{{short description|Cognitive decline}} {{redirect-multi|2|Senile|Demented}} {{For|other uses of the word dementia|Dementia (disambiguation)}} {{pp-pc}} {{cs1 config|name-list-style=vanc|display-authors=3}} {{Use American English|date=June 2025}} {{Use mdy dates|date=May 2024}} {{Infobox medical condition | name = Dementia | synonyms = | image = File:An old man diagnosed as suffering from senile dementia. Colo Wellcome L0026689.jpg | caption = 1896 lithograph of a man with dementia | field = Geriatrics Neurology, Psychiatry, Neuropsychiatry | symptoms = Decreased ability to think and remember, emotional problems, problems with language, decreased motivation, general decline in cognitive abilities<ref name="WHO2026"/> | complications = Malnutrition, pneumonia, inability to perform self-care tasks, personal safety challenges, fractures from falls.<ref name="Emmady2022">{{cite web |last1=Emmady |first1=Prabhu D. |last2=Schoo |first2=Caroline |last3=Tadi |first3=Prasanna |title=Major Neurocognitive Disorder (Dementia) |url=https://www.ncbi.nlm.nih.gov/books/NBK557444/ |website=StatPearls |publisher=StatPearls Publishing |access-date=13 January 2026 |date=2025}}</ref> | onset = Varies, usually gradual<ref name="WHO2026"/> | duration = Varies, usually long term<ref name="WHO2026"/> | causes = Neurodegeneration, vascular disease, stroke, traumatic brain injuries<ref name="WHO2026"/> | risks = Several across the life course (e.g. less education, hearing loss, vision loss, physical inactivity, obesity, high cholesterol, hypertension, diabetes, smoking, excessive alcohol consumption, social isolation, air pollution, traumatic brain injury, depression)<ref name="Livingston-2024a"/> | diagnosis = Clinical assessment, cognitive testing (mini–mental state examination),<ref name=Creavin/> and imaging | differential = Delirium, depression, hypothyroidism<ref name="NICE2">{{cite web |title=Differential diagnosis dementia |url=https://cks.nice.org.uk/topics/dementia/diagnosis/differential-diagnosis/ |website=NICE |access-date=January 20, 2022}}</ref> | prevention = Addressing risk factors throughout the life course, e.g. preventing, reducing or treating hearing and vision loss, depression, head injury and vascular risk factors (e.g. cholesterol, diabetes), decreasing smoking, and maintaining physical activity and cognitive stimulation<ref name="Livingston-2024a"/> | treatment = Varies but supportive care is given<ref name="WHO2026"/> | medication = Varies depending on the type and stage, most medications have a small benefit<ref name="Arvanitakis-2019" /> | prognosis = Varies, dementia is a life limiting condition and life expectancy is usually shortened | frequency = 57 million (2021)<ref name="WHO2026"/> | deaths = 1.62 million dementia-related deaths (2019) estimated to increase to 4.91 million by 2050<ref name="Li-2024" /> | alt = }}
'''Dementia''' is a syndrome, often associated with neurodegenerative diseases such as Alzheimer's, and characterized by a general decline in cognitive processes that affects the ability to perform everyday activities.<ref name="NIA2026">{{cite web |title=What Is Dementia? Symptoms, Types, and Diagnosis |url=https://www.nia.nih.gov/health/alzheimers-and-dementia/what-dementia-symptoms-types-and-diagnosis |website=National Institute on Aging |access-date=26 January 2026 |language=en |date=8 December 2022}}</ref> This typically involves problems with memory, thinking, behavior, and motor control.<ref name="WHO2026">{{cite web |title=Dementia |url=https://www.who.int/news-room/fact-sheets/detail/dementia |website=www.who.int |date= 31 March 2025|access-date=13 January 2026 |language=en}}</ref> Aside from memory impairment and a disruption in thought patterns, the most common symptoms of dementia include emotional problems, difficulties with language, and decreased motivation.<ref name="WHO2026"/> The symptoms may be described as occurring in a continuum over several stages.<ref name="Bathini">{{cite journal | vauthors = Bathini P, Brai E, Auber LA | title = Olfactory dysfunction in the pathophysiological continuum of dementia | journal = Ageing Research Reviews | volume = 55 | article-number = 100956 | date = November 2019 | pmid = 31479764 | doi = 10.1016/j.arr.2019.100956 | url = http://doc.rero.ch/record/327719/files/alb_odp.pdf | s2cid = 201742825 }}</ref> Dementia is an incurable, progressive neurocognitive disorder, with varying degrees of severity (mild to major) and many forms or subtypes.<ref name="ICD11A">{{cite web |title=ICD-11 for Mortality and Morbidity Statistics |url=https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f546689346 |website=icd.who.int |access-date=January 20, 2022 |archive-date=August 1, 2018 |archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f546689346 }}</ref><ref name="DSM5a">{{cite book | author = American Psychiatric Association |url=https://archive.org/details/diagnosticstatis0005unse/page/641|title=Diagnostic and statistical manual of mental disorders: DSM-5|date=2013|publisher=American Psychiatric Association|isbn=978-0-89042-554-1|edition=5th|location=Washington, DC|pages=[https://archive.org/details/diagnosticstatis0005unse/page/591 591–603]}}</ref> The condition has a significant effect on the individual, their caregivers, and their social relationships in general.<ref name="WHO2026"/> Dementia is not the same as age-related decline in cognition and memory, with no change in intelligence.<ref name="NINDS2025"/>
The most common form of dementia is Alzheimer's. Dementia can be caused by brain injuries and stroke.<ref name="WHO2026"/> It has also been described as a spectrum of disorders with subtypes of dementia based on which known disorder caused its development, such as Parkinson's disease for Parkinson's disease dementia, Huntington's disease for Huntington's disease dementia, vascular disease for vascular dementia, HIV infection causing HIV dementia, frontotemporal lobar degeneration for frontotemporal dementia, Lewy body disease for dementia with Lewy bodies, and prion diseases.<ref name="Wilson1">{{cite journal |vauthors=Wilson H, Pagano G, Politis M |title=Dementia spectrum disorders: lessons learnt from decades with PET research |journal=J Neural Transm (Vienna) |volume=126 |issue=3 |pages=233–251 |date=March 2019 |pmid=30762136 |pmc=6449308 |doi=10.1007/s00702-019-01975-4}}</ref> Subtypes of neurodegenerative dementias may also be based on the underlying pathology of misfolded proteins, such as synucleinopathies and tauopathies.<ref name="Wilson1"/> The coexistence of more than one type of dementia is known as mixed dementia.<ref name="DementiaUK2026">{{cite web |title=Mixed dementia |url=https://www.dementiauk.org/information-and-support/types-of-dementia/mixed-dementia/ |website=Dementia UK |access-date=14 January 2026 |language=en}}</ref>
