When do you talk about dementia?

Dementia is an acquired disorder of memory and thinking ability that is so pronounced that it impairs occupational and/or private everyday activities. The disorder must have existed for at least six months.
There are currently more than one million predominantly elderly dementia patients living in Germany. The proportion of dementia patients is about 3 % of those aged 70 to 74; among those aged 80 to 84, more than 13 % are affected and among those over 90, about 35 %. Women are affected by Alzheimer's much more frequently than men. Experts explain this primarily by the difference in life expectancy between the two sexes.
Estimates therefore assume that the number of dementia patients in Germany will increase to over 2 million in the coming decades.

Dementia is therefore not a normal symptom of old age. It is always a disease that goes beyond the "normal aging process" of the brain.
To distinguish this, viz. "age-related forgetfulness" from the "pathological forgetfulness" and then to initiate the appropriate therapeutic steps is our task.

The 2 most common forms of dementia: Alzheimer's dementia and vascular dementia.

What is Alzheimer's?

Alzheimer's dementia, also known as Alzheimer's disease, is the best known and most common cause of dementia - its share in the group of dementias is about 60%.
It was first described at the beginning of the 20th century by the Bavarian neurologist Alois Alzheimer (1864 to 1915). He carried out detailed investigations on patients with conspicuous behaviour and acquired deficits in mental performance. In the course of these investigations, Alois Alzheimer also studied the brains of deceased patients and related the results to his observations. The scientist first published his findings in 1906.

Symptoms of Alzheimer's disease

Alzheimer's dementia usually begins with short-term memory loss. Signs such as orientation and speech difficulties as well as unusual behaviour also indicate this. In many patients, especially in advanced stages of the disease, the personality also changes.

Causes of Alzheimer's dementia

The exact cause of Alzheimer's disease is not yet known. In patients, however, characteristic protein deposits are increasingly found in the brain. On the one hand, these are so-called "senile plaques"which consists of protein fragments (beta-amyloid peptide). On the other hand, fibrous deposits, the so-called neurofibrillary tangles, which consist of abnormal, clumped/aggregated protein (Tau protein with too many phosphate groups attached). In addition, Alzheimer's dementia is associated with an altered concentration of certain messenger substances (neurotransmitters) in the brain.
In many patients, amyloid is also deposited in the wall of small blood vessels. This can worsen their permeability, which impairs the supply of oxygen and energy to the brain.

Another typical feature of Alzheimer's disease is the loss of synapses and, as the disease progresses, the death of nerve cells. This is associated with the formation of abnormally changed protein (tau-potein), which is deposited in the brain in the form of fibrils. These are the neurofibril bundles already described by Alois Alzheimer.

Another characteristic of Alzheimer's dementia is the altered concentration of certain messenger substances (neurotransmitters) in the brain. These include above all Acetylcholine and Glutamate. Both substances are of central importance for the normal function of nerve cells and the transmission of signals between neurons. As nerve cells in different areas of the brain perish, this leads on the one hand to a lack of acetylcholine. On the other hand, an excessive amount of glutamate is formed.

The role of genes

The question is repeatedly asked whether dementia, especially Alzheimer's disease, is hereditary. The nature of the inheritance, as for example in diabetes mellitus (diabetes), is probably based on a Variety of genes that increase the riskAlzheimer's disease, but not necessarily lead to Alzheimer's disease. Only in rare cases is Alzheimer's "firmly" (dominant) anchored in the genes.

Symptoms of Alzheimer's disease

In most cases, it is a noticeable forgetfulness that raises the question of an incipient dementia in the affected elderly people themselves or in their relatives. If this memory disorder is actually due to Alzheimer's disease, then the brain has usually already undergone a gradual change that has lasted for many years. Unnoticed, first the extensions and connections of nerve cells and later the nerve cells themselves die in the brain. The decay leads to a decrease in brain tissue (atrophy). This damage spreads gradually throughout the brain.
Depending on the damaged area of the brain, the functions and abilities located there diminish. Thus, bit by bit, short-term memory, the ability to perform daily routine tasks, the ability to judge and language fade. Later, emotional expressions, behaviour, recognition and communication change. If the dementia is more advanced, patients often lose control over bladder emptying and bowel movements.

