Greater decrease in ability to think and remember than would be expected of simple aging.Encyclopedia Entry for Dementia :Dementia - behavior and sleep problems. Having a daily routine may help. Calmly reassuring and giving cues to orient the person who has dementia is also helpful in the evening and closer to bedtime. Try to keep the person going to bed at the same time every night. Calm activities at the end of the day and before bedtime may help the person with dementia sleep better at night. If they are active during the day, these calm activities can make them tired and better able to sleep. Avoid loud noises and activity in the home at night, so the person does not wake up once they are asleep. DO NOT restrain a person with dementia when they are in bed. If you are using a hospital bed that has guard rails in the home, putting the rails up may help keep the person from wandering at night. Always talk with the person's health care provider before giving them store-bought sleep medicines. Many sleep aids can make confusion worse. If the person with dementia has hallucinations (sees things that are not there): Try to decrease the stimulation around them. Help them avoid things with bright colors or bold patterns. Make sure there is enough light so that there are no shadows in the room. But DO NOT make rooms so bright that there is a glare. Help them avoid movies or television shows that are violent or action-packed. Take the person to places where they can move around and exercise during the day, such as shopping malls. If the person who has dementia has an angry outburst, try not to touch or restrain them -- only do so if you need to for safety. If possible, try to stay calm and distract the person during outbursts. Do not take their behavior personally. Call 911 if you or the person with dementia is in danger. Try to prevent them from getting hurt if they start wandering. Also, try to keep the person's home stress-free. Keep lighting low, but not so low that there are shadows. Take down mirrors or cover them. DO NOT use bare light bulbs.Call the person's provider if: You think medicines may be the cause of changes in the behavior of the person who has dementia. You think the person may not be safe at home.Sundowning - care.Alzheimer disease Alzheimer disease.Budson AE, Solomon PR. Evaluating the behavioral and psychological symptoms of dementia.Encyclopedia Entry for Dementia :Dementia - daily care. People who have early memory loss can give themselves reminders to help them function each day. Some of these include: Asking the person you are talking with to repeat what they said. Repeating what someone said to you 1 or 2 times. This will help you remember it better. Writing down your appointments and other activities in a planner or on a calendar. Keep your planner or calendar in an obvious place, like beside your bed. Posting messages around your home where you will see them, such as the bathroom mirror, next to the coffee pot, or on the phone. Keeping a list of important phone numbers next to every phone. Having clocks and calendars around the house so you stay aware of the date and what time it is. Labeling important items. Developing habits and routines that are easy to follow. Planning activities that improve your thinking, such as puzzles, games, baking, or indoor gardening. Have someone nearby for any tasks that may have a risk of injury.Some people who have dementia may refuse food or not eat enough to stay healthy on their own. Help the person get enough exercise. Ask them to go outside with you for a walk. Have someone the person likes, such as a friend or relative, prepare and serve them food. Reduce distractions around the eating area, such as the radio or TV. Do not give them foods that are too hot or too cold. Give the person finger foods if they have problems using utensils. Try different foods. It is common for people who have dementia to have decreased smell and taste. This will affect their enjoyment of food. In later stages of dementia, the person may have trouble chewing or swallowing. Talk with the person's health care provider about a proper diet. At some point, the person may need a diet of only liquid or soft foods, to prevent choking.Keep distractions and noise down: Turn off the radio or TV Close the curtains Move to a quieter room To avoid surprising the person, try to make eye contact before touching or speaking to them. Use simple words and sentences, and speak slowly. Speak in a quiet voice. Talking loudly, as if the person is hard of hearing, will not help. Repeat your words, if needed. Use names and places the person knows. Try not to use pronouns, such as 'he,' 'she,' and 'them.' This can confuse someone with dementia. Tell them when you are going to change the subject. Talk to people who have dementia as adults. Don't make them feel as if they are children. And don't pretend to understand them if you do not. Ask questions so they can answer with 'yes' or 'no.' Give the person clear choices, and a visual cue, such as pointing to something, if possible. Don't give them too many options. When giving instructions: Break directions down into small and simple steps. Allow time for the person to understand. If they get frustrated, consider switching to another activity. Try to get them talking about something they enjoy. Many people with dementia like to talk about the