Diagnosis is usually based on history of the illness and cognitive testing with imaging. Imaging can help to determine the dementia subtype, and to exclude other causes. Blood tests are usually taken to rule out other possible reversible causes such as hypothyroidism (an underactive thyroid).<ref name="NINDS2025">{{cite web |title=Dementias {{!}} National Institute of Neurological Disorders and Stroke |url=https://www.ninds.nih.gov/health-information/disorders/dementias#toc-reversible-dementia-like-disorders-and-conditions |website=www.ninds.nih.gov |access-date=20 January 2026 |language=en}}</ref> Fluid biomarkers detected in cerebrospinal fluid, and in blood can identify Alzheimer's disease.<ref name="Valletta2025">{{cite journal |vauthors=Valletta M, Briel N, Yuksekel I, Barboure M, Coward A, De Houwer JF, Fawad A, González-Mayoral A, Iaccarino G, Martínez-Dubarbie F, Moukaled S, Andreasson U, Gobom J, Brinkmalm A, Tijms B, Zetterberg H, Blennow K, Suárez-Calvet M, Schöll M, Paterson RW, Montoliu-Gaya L, Sogorb-Esteve A |title=Fluid biomarkers for neurodegenerative diseases: a comprehensive update |journal=Alzheimers Res Ther |volume=18 |issue=1 |article-number=12 |date=December 2025 |pmid=41422050 |pmc=12805704 |doi=10.1186/s13195-025-01919-z |doi-access=free|url=}}</ref> PET scans can detect amyloid beta and tau, the two intrinsically disordered proteins that are the hallmark features of Alzheimer's.<ref name="Valletta2025"/>
Although the greatest risk factor for developing dementia is aging, dementia is not a normal part of the aging process; many people aged 90 and above show no signs of dementia.<ref name="NINDS2025"/> Risk factors, diagnosis and caregiving practices are influenced by cultural and socio-environmental factors.<ref name="Vila-Castelar">{{cite journal |vauthors=Vila-Castelar C, Fox-Fuller JT, Guzmán-Vélez E, Schoemaker D, Quiroz YT |title=A cultural approach to dementia - insights from US Latino and other minoritized groups |journal=Nat Rev Neurol |volume=18 |issue=5 |pages=307–314 |date=May 2022 |pmid=35260817 |pmc=9113534 |doi=10.1038/s41582-022-00630-z |url=}}</ref> Several risk factors for dementia, such as smoking and obesity, are modifiable by lifestyle changes.
{{asof|2025}}, dementia is the seventh leading cause of death worldwide and has 10 million new cases reported every year (approximately one every three seconds).<ref name="WHO2026" /> In the UK it is the leading cause of death.<ref name="Dementia UKg">{{cite web |title=Dementia remains UK's top cause of death |url=https://www.dementiauk.org/news/dementia-named-uk-leading-cause-of-death/ |website=Dementia UK |access-date=19 January 2026 |language=en |date=19 October 2023}}</ref> It is one of the main causes of disabilities in those aged over 65.<ref name="Vedel">{{cite journal |vauthors=Vedel I, Sheets D, McAiney C, Clare L, Brodaty H, Mann J, Anderson N, Liu-Ambrose T, Rojas-Rozo L, Loftus L, Gauthier S, Sivananthan S |title=CCCDTD5: Individual and community-based psychosocial and other non-pharmacological interventions to support persons living with dementia and their caregivers |journal= Alzheimer's & Dementia: Translational Research & Clinical Interventions|volume=6 |issue=1 |article-number=e12086 |date=2020 |pmid=33209973 |pmc=7657138 |doi=10.1002/trc2.12086 |url=}}</ref> There is no known cure for dementia.<ref name="NIA2026"/> Acetylcholinesterase inhibitors such as donepezil are often used in some dementia subtypes and may be beneficial in mild to moderate stages, but the overall benefit may be minor. There are many measures that can improve the quality of life of a person with dementia and their caregivers. Cognitive behavioral therapy may give some benefit for treating the associated symptoms of depression.<ref name="Cochrane2022">{{cite journal | vauthors = Orgeta V, Leung P, Del-Pino-Casado R, Qazi A, Orrell M, Spector AE, Methley AM | title = Psychological treatments for depression and anxiety in dementia and mild cognitive impairment | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 4 | article-number = CD009125 | date = April 2022 | pmid = 35466396 | pmc = 9035877 | doi = 10.1002/14651858.CD009125.pub3 }}</ref> {{TOC limit|3}}
== Signs and symptoms == The signs and symptoms of dementia may vary between individuals, and may vary according to the underlying subtype, particularly in the early stages but at the end stage of all types they are similar.<ref name="ASHA2026">{{cite web |title=Dementia |url=https://www.asha.org/practice-portal/clinical-topics/dementia/#collapse_2 |website=American Speech-Language-Hearing Association |access-date=13 February 2026 |language=en}}</ref> Symptoms may be grouped into three areas: cognitive, neuropsychiatric (behavioral and psychological), and motor.<ref name="Livingston-2024a">{{cite journal |vauthors=Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, Ames D, Banerjee S, Burns A, Brayne C, Fox NC, Ferri CP, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Nakasujja N, Rockwood K, Samus Q, Shirai K, Singh-Manoux A, Schneider LS, Walsh S, Yao Y, Sommerlad A, Mukadam N |title=Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission |journal=Lancet |volume=404 |issue=10452 |pages=572–628 |date=August 2024 |pmid=39096926 |doi=10.1016/S0140-6736(24)01296-0 |bibcode=2024Lanc..404..572L |url=https://discovery.ucl.ac.uk/id/eprint/10196488/}}</ref>
The cognitive symptoms of dementia relate to the area of the brain affected. Typically this includes memory plus one other cognitive region affecting language (commonly), attention, problem solving or perception and orientation.<ref name="Arvanitakis-2019">{{cite journal |vauthors=Arvanitakis Z, Shah RC, Bennett DA |title=Diagnosis and Management of Dementia: Review |journal=JAMA |volume=322 |issue=16 |pages=1589–1599 |date=October 2019 |pmid=31638686 |pmc=7462122 |doi=10.1001/jama.2019.4782 |bibcode=2019JAMA..322.1589A |url=}}</ref> Signs of dementia include wandering, and getting lost in a familiar neighborhood, using unusual words to refer to familiar objects, forgetting the name of a close family member or friend, forgetting old memories, forgetting to pay bills, and being unable to complete tasks independently.<ref name="Arvanitakis-2019"/><ref>{{Cite web |date=December 19, 2019 |title=What Is Dementia? {{!}} CDC |url=https://www.cdc.gov/aging/dementia/index.html |access-date=October 3, 2022 |website=cdc.gov |language=en-us}}</ref> The symptoms progress at a continuous rate over several stages.<ref name="ASHA2026"/><ref name="Bathini" /> Most types of dementia are slowly progressive with some deterioration of the brain well established before signs become apparent.
