Geriatric Psychiatry

Dementia & Memory Disorders

Dementia is a general term for a decline in cognitive ability severe enough to interfere with daily life. It is not a specific disease but a group of symptoms caused by various brain disorders. Alzheimer's disease is the most common cause (60-80%), followed by vascular dementia, Lewy body dementia, and frontotemporal dementia.

Symptoms

Progressive memory loss (especially recent events)

Difficulty with familiar tasks (cooking, managing finances)

Language problems (finding words, following conversations)

Disorientation to time and place

Poor judgment and decision-making

Misplacing things and inability to retrace steps

Changes in mood and personality

Withdrawal from work or social activities

Behavioral changes: agitation, aggression, wandering

Sundowning (increased confusion in evening)

Causes

Alzheimer's disease (amyloid plaques and tau tangles)
Vascular disease (stroke-related brain damage)
Lewy body disease (abnormal protein deposits)
Frontotemporal degeneration
Parkinson's disease
Traumatic brain injury
Chronic alcohol abuse
Vitamin B12 deficiency (reversible)
Thyroid disorders (reversible)
Normal pressure hydrocephalus (potentially reversible)

Diagnosis

Comprehensive evaluation including detailed cognitive assessment (MMSE, MoCA), neurological examination, blood tests (B12, thyroid, syphilis), brain imaging (MRI, CT), and sometimes PET scan or CSF analysis. Establishing the specific type of dementia guides treatment decisions.

Treatment Options

Cholinesterase inhibitors: Donepezil (Aricept), Rivastigmine, Galantamine

NMDA receptor antagonist: Memantine (for moderate-severe)

Management of behavioral symptoms (agitation, psychosis, depression)

Cognitive stimulation therapy

Caregiver education and support

Safety planning and home modifications

Treatment of reversible causes when identified

Occupational therapy for daily living skills

When to Seek Help

Seek evaluation if you notice progressive memory loss in yourself or a loved one, difficulty performing familiar tasks, confusion about time or place, personality changes, or declining ability to manage daily activities.

Your Action Plan

1.Step 1: Get a thorough evaluation — some causes of memory problems are REVERSIBLE (B12, thyroid, depression, medication effects)

2.Step 2: Start medication early if Alzheimer's is diagnosed — benefits are greatest in early stages

3.Step 3: Legal and financial planning NOW while capacity exists: will, power of attorney, advance directives

4.Step 4: Stay physically active — exercise slows cognitive decline and reduces fall risk

5.Step 5: Stay mentally active — social engagement, hobbies, puzzles (enjoyable activities, not frustrating ones)

6.Step 6: Manage cardiovascular risk factors: these accelerate all types of dementia

7.Step 7: Create memory aids: labels, written schedules, photo boards, medication organizers

8.Step 8: Build your support team: family, friends, day programs, eventual care planning

9.Step 9: Address mood and sleep problems — depression is common and treatable in dementia

10.Step 10: Focus on quality of life: meaningful activities, social connection, dignity, and comfort