past, and many can remember the distant past better than recent events. Even if they remember something wrong, do not insist on correcting them.People with dementia may need help with personal care and grooming. Their bathroom should be nearby and easy to find. Consider leaving the bathroom door open, so they can see it. Suggest that they visit the bathroom several times a day. Make sure their bathroom is warm. Get them undergarments made for urine or stool leakage. Make sure they are cleaned well after going to the bathroom. Be gentle when helping. Try to respect their dignity. Make sure the bathroom is safe. Common safety devices are: A tub or shower seat Handrails Anti-skid mats Do not let them use razors with blades. Electric razors are best for shaving. Remind the person to brush their teeth at least 2 times a day. A person with dementia should have clothing that is easy to put on and take off. Do not give them too many choices about what to wear. Velcro is much easier than buttons and zippers to use. If they still wear clothes with buttons and zippers, they should be in the front. Get them pullover clothes and slip on shoes, as their dementia gets worse.Alzheimer disease Alzheimer disease.Alzheimer's Association website. Dementia care practice recommendations for professionals working in a home setting. www.alz.org/national/documents/phase_4_home_care_recs.pdf. Accessed on May 10, 2018. Budson AE, Solomon PR. Life adjustments for memory loss, Alzheimer's disease, and dementia.Encyclopedia Entry for Dementia :Dementia - home care. A loved one with dementia will need support in the home as the disease gets worse. You can help by trying to understand how the person with dementia perceives his or her world. Give the person a chance to talk about any challenges and take part in his or her own daily care. Start by talking with your loved one's health care provider. Ask how you can: Help the person stay calm and oriented Make dressing and grooming easier Talk to the person Help with memory loss Manage behavior and sleep problems Encourage activities that are both stimulating and enjoyable Tips for reducing confusion in people with dementia include: Have familiar objects and people around. Family photo albums can be useful. Keep lights on at night. Use reminders, notes, lists of routine tasks, or directions for daily activities. Stick to a simple activity schedule. Talk about current events. Taking regular walks with a caregiver can help improve communication skills and prevent wandering. Calming music may reduce wandering and restlessness, ease anxiety, and improve sleep and behavior. People with dementia should have their eyes and ears checked. If problems are found, hearing aids, glasses, or cataract surgery may be needed. People with dementia should also have regular driving tests. At some point, it won't be safe for them to continue to drive. This may not be an easy conversation, so seek help from their provider and other family members. State laws vary on the ability of a person with dementia to continue to drive. Supervised meals can help with feeding. People with dementia often forget to eat and drink, and can become dehydrated as a result. Talk to the provider about the need for extra calories due to increased physical activity from restlessness and wandering. Also talk to the provider about: Watching for risk of choking and what to do if choking occurs How to increase safety in the home How to prevent falls Ways to improve bathroom safety The Alzheimer's Association's Safe Return Program requires people with dementia to wear an identification bracelet. If they wander, their caregiver can contact the police and the national Safe Return office, where information about them is stored and shared nationwide. Eventually, people with dementia may need 24-hour monitoring and assistance to provide a safe environment, control aggressive or agitated behavior, and meet their needs. LONG-TERM CARE A person with dementia may need monitoring and help at home or in an institution. Possible options include: Adult day care Boarding homes Nursing homes In-home care Many organizations are available to help you care for a person with dementia. They include: Adult protective services Community resources Local or state government departments of aging Visiting nurses or aides Volunteer services In some communities, dementia-related support groups may be available. Family counseling can help family members cope with home care. Advance directives, power of attorney , and other legal actions may make it easier to decide on care for the person with dementia. Seek legal advice early, before the person is unable to make these decisions. There are support groups that can provide information and resources for people with Alzheimer disease and their caregivers.Caring for someone with dementia; Home care - dementia.Budson AE, Solomon PR. Why diagnose and treat memory loss, Alzheimer's disease, and dementia?Encyclopedia Entry for Dementia :Dementia - keeping safe in the home. Wandering can be a serious problem for people who have more advanced dementia. These tips may help prevent wandering: Place alarms on all doors and windows that will sound if the doors are opened. Place a 'Stop' sign on doors to the outside. Keep car keys out of sight. To prevent harm when someone with dementia does wander: Have the person wear an ID bracelet or