Neuropsychiatric symptoms (NPS) are a major feature of dementia affecting more than 90% of all cases, at different stages.<ref name="Tampi2022">{{cite journal |vauthors=Tampi RR, Jeste DV |title=Dementia Is More Than Memory Loss: Neuropsychiatric Symptoms of Dementia and Their Nonpharmacological and Pharmacological Management |journal=Am J Psychiatry |volume=179 |issue=8 |pages=528–543 |date=August 2022 |pmid=35921394 |doi=10.1176/appi.ajp.20220508 |url=}}</ref> They often present as first or early symptoms or syndromes, as '''mild behavioral impairment''' (MBI) that may reflect the subtype of dementia at issue.<ref name="Shaw2024">{{cite journal |vauthors=Shaw JS, Leoutsakos JM, Rosenberg PB |title=The Relationship Between First Presenting Neuropsychiatric Symptoms in Older Adults and Autopsy-Confirmed Memory Disorders |journal=Am J Geriatr Psychiatry |volume=32 |issue=6 |pages=754–764 |date=June 2024 |pmid=38296755 |pmc=11096035 |doi=10.1016/j.jagp.2024.01.015 |url=}}</ref> For example, a study has found that the first symptoms as NPS of personality change, and disinhibition will relate to a diagnosis of frontotemporal dementia.<ref name="Shaw2024"/> The presence of MBI on its own is not a cognitive impairment and is not recognized as dementia but may be an indicator for the development of mild cognitive impairment, as a predementia type.<ref name="Jin2023">{{cite journal |vauthors=Jin P, Xu J, Liao Z, Zhang Y, Wang Y, Sun W, Yu E |title=A review of current evidence for mild behavioral impairment as an early potential novel marker of Alzheimer's disease |journal=Front Psychiatry |volume=14 |issue= |article-number=1099333 |date=2023 |pmid=37293396 |pmc=10246741 |doi=10.3389/fpsyt.2023.1099333 |doi-access=free |url=}}</ref> It may also be seen as a transitional state in the development of dementia.<ref name="Jin2023"/>
The behavioral symptoms can include agitation, restlessness, inappropriate behavior, disinhibition, and verbal or physical aggression.<ref name="Arvanitakis-2019"/> Many of these symptoms may be improved by non-pharmacological measures with higher ranking interventions given as massage therapy, personally-tailored therapy, animal-assisted therapy, and pet robot use.<ref name="Tampi2022"/>
Psychological symptoms can include depression, hallucinations, delusions, apathy, and anxiety.<ref name="Arvanitakis-2019"/> Also common are personality changes with the progression of dementia, such as increases in neuroticism (negativity), and a decline in conscientiousness.<ref name="Terracciano2025">{{cite journal |vauthors=Terracciano A, Luchetti M, Karakose S, Miller AA, Stephan Y, Sutin AR |title=Meta-analyses of personality change from the preclinical to the clinical stages of dementia |journal=Ageing Res Rev |volume=112 |issue= |article-number=102852 |date=December 2025 |pmid=40752776 |pmc=12358811 |doi=10.1016/j.arr.2025.102852 |url=}}</ref>
Motor symptoms and signs may include changes in gait, repetitive movements, parkinsonism, or seizures.<ref name="Arvanitakis-2019" /> Changes in gait can be responsible for falls.<ref name="Arvanitakis-2019" /> An inability to relax muscles, known as paratonia is an induced motor dysfunction that affects most people with dementia. Motor impairments are correlated with cognitive impairments, and are a main cause of disability and dependency.<ref name="Drenth2020">{{cite journal |vauthors=Drenth H, Zuidema S, Bautmans I, Marinelli L, Kleiner G, Hobbelen H |title=Paratonia in Dementia: A Systematic Review |journal=J Alzheimers Dis |volume=78 |issue=4 |pages=1615–1637 |date=2020 |pmid=33185600 |pmc=7836054 |doi=10.3233/JAD-200691 |url=}}</ref> In advanced dementia paratonia may lead to fixed postures with contracted muscles, which can lead to broken skin, and infection, and also cause pain on movement. This type of motor disorder is not the same as that found in Lewy body dementias.<ref name="Drenth2020"/>
== Stages == The course of dementia is generally described in three major stages (early or mild, middle or moderate, and late or severe) that show a pattern of progressive cognitive and functional impairment. Other more detailed scales outline five or seven stages.<ref name="Stages2026">{{cite web |title=Seven Stages of Dementia {{!}} Symptoms, Progression & Durations |url=https://www.dementiacarecentral.com/aboutdementia/facts/stages/#:~:text=you%2C%20click%20here.-,Scales%20for%20Rating%20Dementia,GDS%20Stage%204%20or%20beyond. |access-date=17 March 2026}}</ref> A prodromal stage, or pre-dementia stage may also be included.<ref name="Jin2023"/> With Alzheimer's disease an asymptomatic preclinical stage may precede the onset of symptoms in the prodromal stage.<ref name="Watermeyer"/> A preclinical stage can be identified by the presence of noted brain changes of Alzheimer's disease but this stage does not always develop into dementia.<ref name="A and D2026">{{cite journal |title=2026 Alzheimer's disease facts and figures |journal=Alzheimer's & Dementia |date=April 2026 |volume=22 |issue=4 |article-number=e71345 |doi=10.1002/alz.71345 |pmc=13098189 }}</ref> As of 2024 this stage is now classed as ''Clinical Stage 1''.<ref name="A and D2026"/>
Different scales used to assess the stage of dementia include the Global Deterioration Scale (GDS) that uses seven stages in the progression, with mild (early) dementia only appearing as stage 4.<ref name="GDS">{{cite web |title=Understanding the Seven Stages of Dementia |url=https://www.nccdp.org/understanding-the-seven-stages-of-dementia-a-guide-for-caregivers-and-professionals/ |website=NCCDP |access-date=18 January 2026 |date=30 May 2025}}</ref><ref name="Stages2026"/> Two other scales used in relation to GDS are the Brief Cognitive Rating Scale (BCRS),<ref name="Apta2026">{{cite web |title=Brief cognitive rating scale |url=https://aptageriatrics.org/wp-content/uploads/2024/01/Brief-Cognitive-Rating-Scale-Pocket-Guide-APTA-Geriatrics.pdf |website=aptageriatrics |access-date=18 January 2026}}</ref> and the Functional Assessment Staging Tool (FAST).<ref name="GDS"/> The BCRS is a quick assessment that coincides with the GDS. It uses five axes in assessment – concentration, memory (recent and past), orientation, functioning and self-care.<ref name="Apta2026"/> FAST places more emphasis on functioning in daily living.<ref name="GDS"/> Another scale used is the Clinical Dementia Rating (CDR) scale originally designed just for Alzheimer's, that evaluates six main areas including memory, judgement, problem-solving, and personal care.<ref name="GDS"/>
