding caffeine and alcohol in the evening. In some people, medication to help with sleep may be recommended, although these medications almost always have side effects (eg, worsened confusion and increased risk of falls). Maintaining daily rhythms, using artificial lighting when needed during the day, and avoiding bright light exposures during the night may help maintain normal wake-sleep cycles.
COPING WITH DEMENTIA — Being diagnosed with any form of dementia can be distressing and overwhelming for the person affected as well as their loved ones.
For people with dementia — It is important for people with early dementia to care for their physical and mental health. This means getting regular checkups, taking medicines if needed, eating a healthy diet, exercising regularly, getting enough sleep, and avoiding activities that may be risky.
It is often helpful to talk to others through support groups or a counselor or social worker to discuss any feelings of anxiety, frustration, anger, loneliness, or depression. All of these feelings are normal, and dealing with these feelings can help you to feel more in control of your life and health. It can also help to talk to other people who are going through a similar experience.
Another issue to consider is how to tell your family and friends about your diagnosis. Explaining the disease can help others to understand what to expect and how they can help, now and in the future. This can be especially helpful for children and grandchildren, who may not be familiar with the condition.
While many people are able to live alone in the early stages of dementia, you may need help with tasks such as housekeeping, cooking, transportation, and paying bills. If possible, ask a friend or family member for help making plans to deal with these and other issues as dementia progresses. Occupational therapists, and sometimes speech pathologists, can help to set up your home to minimize confusion and keep you independent for as long as possible.
It's also important to establish Power of Attorney and Health Care Proxy statuses early, before a financial or health care crisis happens. This involves completing paperwork to determine who can make decisions on your behalf if needed.
In addition, you should discuss your preferences regarding issues that are likely to become important as your dementia worsens, including:
●Is health insurance available, and what does it cover?
●Where will I live?
●Who will make health care and end-of-life decisions if I can't make them for myself?
●Who will pay for care?
A number of resources are available to assist in this type of planning (see 'Where to get more information' below). In some communities there are support groups specifically for people with frontotemporal dementia (FTD). These may be a better fit than groups for anyone with dementia since people with FTD are often younger and may have more bothersome behavioral problems.
For caregivers — Dementia can also impose an enormous burden on families and other caregivers. People with dementia become less able to care for themselves as the condition progresses. If you are caring for someone with dementia, the following may help:
●Make a daily plan and prepare to be flexible if needed.
●Try to be patient when responding to repetitive questions, behaviors, or statements.
●Try not to argue or confront the person with dementia when they express mistaken ideas or facts. Change the subject or gently remind the person of an inaccuracy. Arguing or trying to convince a person of "the truth" is a natural reaction but it can be frustrating to all and can trigger unwanted behavior and feelings.
●Use memory aids such as writing out a list of daily activities, phone numbers, and instructions for usual tasks (ie, the telephone, microwave, etc). It may help if these are posted and easily visible so that the person need not remember to look for the aids.
●Establish calm and consistent nighttime routines to manage behavioral problems, which are often worst at night. Leave a night light on in the person's bedroom.
●Avoid major changes to the home environment (for example, rearranging furniture).
●Employ safety measures in the home, such as putting locks on medicine cabinets, keeping furniture in the same place to prevent falls, reducing clutter, removing electrical appliances from the bathroom, installing grab bars in the bathroom, and setting the water heater below 120°F.
●Help the person with personal care tasks as needed. It is not necessary to bathe every day, although a health care provider should be notified if the person develops sores in the mouth or genitals related to hygiene problems (eg, ill-fitting dentures, urine leakage).
●Speak slowly, present only one idea at a time, and be patient when waiting for responses.
●Encourage physical activity and exercise. Even a daily walk can help prevent physical decline and improve behavioral problems.
●Consider respite care. Respite care can provide a needed break and give you a chance to recharge. This is offered in many communities in the form of in-home care or adult day care. Caregiving can be an all-consuming experience, and it's essential to take time for yourself, take care of your own medical problems, and arrange for breaks when you need them.
●See if your area has a support group for people caring for loved ones with dementia. It can help to talk with other people who understand what you are going through.
WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Dementia (including Alzheimer disease) (The Basics)
Patient education: Dementia with Lewy bodies (The Basics)
Patient education: HIV-associated neurocognitive disorders (The Basics)
Patient education: Elder abuse (The Basics)
Patient education: Caring for someone with Alzheimer disease or dementia (The Basics)
Patient education: Mild cognitive impairment (The Basics)
Patient education: Evaluating memory and thinking problems (The Basics)
Patient education: Vitamin B12 deficiency and folate deficiency (The Basics)
Patient education: Creutzfeldt-Jakob disease (The Basics)
Patient education: Time to stop driving? (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Parkinson disease symptoms and diagnosis (Beyond the Basics)
Patient education: Parkinson disease treatment options — medications (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Cholinesterase inhibitors in the treatment of dementia
Clinical features and diagnosis of dementia with Lewy bodies
Diseases of the central nervous system caused by prions
Epidemiology, pathology, and pathogenesis of dementia with Lewy bodies
Etiology, clinical manifestations, and diagnosis of vascular dementia
Evaluation of cognitive impairment and dementia
Frontotemporal dementia: Clinical features and diagnosis
Mild cognitive impairment: Epidemiology, pathology, and clinical assessment
Mild cognitive impairment: Prognosis and treatment
Cognitive impairment and dementia in Parkinson disease
Prevention of dementia
Prognosis and treatment of dementia with Lewy bodies
Risk factors for cognitive decline and dementia
Management of the patient with dementia
Treatment of vascular cognitive impairment and dementia
Management of neuropsychiatric symptoms of dementia
Treatment of Alzheimer disease
Care of patients with advanced dementia
The following organizations also provide reliable health information.
●Alzheimer's Disease Education and Referral (ADEAR) Center (National Institute on Aging)
(www.nia.nih.gov/health/topics/alzheimers-and-dementia)
●National Institute of Neurological Disorders and Stroke
●Department of Health and Human Services
●The American Geriatrics Society
●Alzheimer's Association
●The Association of Frontotemporal Degeneration
●Eldercare Locator (Administration on Aging)
●Family Caregiver Alliance
ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Michael Alexander, MD, who contributed to earlier versions of this topic review.
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