necklace with their name, address, and phone number on it. Tell neighbors and others in the area that the person who has dementia may wander. Ask them to call you or to help them get home if this happens. Fence and close off any areas that may be dangerous, such as a stairwell, deck, a hot tub, or a swimming pool. Consider giving the person a GPS device or a cell phone with a GPS locator embedded in it. Inspect the person's house and remove or reduce hazards for tripping and falling. DO NOT leave a person who has advanced dementia alone at home. Lower the temperature of the hot water tank. Remove or lock up cleaning products and other items that may be poisonous. Make sure the kitchen is safe. Remove knobs on the stove when it is not in use. Lock up sharp objects. Remove, or store the following in locked areas: All medicines, including the person's medicines and any over-the-counter drugs and supplements. All alcohol. All guns. Separate ammunition from the weapons.Alzheimer disease Alzheimer disease Preventing falls Preventing falls.Alzheimer's Association website. Dementia care practice recommendations for professionals working in a home setting. www.alz.org/national/documents/phase_4_home_care_recs.pdf. Accessed May 10, 2018. Budson AE, Solomon PR. Life adjustments for memory loss, Alzheimer's disease, and dementia.Encyclopedia Entry for Dementia :Dementia - what to ask your doctor. Are there ways that I can help someone remember things around the home? How should I talk with someone who is losing or has lost their memory? What type of words should I use? What is the best way to ask them questions? What is the best way to give instructions to someone with memory loss? How can I help someone with dressing? Are some clothes or shoes easier? Will an occupational therapist be able to teach us skills? What is the best way to react when the person I am caring for becomes confused, hard to manage, or does not sleep well? What can I do to help the person calm down? Are there activities that are more likely to agitate them? Can I make changes around the home that will help keep the person calmer? What should I do if the person I am caring for wanders around? How can I keep them safe when they do wander? Are there ways to keep them from leaving the home? How can I keep the person I am caring for from hurting themselves around the house? What should I hide? Are there changes in the bathroom or kitchen I should make? Are they able to take their own medicines? What are the signs that driving is becoming unsafe? How often should this person have a driving evaluation? What are the ways I can lessen the need for driving? What are the steps to take if the person I am caring for refuses to stop driving? What diet should I give this person? Are there hazards I should watch for while this person is eating? What should I do if this person starts to choke?.What to ask your doctor about dementia; Alzheimer disease - what to ask your doctor; Cognitive impairment - what to ask your doctor.Alzheimer disease Alzheimer disease.Budson AE, Solomon PR. Life adjustments for memory loss, Alzheimer's disease, and dementia.Encyclopedia Entry for Dementia :Dementia and driving. People with signs of dementia should have regular driving tests. Even if they pass a driving test, they should be retested in 6 months. If your loved one does not want you getting involved in their driving, get help from their health care provider, lawyer, or other family members. Even before you see driving problems in someone with dementia, look for signs that the person may not be able to drive safely, such as: Forgetting recent events Mood swings or getting angry more easily Problems doing more than one task at a time Problems judging distance Trouble making decisions and solving problems Becoming confused more easily Signs that driving may be getting more dangerous include: Getting lost on familiar roads Reacting more slowly in traffic Driving too slowly or stopping for no reason Not noticing or paying attention to traffic signs Taking chances on the road Drifting into other lanes Getting more agitated in traffic Getting scrapes or dents on the car Having trouble parking.It may help to set limits when driving problems start. Stay off busy roads, or do not drive at times of the day when traffic is heaviest. Do not drive at night when it is hard to see landmarks. Do not drive when the weather is bad. Do not drive long distances. Drive only on roads the person is used to. Caregivers should try to lessen the person's need to drive without making them feel isolated. Have someone deliver groceries, meals, or prescriptions to their home. Find a barber or hairdresser who will make home visits. Arrange for family and friends to visit and take them out for a few hours at a time. Plan other ways to get your loved one places. Family members or friends, buses, taxis, and senior transportation services may be available. As danger to others or to your loved one increases, you may need to prevent them from being able to use the car. Ways to do this include: Hiding the car keys Leaving out car keys that will not start the car Disabling the car so it will not start Selling the car Storing the car away from the home.Alzheimer disease Alzheimer disease.Budson AE, Solomon PR. Life adjustments for memory loss, Alzheimer's disease, and dementia.Encyclopedia Entry for Dementia :Dementia