=== Prodromal === A prodromal stage is a mild cognitive impairment (MCI) stage of pre-dementia, and may include mild behavioral impairment.<ref name="Jin2023"/> Signs and symptoms at the prodromal stage may be subtle, often only becoming apparent in hindsight.<ref name="ADCS">{{cite journal |vauthors=Atri A |title=The Alzheimer's Disease Clinical Spectrum: Diagnosis and Management |journal=Med Clin North Am |volume=103 |issue=2 |pages=263–293 |date=March 2019 |pmid=30704681 |doi=10.1016/j.mcna.2018.10.009 |doi-access=free }}</ref>
Mild cognitive impairment may progress to a dementia subtype; changes in the person's brain have been happening for a long time, but the symptoms are just beginning to appear, and are not severe enough to affect daily function. If and when they do, the diagnosis becomes one of a causative dementia subtype, such as minor neurocognitve disorder of Lewy body disease, for example. The person may have some memory problems and trouble finding words, but they can solve everyday problems and competently handle their life affairs.<ref name="Anand2024">{{cite journal |last1=Anand |first1=Shruti |last2=Schoo |first2=Caroline |title=Mild Cognitive Impairment |url=https://www.ncbi.nlm.nih.gov/books/NBK599514/ |website=StatPearls |publisher=StatPearls Publishing |access-date=9 April 2026 |date=2026 |pmid=38261679 }}</ref>
Mild cognitive impairment has been relisted in both DSM-5 and ICD-11 as "mild neurocognitive disorder", a milder form of a major neurocognitive disorder (dementia).<ref name="DSM5">{{cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |date=2013 |publisher=American psychiatric association |location=Washington |isbn=978-0-89042-554-1 |pages=605-606 |edition=5th}}</ref><ref name="ICD11">{{cite web |title=ICD-11 for Mortality and Morbidity Statistics |url=https://icd.who.int/browse/2026-01/mms/en#195531803 |website=icd.who.int |access-date=25 May 2026 |language=en}}</ref> MCI does not always progress to dementia, as sometimes symptoms resolve.<ref name="NINDS2025"/>
=== Early === In the early or mild stage of dementia, symptoms become noticeable to other people, and begin to interfere with daily activities, but only some help is needed.<ref name="Arvanitakis-2019" /> During this stage, it is good practice to ensure that advance care planning including advance directives are discussed.<ref name="EoLNHS2026"/>
Dementia subtypes affect different regions of the brain which in the early stage means that the symptoms are varied between individuals.<ref name="Stages2026A">{{cite web |title=Stages of dementia and progression {{!}} Alzheimer's Society |url=https://www.alzheimers.org.uk/about-dementia/stages-and-symptoms/progression-stages-dementia |website=www.alzheimers.org.uk |access-date=25 May 2026 |language=en}}</ref> The symptoms of early dementia usually include memory difficulty, but can also include some problems with language.<ref name="Arvanitakis-2019" /> Managing finances may prove difficult. Other signs might be getting lost in new places, repeating things, and personality changes.<ref>{{cite journal | vauthors = Islam M, Mazumder M, Schwabe-Warf D, Stephan Y, Sutin AR, Terracciano A | title = Personality Changes With Dementia From the Informant Perspective: New Data and Meta-Analysis | journal = Journal of the American Medical Directors Association | volume = 20 | issue = 2 | pages = 131–137 | date = February 2019 | pmid = 30630729 | pmc = 6432780 | doi = 10.1016/j.jamda.2018.11.004 }}</ref>
=== Middle === In the middle or moderate stage symptoms become more pronounced and more support will be needed with daily activities. Memory impairment worsens and frequent reminders may be needed. There may be difficulty in the recognition of familiar people. Holding onto new information becomes more difficult, causing questions to be continually repeated. In the middle stage word retrieval may be a problem; forgetting what they are saying in mid-sentence, and it may be harder to follow what is being said.<ref name="Stagesmid2026" />
In neurodegenerative dementias a lack of insight into having the condition will become evident.<ref name="Gallingani2025">{{cite journal |vauthors=Gallingani C, Tondelli M, Vannini P, Zamboni G |title=The association between anosognosia and neuropsychiatric symptoms in neurodegenerative dementias: a narrative review |journal=Front Neurol |volume=16 |issue= |article-number=1649627 |date=2025 |pmid=41079349 |pmc=12511066 |doi=10.3389/fneur.2025.1649627 |doi-access=free|url=}}</ref>