Characteristic symptoms of Alzheimer's disease

Even though the symptoms and complaints of a dementia patient are usually very varied, some characteristic signs can be recognised with close observation. The following changes in a person should make him or those around him alert:

  • Forgetfulness, loss of short-term memory, later also of long-term memory (affected person constantly repeats the same questions; forgets the current date)
  • Difficulty in performing everyday and domestic tasks correctly.
  • Word-finding disorder, words no longer come to mind
  • Loss of orientation over time, space and
  • Change of the waking and sleeping rhythm, day becomes night and vice versa
  • failing of judgement
  • Problems with concentration and abstract thinking (affected person can no longer manage a bank account; can no longer complete a bank transfer)
  • Incorrect allocation of objects and circumstances (affected person repeatedly misplaces objects and can no longer find them)
  • Persons are no longer recognized
  • extreme mood swings, distrust of familiar people
  • Change of temper, irritable
  • No drive (person generally loses interest in current affairs, work and hobbies; withdraws more and more, becomes depressed)

The course of Alzheimer's dementia

The course can be individually very different be. However, Alzheimer's disease is a chronically progressive process that can so far be delayed with medication, but not permanently averted. The progression can be divided into three stages, each of which - with individual differences - can last several years:

Symptoms of Alzheimer's disease at an early stage

  • memory and retentiveness disorders
  • Mood swings
  • Problems in the execution of difficult activities, loss of efficiency
  • Loss of precise language
  • Ability to work and social contacts significantly reduced

Middle stage symptoms

  • All intellectual performance losses intensify as well as the changes of psyche and personality
  • Although the patient is often still able to lead an independent life to a certain extent, he or she increasingly needs support in everyday practical matters.

Symptoms in the late stage

  • The patient is no longer able to live without outside help. Personal hygiene is no longer possible alone, short-term memory is almost completely extinguished

Diagnosis of Alzheimer's disease

  • The doctor takes a detailed medical history of the patient.
  • This is followed by a physical examination.
  • Standardised tests provide information about intellectual performance and abilities. In addition, it is important to assess how well the patient is still able to perform activities of daily living.
  • Blood tests help rule out other causes of dementia, such as infections, vitamin deficiencies, or hypothyroidism.
  • Today, examinations of cerebrospinal fluid (CSF) are routine in specialised memory consultations. The specific markers (biomarkers) that are typically altered in Alzheimer's disease (beta-amyloid, tau protein) can be determined in the cerebrospinal fluid.

With imaging techniques such as computer tomography or magnetic resonance imaging (CCT or MRI), preferably MRI, the brain structures can be assessed and indications of brain changes typical of Alzheimer's or other dementia diseases can be found. In addition, imaging methods can be used, among other things, to detect vascular diseases of the brain or to rule out tumours.


In addition to medications that slow the progression of dementia, several non-drug approaches to treating Alzheimer's can help.
So far, there is no cure for Alzheimer's disease. However, there are various medications that can help the dementia to progress less quickly and the memory to improve again. With various other therapeutic measures, the mental abilities of the person affected can be promoted and the symptoms alleviated. Especially in advanced stages of the disease, it is important to provide good nursing care for those affected and to relieve the burden on relatives.

Non-drug treatment

Non-drug treatment measures make a decisive contribution to improving the symptoms, the quality of life and the independence of the Alzheimer's patient, as well as to relieving the burden on caring relatives and nursing staff. Such measures mainly include training close to everyday life and aim at physical and mental stimulation.
The following have proven to be useful non-drug measures: adaptation of the daily routine and living conditions (milieu therapy), occupational therapy (ergotherapy), consideration of the life story of the individual patient (biography work), special respect and acceptance of the patient as a whole person (validation), treatment of speech disorders (speech therapy), physiotherapy, and art and music therapy. Finally, the patient requires increasing nursing assistance as the disease progresses. It has been shown that the use of medical nutrition in the early stages leads to improved memory performance.

Drug therapy

The drugs mentioned below, so-called anti-dementia drugs, are used in the therapy of Alzheimer's dementia to improve memory performance and coping with everyday life with individually varying success. The aim of this treatment is to maintain the independence and quality of life of the dementia sufferer for as long as possible and to reduce the amount of care required.

Cholinesterase inhibitor

In the early and middle stages, drugs that inhibit the enzyme cholinesterase, which breaks down the neurotransmitter acetylcholine, can be used. This makes the neurotransmitter acetylcholine more available again for signal processing in the brain. The agents currently in use in this group are: Donepezil, Galantamine, Rivastigmine.


The active substance Memantine influences the receptor of the neurotransmitter glutamate in the brain. Memantine can improve attention and daily living skills - especially in advanced dementia.

Further information:

German Alzheimer Society e.V. - Dementia self-help group

Vascular dementia

In vascular dementia, the cause is a chron. Circulatory disturbance in the brain. It is the second most common form of dementia.

What does vascular dementia and its causes

"Vascular" means as much as "vascular, blood flow-related, concerning the blood vessels".
Often the disease develops insidiously. For example, years of untreated high blood pressure can damage the walls of the small blood vessels. They become thicker and more rigid, the blood flows worse. Gradually, there is a shortage of blood supply in various places in the brain.