due to metabolic causes. Possible metabolic causes of dementia include: Hormonal disorders, such as Addison disease , Cushing disease Heavy metal exposure, such as to lead, arsenic, mercury, or manganese Repeat episodes of low blood sugar ( hypoglycemia ), most often seen in people with diabetes who use insulin High level of calcium in the blood, such as due to hyperparathyroidism Low level of thyroid hormone ( hypothyroidism ) or high level of thyroid hormone ( thyrotoxicosis ) in the body Liver cirrhosis Kidney failure Nutritional disorders, such as vitamin B1 deficiency, vitamin B12 deficiency, pellagra , or protein-calorie malnutrition Porphyria Poisons, such as methanol Severe alcohol use Wilson disease Disorders of the mitochondria (energy-producing parts of cells) Rapid changes in sodium level.Metabolic disorders may cause confusion and changes in thinking or reasoning. These changes may be short-term or lasting. Dementia occurs when the symptoms are not reversible. Symptoms can be different for everyone. They depend on the health condition causing the dementia. The early symptoms of dementia can include: Difficulty with tasks that take some thought but used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines Getting lost on familiar routes Language problems, such as trouble with names of familiar objects Losing interest in things previously enjoyed, flat mood Misplacing items Personality changes and loss of social skills, which can lead to inappropriate behaviors As the dementia gets worse, symptoms are more obvious and interfere with the ability to take care of yourself: Changing sleep patterns, often waking up at night Forgetting details about current events, forgetting events in one's life history Having difficulty doing basic tasks, such as preparing meals, choosing proper clothing, or driving Having hallucinations, arguments, striking out, and behaving violently More difficulty reading or writing Poor judgment and losing the ability to recognize danger Using the wrong word, not pronouncing words correctly, speaking in confusing sentences Withdrawing from social contact The person may also have symptoms from the disorder that caused dementia.Depending on the cause, a nervous system (neurologic examination) is done to identify the problems. Tests to diagnose a medical condition causing the dementia may include: Ammonia level in the blood Blood chemistry , electrolytes Blood glucose level BUN , creatinine to check kidney function Liver function tests Lumbar puncture (spinal tap) Nutritional assessment Thyroid function tests Urinalysis Vitamin B12 level To rule out certain brain disorders, an EEG (electroencephalogram), head CT scan , or head MRI scan is usually done.The aim of treatment is to manage the disorder and control symptoms. With some metabolic disorders, treatment may stop or even reverse the dementia symptoms. Medicines used to treat Alzheimer disease have not been shown to work for these types of disorders. Sometimes, these drugs are used anyway, when other treatments fail to control the underlying problems. Plans should also be made for home care for people with dementia.Outcome varies, depending on the cause of the dementia and the amount of damage to the brain.Complications may include the following: Loss of ability to function or care for self Loss of ability to interact Pneumonia , urinary tract infections , and skin infections Pressure sores Symptoms of the underlying problem (such as loss of sensation due to a nerve injury from vitamin B12 deficiency).Call for an appointment with your health care provider if symptoms get worse or continue. Go to the emergency room or call the local emergency number (such as 911) if there is a sudden change in mental status or a life-threatening emergency.Treating the underlying cause may reduce the risk for metabolic dementia.Chronic brain - metabolic; Mild cognitive - metabolic; MCI - metabolic.Brain Brain Brain and nervous system Brain and nervous system.Budson AE, Solomon PR. Other disorders that cause memory loss or dementia.Encyclopedia Entry for Dementia :Dementia. Dementia usually occurs in older age. Most types are rare in people under age 60. The risk of dementia increases as a person gets older. Most types of dementia are nonreversible (degenerative). Nonreversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer disease is the most common type of dementia. Another common type of dementia is vascular dementia. It is caused by poor blood flow to the brain, such as with stroke. Lewy body disease is a common cause of dementia in older adults. People with this condition have abnormal protein structures in certain areas of the brain. The following medical conditions can also lead to dementia: Huntington disease Brain injury Multiple sclerosis Infections such as HIV/ AIDS , syphilis , and Lyme disease Parkinson disease Pick disease Progressive supranuclear palsy Some causes of dementia may be stopped or reversed if they are found soon enough, including: Brain injury Brain tumors Long-term (chronic) alcohol abuse Changes in blood sugar, sodium, and calcium levels ( dementia due to metabolic causes ) Low vitamin B12 level Normal pressure hydrocephalus Use of certain medicines, including cimetidine and some cholesterol drugs Some brain infections.Dementia symptoms include difficulty with many areas of mental function, including: Emotional behavior or personality Language Memory Perception Thinking and judgment (cognitive skills) Dementia usually first appears as forgetfulness. Mild cognitive impairment (MCI) is the stage between normal forgetfulness due to aging and the development of dementia. People with MCI have mild problems with thinking and memory that do not interfere with daily activities. They often know about their forgetfulness. Not everyone with MCI develops dementia. Symptoms of MCI include: Difficulty doing more than one task at a time Difficulty solving problems or making decisions Forgetting recent events or conversations Taking longer to do more difficult mental activities Early symptoms of dementia can include: Difficulty with tasks that take some thought, but that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines Getting lost on familiar routes Language problems, such as trouble with the names of familiar objects Losing interest in things previously enjoyed, flat mood Misplacing items Personality changes and loss of social skills, which can lead to inappropriate behaviors As dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of oneself. Symptoms may include: Change in sleep patterns, often waking up at night Difficulty with basic tasks, such as preparing meals, choosing proper clothing, or driving Forgetting details about current events Forgetting events in one's own life history, losing self-awareness Having hallucinations , arguments, striking out, and violent behavior Having delusions, depression, and agitation More difficulty reading or writing Poor judgment and loss of ability to recognize danger Using the wrong word, not pronouncing words correctly, speaking in confusing sentences Withdrawing from social contact People with severe dementia can no longer: Perform basic activities of daily living, such as eating, dressing, and bathing Recognize family members Understand language Other symptoms that may occur with dementia: Problems controlling bowel movements or urine Swallowing problems.A skilled health care provider can often diagnose dementia using the following: Complete physical exam, including nervous system exam Asking about the person's medical history and symptoms Mental function tests (mental status examination) Other tests may be ordered to find out if other problems may be causing dementia or making it worse. These conditions include: Anemia Brain tumor Long-term (chronic) infection Intoxication from medicines Severe depression Thyroid disease Vitamin deficiency The following tests and procedures may be done: B12 level Blood ammonia levels Blood chemistry ( chem-20 ) Blood gas analysis Cerebrospinal fluid (CSF) analysis Drug or alcohol levels ( toxicology screen ) Electroencephalograph (EEG) Head CT Mental status test MRI of head Thyroid function tests , including thyroid stimulating hormone (TSH) Thyroid stimulating hormone level Urinalysis.Treatment depends on the condition causing the dementia. Some people may need to stay in the hospital for a short time. Sometimes, dementia medicine can make a person's confusion worse. Stopping or changing these medicines is part of the treatment. Certain mental exercises can help with dementia. Treating conditions that can lead to confusion often greatly improve mental function. Such conditions include: Anemia Congestive heart failure Decreased blood oxygen ( hypoxia ) Depression Heart failure Infections Nutritional disorders Thyroid disorders Medicines may be used to: Slow the rate at which symptoms get worse, though improvement with these drugs may be small Control problems with behavior, such as loss of judgment or confusion Someone with dementia will need support in the home as the disease gets worse. Family members or other caregivers can assist by helping the person cope with memory loss and behavior and sleep problems. It is important to make sure the homes of people who have dementia are safe for them.People with MCI do not always develop dementia. When dementia does occur, it usually gets worse over time. Dementia often decreases quality of life and lifespan. Families will likely need to plan for their loved one's future care.Call your provider if: Dementia develops or a sudden change in mental status occurs The condition of a person with dementia gets worse You are unable to care for a person with dementia at home.Most causes of dementia are not preventable. The risk of vascular dementia may be reduced by preventing strokes through: Eating healthy foods Exercising Quitting smoking Controlling high blood pressure Managing diabetes.Chronic brain syndrome; Lewy body dementia; DLB; Vascular dementia; Mild cognitive impairment; MCI.Communicating with someone with aphasia Communicating with someone with dysarthria Dementia and driving Dementia - behavior and sleep problems Dementia - daily care Dementia - keeping safe in the home Dementia - what to ask your doctor Eating extra calories when sick - adults Preventing falls.Brain Brain Arteries of the brain Arteries of the brain.Knopman DS. Alzheimer disease and other dementias.Encyclopedia Entry for Dementia :Dementia. Can be caused by Herpes simplex virus type 1, Herpes simplex virus type 2, Cytomegalovirus, West Nile virus, Borna virus, HIV, the helminth Taenia solium (pork tapeworm), and by Borrelia species bacteria. Can be associated with Chlorovirus ATCV-1.Information from Marcello Allegretti.