=== Late === People with late-stage, or severe, dementia typically turn increasingly inward and need assistance with most or all of their personal care. 24-hour supervision to meet basic needs and ensure personal safety is usually needed. If left unsupervised, they may wander or fall, fail to recognize common dangers such as a hot stove, or fail to realize that they need to use the bathroom and become incontinent. Both urinary and fecal incontinence may become prominent features that can prove challenging for both the person affected and the caregiver.<ref>{{Cite journal |date=June 21, 2022 |title=Continence, dementia, and care that preserves dignity |url=https://evidence.nihr.ac.uk/themedreview/continence-dementia-and-care-that-preserves-dignity/ |journal=NIHR Evidence |doi=10.3310/nihrevidence_51255 |s2cid=251785991|url-access=subscription }}</ref> They may not want to get out of bed, or may need assistance doing so. They may also struggle to walk.<ref>{{cite journal | vauthors = Mc Ardle R, Galna B, Donaghy P, Thomas A, Rochester L | title = Do Alzheimer's and Lewy body disease have discrete pathological signatures of gait? | journal = Alzheimer's & Dementia | volume = 15 | issue = 10 | pages = 1367–1377 | date = October 2019 | pmid = 31548122 | doi = 10.1016/j.jalz.2019.06.4953 | doi-access = free }}</ref> Commonly, the person no longer recognizes familiar faces. Sleep disturbances become more common and worsen in this stage.<ref name="Alz2026">{{cite web |title=Sleep problems and treatments for people with dementia {{!}} Alzheimer's Society |url=https://www.alzheimers.org.uk/about-dementia/stages-and-symptoms/sleep-problems-treatments-dementia |website=www.alzheimers.org.uk |access-date=27 May 2026 |language=en}}</ref>
Changes in eating frequently occur. Cognitive awareness is needed for eating and swallowing and progressive cognitive decline in advanced dementia, can result in eating and swallowing difficulties. This can cause food to be refused, or choked on, and help with feeding will often be required.<ref name="Payne">{{cite journal | vauthors = Payne M, Morley JE | title = Editorial: Dysphagia, Dementia and Frailty | journal = The Journal of Nutrition, Health & Aging | volume = 22 | issue = 5 | pages = 562–565 | date = May 1, 2018 | pmid = 29717753 | doi = 10.1007/s12603-018-1033-5 | s2cid = 13753522 | doi-access = free | pmc = 12876338 }}</ref> For ease of feeding, food may be liquidized into a thick purée.<ref>{{cite web |title=Mental, physical and speech abilities in later stages of dementia |url=https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/mental-and-physical-activities |website=Alzheimer's Society |date=June 29, 2022 |access-date=July 30, 2022}}</ref> The use of a feeding tube is not recommended; there are many complications and unwanted consequences associated with tube feeding.<ref name="NiCe2025">{{Cite web |title=Patient decision aid on enteral (tube) feeding for people living with severe dementia. |url=https://www.nice.org.uk/guidance/ng97/resources/enteral-tube-feeding-for-people-living-with-severe-dementia-patient-decision-aid-pdf-4852697007 |access-date=16 April 2025 |website=National Institute for Health and Care Excellence (NICE)}}</ref><ref name="AGSantipsychotic" /><ref name="NYT20160816">{{Cite news | url = https://www.nytimes.com/2016/08/30/health/tube-feeding-dementia-patients.html | title = The Decline of Tube Feeding for Dementia Patients | date = August 29, 2016 | work = The New York Times | vauthors = Span P | access-date = August 31, 2016 | url-status = live | archive-url = https://web.archive.org/web/20160903051930/http://www.nytimes.com/2016/08/30/health/tube-feeding-dementia-patients.html | archive-date = September 3, 2016 }}</ref>
''Paradoxical lucidity'', an unexpected transient recovery of mental clarity, can occur in some cases.<ref name="Ross2024">{{cite journal |vauthors=Ross JP, Post SG, Scheinfeld L |title=Lucidity in the Deeply Forgetful: A Scoping Review |journal=J Alzheimers Dis |volume=98 |issue=1 |pages=3–11 |date=2024 |pmid=38339937 |doi=10.3233/JAD-231396 |pmc=10977389 |url=}}</ref> Terminal lucidity may manifest shortly before death.<ref name="Ross2024"/>
==Types== Most types of dementia including Alzheimer's (the most common), Lewy body dementias, and frontotemporal dementia are neurodegenerative diseases, with protein misfolding as a cardinal feature.<ref name=Chung>{{cite journal |vauthors=Chung CG, Lee H, Lee SB |title=Mechanisms of protein toxicity in neurodegenerative diseases |journal=Cell Mol Life Sci |volume=75 |issue=17 |pages=3159–3180 |date=September 2018 |pmid=29947927 |pmc=6063327 |doi=10.1007/s00018-018-2854-4}}</ref> The next most common type of dementia after Alzheimer's is vascular dementia, a cerebrovascular disease. These are the main primary types.<ref name="NIAinfographic2025">{{cite web |title=Infographic: Understanding Different Types of Dementia |url=https://www.nia.nih.gov/health/alzheimers-and-dementia/understanding-different-types-dementia |website=National Institute on Aging |access-date=9 March 2026 |language=en}}</ref> Secondary types of dementia are secondary to a pre-existing condition, such as Huntington's dementia secondary to Huntington's disease, and HIV-associated dementia secondary to HIV. Different dementias have different causes and risk factors.<ref name="DementiaUK2026"/> But all types are characterized by loss of neurons, and consequent functioning.<ref name="NIA2026"/> Depressive cognitive disorder, formerly pseudodementia, describes dementia-like symptoms as a dementia secondary to a psychiatric condition especially to clinical depression.<ref name="Mars2025">{{cite journal |last1=Mars |first1=Jonathan A. |last2=Marwaha |first2=Raman |title=Depressive Cognitive Disorders |url=https://www.ncbi.nlm.nih.gov/books/NBK559256/ |website=StatPearls |publisher=StatPearls Publishing |access-date=26 February 2026 |date=2025 |pmid=32644682 }}</ref>
=== Alzheimer's disease === {{Main|Alzheimer's disease}} [[File:Alzheimers brain.jpg|thumb|Brain atrophy in severe Alzheimer's]]
Alzheimer's disease, also called Alzheimer's dementia, accounts for 60–70% of cases of dementia worldwide. Alzheimer's is often part of a mixed dementia diagnosis, typically together with vascular dementia, but also with Lewy body dementia.<ref name="DementiaUK2026"/> Mixed dementia has been acknowledged to be the most common type of dementia.<ref name="NIAAD2025">{{cite web |title=2025 NIH Alzheimer's Disease and Related Dementias Research Progress Report: Advances and Achievements |url=https://www.nia.nih.gov/about/2025-nih-dementia-research-progress-report |website=National Institute on Aging |access-date=22 February 2026 |language=en}}</ref>