The 4 major risk factors for vascular dementia, which usually occurs in older age, are:

  • High blood pressure (arterial hypertension)
  • Smoking
  • Diabetes mellitus ("diabetes")
  • Unfavourable blood lipid values (especially high LDL cholesterol, low HDL cholesterol)

But also heart diseases that can lead to frequent minor strokes, such as cardiac arrhythmias - especially so-called atrial fibrillation - pose an increased risk.

Symptoms and course of vascular dementia

The symptoms of "vascular dementia" are often indistinguishable from those of Alzheimer's-type dementia. Rather, they differ in the Course. While in Alzheimer's type dementia develops rather insidiously, the course of vascular dementia is more associated with a Stairs comparable. Whenever a new infarct area develops in the brain, deterioration occurs.
In addition, there are often neurological symptoms such as dizziness, gait disturbances, visual disturbances or motor/sensory deficits. Those affected fall easily. Epileptic seizures also occur. Sometimes symptoms such as stiffness of the muscles, a small-stepped gait and slowing of movement are reminiscent of the symptoms of Parkinson's disease. Most sufferers eventually lose bladder and bowel control.
Important to know: There are no "proving" symptoms for vascular dementia. All the complaints mentioned can also have other causes - including metabolic disorders, vitamin deficiencies or chronic infections. In case of doubt, the doctor should therefore be asked for advice.
It is not always possible to distinguish with certainty between Alzheimer's disease and vascular dementia. There are also mixed forms of both types of dementia.

How to recognize vascular dementia?

The first point of contact is usually the family doctor. If necessary, he or she can refer the patient to a specialist - usually a neurologist or psychiatrist.
The doctor will first inquire about the patient's symptoms and personal medical history. Have there been any strokes in the past? Are there risk factors for vascular dementia - such as smoking, high blood pressure, diabetes mellitus or heart disease? If the answer is "yes", this already raises suspicion of the disease. It is also interesting to know which medications the patient is taking. This is because some drugs can interfere with brain function.
If the person concerned agrees, the doctor will also talk to their relatives. They can describe from their point of view what they have noticed.

Physical examination

This is followed by a physical examination. The doctor will pay particular attention to whether there are indications of circulatory disorders in the brain - whether, for example, coordination is disturbed, signs of paralysis, sensory disturbances or other failures are detectable.

Test procedure

A series of simple standard tests can help the doctor to classify the patient's mental capacity. Healthy people can usually cope with the exercises without major problems. If difficulties occur, they indicate certain disorders. The tests include orientation, memory, attention and language comprehension. The tests also help the doctor to assess the severity of the impairment.
But: There is no single test that can prove dementia. The diagnosis is always based on the result of many different tests. Daily form, education level, medication and accompanying illnesses can have an influence on the test result and are taken into account accordingly. For a definite diagnosis of dementia, symptoms must be present for at least six months. However, this in no way means waiting six months before examinations or treatment can take place.
The doctor must not only find out whether dementia is present, what type it is and how pronounced it is. He must also rule out other diseases that could also be the cause of the symptoms - for example, physical diseases and disorders, neurological diseases such as Parkinson's disease, or mental diseases such as depression. This usually requires further examinations.

 Laboratory tests

Blood tests and urine tests help to detect a severe vitamin deficiency (e.g. B12) or other internal diseases. They also provide evidence of chronic infections that could affect the brain - for example, Lyme disease.

Imaging techniques

Important components of diagnostics are imaging procedures, such as the Magnetic resonance imaging (MRI) or the Computer tomography of the head (CCT). They provide evidence of circulatory disorders as a possible cause of dementia.


In contrast to the imaging methods, the measurement of brain waves often allows an assessment of the function of the brain. If the brain waves are too slow (general change), this indicates insufficient function. They can then be a useful supplement to the imaging procedures.


Early therapy is important in order to influence the course of the disease favourably and to maintain the quality of life of those affected as long and as well as possible.
Even more than in the case of dementia of Alzheimer's type I, the treatment of the causes (see above) is in the foreground:

  • High blood pressure (arterial hypertension)
  • Smoking
  • Diabetes mellitus ("diabetes")
  • Unfavourable blood lipid values (especially high LDL cholesterol, low HDL cholesterol)

To treat the circulatory disorder in the brain and prevent further strokes, the doctor may prescribe various medications depending on the case.
Among others, acetylsalicylic acid/ASS or clopidogrel: These drugs cause the blood platelets to adhere to each other less easily, thus counteracting the formation of thrombosis in already damaged vessels.

Additional measures may include:

  • Physiotherapy (physical therapy)
  • Ergotherapy (occupational therapy)
  • Logopedics (speech therapy)
  • Special memory training (for example memory training)
  • Music therapy, memory therapy and other methods
  • Accompanying psychotherapy