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Serious forgetfulness, mood swings, and other behavior changes are not a normal part of aging. Some of these changes are caused by problems that can be treated or corrected, like a poor diet or lack of sleep. Sometimes, too many medicines cause these symptoms in older people. Feelings of loneliness, boredom, or depression also can cause a person to be forgetful. These problems are serious and should be treated. Often, they can be reversed.

Sometimes, mental changes cannot be treated easily because they are caused by diseases that permanently damage brain cells. The term dementia is used to describe symptoms that are usually caused by changes in the normal activity of very sensitive brain cells. Dementia seriously interferes with a person's ability to carry out daily activities.

Two common causes of dementia in older people are Alzheimer's disease and multi-infarct dementia.

Alzheimer's disease is the most common cause of dementia in older persons. Alzheimer's disease develops when nerve cells in the brain die. Symptoms begin slowly and become steadily worse. At this time, no one knows what causes the nerve cells to die, and there is no cure for the disease.

The second most common cause of dementia in older people is multi-infarct dementia. Multi-infarct dementia usually affects people between the ages of 60 and 75. Men are slightly more likely than women to have multi-infarct dementia. Multi-infarct dementia is caused by a series of strokes that damage or destroy brain tissue. A stroke occurs when blood cannot get to the brain. A blood clot or fatty deposits (called plaques) can block the vessels that supply blood to the brain, causing a stroke. A stroke also can happen when a blood vessel in the brain bursts. The main causes of strokes are untreated high blood pressure, high blood cholesterol, diabetes, and heart disease. Of these, the most important risk factor for multi-infarct dementia is high blood pressure. It is rare for a person without high blood pressure to develop multi-infarct dementia.

Symptoms

Symptoms that begin suddenly may be a sign of multi-infarct dementia. In addition to confusion and problems with recent memory, symptoms of multi-infarct dementia may include wandering or getting lost in familiar places; moving with rapid, shuffling steps; loss of bladder or bowel control (incontinence); emotional problems, such as laughing or crying inappropriately; difficulty following instructions; and problems handling money.

Multi-infarct dementia is often the result of a series of small strokes, called ministrokes or TIAs (transient ischernic attacks). The symptoms of a TIA often are very slight. They may include mild weakness in an arm or leg, slurred speech, and dizziness. The symptoms generally do not last for more than a few days. Several TIAs may occur before the person notices any symptoms of multi-infarct dementia. People with multi-infarct dementia may improve for short periods of time, then decline again upon having further strokes.

Diagnosis

People who show signs of dementia or who have a history of strokes should have a complete physical exam. The doctor will ask the patient and the family about the person's diet, medications, sleep patterns, personal habits, past strokes, and other medical problems. The doctor will ask about recent illnesses or stressful events like the death of someone close and problems at home or work that may account for the symptoms. To look for signs of stroke, the doctor will check for weakness or numbness in the arms or legs, difficulty with speech, or dizziness. To check for other health problems that could cause symptoms of dementia, the doctor may order office or laboratory tests. These tests may include a blood pressure reading, an electroencephalogram (EEG), a test of thyroid function, and blood tests.

The doctor also may ask for x-rays or special tests such as a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) test. Both CT scans and MRI tests take pictures of sections of the brain. The pictures are then displayed on a computer screen to allow the doctor to see inside the brain; CT scans and MRI tests are painless and do not require surgery. Specialists called radiologists and neurologists interpret these tests. In addition, the doctor may send the patient to a psychologist or psychiatrist to test reasoning, learning ability, memory, and attention span. Sometimes, multi-infarct dementia is difficult to distinguish from Alzheimer's disease. It is possible for a person to have both multi-infarct dementia and Alzheimer's disease, making it hard for the doctor to diagnose either.

Treatment

While no treatment can reverse damage that has already been done, treatment to prevent additional strokes is very important. High blood pressure, the primary risk factor for multi-infarct dementia, can be treated successfully. Diabetes also is a treatable risk for stroke. To prevent additional strokes, doctors may prescribe medicines to control high blood pressure, high cholesterol, heart disease, and diabetes. They will counsel patients about good health habits, such as exercising and avoiding smoking and drinking alcohol. The patient may require a special diet.

Doctors sometimes prescribe aspirin or other drugs to prevent clots from forming in the small blood vessels. Drugs also can be prescribed to relieve restlessness or depression or to help the patient sleep better. Sometimes, doctors recommend a type of surgery known as carotid endarterectomy. This surgery is done to remove blockage in the carotid artery, the main blood vessel to the brain. Studies are under way to see how well this surgery works in treating patients with multi-infarct dementia. Some scientists also are studying drugs that increase the flow of blood to the brain.

Helping Someone with Multi-infarct Dementia

Family members and friends can help someone with multi-infarct dementia cope with mental and physical problems. They can encourage patients to keep up their daily routines and regular social and physical activities. By talking with them about events and daily activities, family members can help patients use their mental abilities as much as possible. Some families find it helpful to use reminders such as lists, alarm clocks, and calendars to help the patient remember important times and events.
A person with multi-infarct dementia should be under the regular care of a doctor. If the patient has health problems, such as diabetes, other specialists may be consulted as well.

Help and advice for home caregivers are available from a variety of sources, including nurses, family doctors, social workers, and physical and occupational therapists. Home health care and respite or day care services in some neighborhoods can provide much-needed relief to caregivers.

A state or local health department, a local hospital, or the patient's doctor may be able to provide a telephone number to call for such services. Support groups offer emotional support for family members caring for a person with dementia. A state or local health department, government agency on aging, or local hospital can provide information about support groups in the community.