A preclinical stage is described for Alzheimer's which is asymptomatic but which shows evidence of Alzheimer's pathology.<ref name="Watermeyer"/> This can precede the prodromal stage where symptoms become apparent. The loss of the sense of smell (anosmia) is recognized as a long prodromal stage in Alzheimer's.<ref name="Bhatia-Dey">{{cite journal |vauthors=Bhatia-Dey N, Heinbockel T |title=The Olfactory System as Marker of Neurodegeneration in Aging, Neurological and Neuropsychiatric Disorders |journal=Int J Environ Res Public Health |volume=18 |issue=13 |date=June 2021 |page=6976 |pmid=34209997 |doi=10.3390/ijerph18136976 |pmc=8297221 |doi-access=free }}</ref>
Symptoms may vary among individuals. Typically one of the first signs is a problem with memory. Other cognitive impairments can include difficulty in finding the right word, difficulties with visuospatial ability, and impaired reasoning and judgment. In the middle stage hallucinations may be a feature.<ref name="Stagesmid2026">{{cite web |title=The middle stage of dementia {{!}} Alzheimer's Society |url=https://www.alzheimers.org.uk/about-dementia/stages-and-symptoms/middle-stage-dementia |website=www.alzheimers.org.uk |access-date=25 May 2026 |language=en}}</ref> In later stages the symptoms become more severe, and include greater confusion, and changes in behavior.<ref name="NIAFacts2022">{{cite web |title=What Are the Signs of Alzheimer's Disease? |url=https://www.nia.nih.gov/health/alzheimers-symptoms-and-diagnosis/what-are-signs-alzheimers-disease |website=National Institute on Aging |access-date=6 March 2026 |language=en |date=18 October 2022}}</ref> A lack of insight into having a condition will become evident.<ref name="Gallingani2025"/>
The hallmark features of Alzheimer's disease are the deposits of amyloid beta in extracellular amyloid plaques, and the intracellular neurofibrillary tangles formed by hyperphosphorylated tau proteins.<ref name="NIA2024">{{cite web |title=What Happens to the Brain in Alzheimer's Disease? |url=https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/what-happens-brain-alzheimers-disease |website=National Institute on Aging |access-date=21 March 2026 |language=en |date=19 January 2024}}</ref> A protein (TREM2) malfunction can affect the microglial role of clearing cellular debris, allowing a build up of debris and plaques. Astrocytes another type of glial cell are recruited to help clear the debris but they too can become faulty as a result of the protein malfunction, and they with the microglia build up around the neurons and cause chronic inflammation that further damages the neurons.<ref name="NIA2024"/> The plaques and tangles may be detected in a preclinical stage decades before the onset of symptoms that appear in the prodromal stage.<ref name="Watermeyer">{{cite journal |vauthors=Watermeyer T, Calia C |title=Neuropsychological assessment in preclinical and prodromal Alzheimer disease: a global perspective |journal=J Glob Health |volume=9 |issue=1 |article-number=010317 |date=June 2019 |pmid=31073397 |pmc=6486120 |doi=10.7189/jogh.09.010317 |url=}}</ref>
Before the early 2000s, only brain tissue at autopsy could definitively diagnose Alzheimer's. Cerebrospinal fluid (CSF) analysis has since become available for detecting AD biomarkers, but blood-based biomarkers have taken the lead.<ref name="Valletta2025"/> Flotillin has been proposed as a potential fluid biomarker for detecting early Alzheimers in either CSF or blood.<ref name=Angelopoulou>{{cite journal |vauthors=Angelopoulou E, Paudel YN, Shaikh MF, Piperi C |title=Flotillin: A Promising Biomarker for Alzheimer's Disease |journal=J Pers Med |volume=10 |issue=2 |date=March 2020 |page=20 |pmid=32225073 |pmc=7354424 |doi=10.3390/jpm10020020 |doi-access=free }}</ref> A finger-prick blood sample for the diagnosis of early AD has been developed using p-tau 217 as biomarker.<ref name="Naturemed2026">{{cite journal |vauthors=Huber H, Montoliu-Gaya L, Brum WS, Vávra J, Yakoub Y, Weninger H, Braun-Wohlfahrt LS, Simrén J, Boada M, Ruiz A, Cano A, Orellana A, Valero S, Cañada L, Tantinya N, Nogales AB, Sanz-Cartagena P, Dittrich A, Skoog I, Sander-Long M, Ballard C, Richards M, O'Leary M, Clemmensen FK, Wandall HH, Altomare D, Cantoni V, Stomrud E, Palmqvist S, Lleo A, Alcolea D, Carmona Iragui M, Hernandez AS, Benejam B, Videla Toro L, Singh A, Denkinger MN, Simonsen AH, Kern S, Corbett A, Fortea J, Honigberg L, Borroni B, Hansson O, Morató X, Blennow K, Zetterberg H, Ashton NJ |title=A minimally invasive dried blood spot biomarker test for the detection of Alzheimer's disease pathology |journal=Nat Med |volume=32 |issue=2 |pages=599–608 |date=February 2026 |pmid=41491101 |pmc=12920126 |doi=10.1038/s41591-025-04080-0 |url=}}</ref>
Several neuroimaging techniques are also now available to help diagnose and differentiate dementia types and show their stage of progression.<ref name="Chouliaras2023" /> These include magnetic resonance imaging (MRI), CT scans, and amyloid PET scans using a tracer Pittsburgh compound B or florbetapir. Amyloid PET imaging has made possible the development of anti-amyloid immunotherapies, such as donanemab, and lecanemab, for use in mild NCI due to Alzheimer's or in mild Alzheimer's.<ref name="NIAAD2025"/> For detecting tau protein another PET scan tracer flortaucipir was approved for use in the US and Europe in 2024.<ref name="Tauvid EPAR">{{cite web | title=Tauvid EPAR | website=European Medicines Agency | date=27 June 2024 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/tauvid | access-date=25 February 2025}}</ref>
The part of the brain most affected by Alzheimer's is the medial temporal lobe which has a vital role in spatial and episodic memory. The medial temporal lobe includes the hippocampus, amygdala, and parahippocampal gyrus, and is the earliest site of atrophy and tau pathology.<ref name="Parker2025">{{cite journal |vauthors=Parker DM, Adams JN, Kim S, McMillan L, Yassa MA |title=NODDI-derived measures of microstructural integrity in medial temporal lobe white matter pathways are associated with Alzheimer's disease pathology and cognition |journal=Imaging Neurosci (Camb) |volume=3 |issue= |date=2025 |article-number=IMAG.a.950 |pmid=41143078 |pmc=12550277 |doi=10.1162/IMAG.a.950 |url=}}</ref> NODDI (neurite orientation dispersion and density imaging) is an emerging diffusion MRI technique for examining the microstructure of the grey and white matter of the brain's tissue.<ref name="Parker2025"/> It can show changes in neurodegeneration in relation to ageing and to Alzheimer's, and is used for investigating links between neurite density, MCI and Alzheimer's.<ref name="Brito2025">{{cite journal | last1=Brito | first1=Lucas Z. | last2=Cabeen | first2=Ryan P. | last3=Laidlaw | first3=David H. | title=General Microstructure Factor Analysis of Diffusion MRI in Gray-Matter Predicts Cognitive Scores | journal=Arxiv | date=2025 | pmid=41281215 | pmc=12636761 | arxiv=2510.24879 }}</ref>
=== Vascular dementia=== {{Main|Vascular dementia}} [[File:Fcvm-08-803169-g0001.jpg|thumb|Risk factors and signs and symptoms of vascular dementia]] Vascular dementia accounts for at least 20% of dementia cases, making it the second most common type.<ref name="Iadecola">{{cite journal | vauthors = Iadecola C | title = The pathobiology of vascular dementia | journal = Neuron | volume = 80 | issue = 4 | pages = 844–866 | date = November 2013 | pmid = 24267647 | pmc = 3842016 | doi = 10.1016/j.neuron.2013.10.008 }}</ref> It is also the most common type found with Alzheimer's in mixed dementia.<ref name="DementiaUK2026"/> Vascular dementia is caused by disease or injury affecting the blood supply to the brain, typically involving a series of mini-strokes. Symptoms depend on where in the brain the strokes occurred and whether the blood vessels affected were large or small.<ref name="Wong2022">{{cite journal |vauthors=Wong CE, Chui CH |title=Vascular cognitive impairment and dementia |journal=Continuum|volume=28 |issue=3 |pages=750–780 |date=June 2022 |pmid=35678401 |pmc=9833847 |doi=10.1212/CON.0000000000001124}}</ref> Hallucinations may also feature in the middle stage.<ref name="Stagesmid2026" /> Repeated injury can cause progressive dementia over time, while a single injury located in an area critical for cognition such as the hippocampus, or thalamus, can lead to sudden cognitive decline.<ref name="Iadecola" /> Elements of vascular dementia may be present in all other forms of dementia.<ref name=Baskys>{{cite journal |vauthors=Baskys A, Cheng JX |title=Pharmacological prevention and treatment of vascular dementia: approaches and perspectives |journal=Exp Gerontol |volume=47 |issue=11 |pages=887–891 |date=November 2012 |pmid=22796225 |doi=10.1016/j.exger.2012.07.002 |s2cid=1153876}}</ref>
Brain scans may show evidence of multiple strokes of different sizes in various locations. Risk factors include tobacco use, high blood pressure, atrial fibrillation, high cholesterol, diabetes, or other signs of vascular disease such as a previous heart attack or angina.<ref>{{Cite web|title=Vascular dementia – Symptoms and causes|url=https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793|access-date=July 8, 2021|website=Mayo Clinic|language=en}}</ref>
=== Lewy body dementias === {{Main|Dementia with Lewy bodies}} Lewy body dementias include dementia with Lewy bodies, and Parkinson's disease dementia. Parkinson's disease and dementia with Lewy bodies are synucleinopathies characterized by the presence of Lewy bodies in the brain. (A Lewy body is an inclusion body as an aggregate of alpha-synuclein protein). Parkinson's disease dementia, and dementia with Lewy bodies both present with similar signs and symptoms, and the only real difference between them is that Parkinson's disease precedes Parkinson's dementia typically by about a year.<ref name="Abdelmoaty">{{cite journal |vauthors=Abdelmoaty MM, Lu E, Kadry R, Foster EG, Bhattarai S, Mosley RL, Gendelman HE |title=Clinical biomarkers for Lewy body diseases |journal=Cell Biosci |volume=13 |issue=1 |article-number=209 |date=November 2023 |pmid=37964309 |pmc=10644566 |doi=10.1186/s13578-023-01152-x |doi-access=free |url=}}</ref>
The prodromal symptoms of dementia with Lewy bodies (DLB) include mild cognitive impairment, and delirium onset.<ref name="McKeith">{{cite journal |vauthors=McKeith IG, Ferman TJ, Thomas AJ, et al |title=Research criteria for the diagnosis of prodromal dementia with Lewy bodies |journal=Neurology |volume=94 |issue=17 |pages=743–755 |date=April 2020 |pmid=32241955 |pmc=7274845 |doi=10.1212/WNL.0000000000009323}}</ref> The symptoms of DLB are more frequent, more severe, and earlier presenting than in the other subtypes.<ref name="Jurek">{{cite journal |vauthors=Jurek L, Herrmann M, Bonze M et al. |title=Behavioral and psychological symptoms in Lewy body disease: a review |journal= Gériatrie et Psychologie Neuropsychiatrie du Vieillissement|volume=16 |issue=1 |pages=87–95 |date=March 1, 2018 |pmid=29569570 |doi=10.1684/pnv.2018.0723 }}</ref> Dementia with Lewy bodies has the primary symptoms of fluctuating cognition, alertness or attention; REM sleep behavior disorder (RBD); one or more of the main features of parkinsonism, not due to medication or stroke; and repeated visual hallucinations.<ref name= McKeithConsensus2017>{{cite journal |vauthors=McKeith IG, Boeve BF, Dickson DW, et al |title=Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium |journal=Neurology |volume=89 |issue=1 |pages=88–100 |date=July 2017 |pmid=28592453 |pmc=5496518 |doi=10.1212/WNL.0000000000004058 |type=Review}}</ref> Up to 80% of cases experience visual hallucinations that are well formed and usually of people, animals, or children.<ref name= McKeithConsensus2017 /> There is also disruption in autonomic bodily functions.<ref name= Taylor2020>{{cite journal |vauthors=Taylor JP, McKeith IG, Burn DJ et al |title=New evidence on the management of Lewy body dementia |journal=Lancet Neurol |volume=19 |issue=2 |pages=157–169 |date=February 2020 |pmid=31519472 |doi=10.1016/S1474-4422(19)30153-X |pmc=7017451 |type= Review }} Courtesty link available [https://ore.exeter.ac.uk/repository/bitstream/handle/10871/36535/Management%20Lewy%20body%20dementia_versionsubmittedtoTLNwithappendix.pdf?sequence=10&isAllowed=y here.] {{Webarchive|url=https://web.archive.org/web/20200703102323/https://ore.exeter.ac.uk/repository/bitstream/handle/10871/36535/Management%20Lewy%20body%20dementia_versionsubmittedtoTLNwithappendix.pdf?sequence=10&isAllowed=y |date=July 3, 2020 }}</ref> Abnormal sleep behaviors may begin before cognitive decline is observed and are a core feature of DLB.<ref name= McKeithConsensus2017/> RBD is diagnosed either by sleep study recording or, when sleep studies cannot be performed, by medical history and validated questionnaires.<ref name= McKeithConsensus2017/>
=== Frontotemporal dementias=== {{Main|Frontotemporal dementia}}
Frontotemporal dementias (FTDs) are characterized by drastic personality changes, and language difficulties. In all types, early social withdrawal and lack of insight are major features but not memory problems.<ref>{{cite journal | vauthors = Finger EC | title = Frontotemporal Dementias | journal = Continuum | volume = 22 | issue = 2 Dementia | pages = 464–489 | date = April 2016 | pmid = 27042904 | pmc = 5390934 | doi = 10.1212/CON.0000000000000300 }}</ref> The most common variant known as behavioral variant FTD (bv-FTD) presents major symptoms of changes in personality and behavior. bv-FTD is a young onset dementia typically affecting those between the ages of 45 and 65.<ref name="Chen2025">{{cite journal |vauthors=Chen T, Ahmed RM, Narasimhan M, Yang T, Foxe D, Piguet O, Irish M |title=Anterior Insula Drives Progressive Structural Brain Network Atrophy in the Behavioural Variant of Frontotemporal Dementia |journal=Hum Brain Mapp |volume=46 |issue=14 |article-number=e70374 |date=October 2025 |pmid=41065198 |pmc=12509179 |doi=10.1002/hbm.70374 |url=}}</ref> In bv-FTD, there is a progressive atrophy of grey matter that in early stages affects areas of executive function responsible for inhibitory control for example. This early atrophy results in socioemotional disturbances such as impulsive behavior.<ref name="Chen2025"/>
Other rare subtypes of FTD are three variants of primary progressive aphasia – language-led dementias that feature aphasia (language problems) as the main symptom.<ref name="NINDS2025"/> One type is semantic dementia (or semantic PPA) with the main feature of the loss of the meaning of words.<ref name="NIA2025"/> Another type is called progressive nonfluent aphasia (or agrammatic PPA), mainly a difficulty in producing speech, not being able to find the right words, and also problems in coordinating the muscles needed for speech. Eventually the ability to talk at all may be lost.<ref name="NIA2025"/> The third type is logopenic progressive aphasia (discovered in 2004) and features impairment in the repetition of words or phrases, and impairment in retrieving words.<ref name="Taylor">{{cite journal |vauthors=Taylor B, Bocchetta M, Shand C, Todd EG, Chokesuwattanaskul A, Crutch SJ, Warren JD, Rohrer JD, Hardy CJ, Oxtoby NP |title=Data-driven neuroanatomical subtypes of primary progressive aphasia |journal=Brain |volume=148 |issue=3 |pages=955–968 |date=March 2025 |pmid=39374849 |pmc=11884653 |doi=10.1093/brain/awae314 |url=}}</ref>
A frontotemporal dementia (bvFTD) that overlaps with amyotrophic lateral sclerosis (ALS) is known as (FTD-ALS), and includes the symptoms of bvFTD (behavior, language and movement problems) and decline in motor functions of amyotrophic lateral sclerosis.<ref name="NIA2025">{{cite web |title=Frontotemporal Disorders: Causes, Symptoms, and Diagnosis |url=https://www.nia.nih.gov/health/frontotemporal-disorders/what-are-frontotemporal-disorders-causes-symptoms-and-treatment |website=National Institute on Aging |access-date=24 January 2026 |language=en |date=22 January 2025}}</ref> Two FTD-related disorders are progressive supranuclear palsy, and corticobasal degeneration, both of which are tauopathies.<ref name="NIA2025"/>
=== Mixed dementia === More than one type of dementia, known as mixed dementia, may exist together in at least 10% of dementia cases. The most common type of mixed dementia is Alzheimer's disease and vascular dementia, and the second most common is Alzheimer's and Lewy body dementia. Mixed dementia occurs more frequently in the elderly and seem to progress more rapidly.<ref name="DementiaUK2026"/> In 2025 an NIH study reported that mixed dementia has been acknowledged as the most common type of dementia.<ref name="NIAAD2025"/>
Diagnosis of mixed dementia can be difficult, as often only one type will predominate, which means that many people may miss out on potentially helpful treatments. Mixed dementia can mean that symptoms onset earlier, and worsen more quickly since more parts of the brain will be affected.<ref name="DementiaUK2026"/>
===Autoimmune dementia=== Cognitive decline due to an autoimmune disease can be mistaken for that of a dementia subtype. The importance of correctly identifying an autoimmune dementia is critical in approved treatments. Being treated for dementia rules out immmunotherapy which could treat and reverse the disorder. Also to treat Alzheimer's with monoclonal antibodies would be contraindicated if there are unreported autoantibodies present.<ref name="Hansen2025">{{cite journal |vauthors=Hansen N |title=Update on autoimmune dementia and its precursors |journal=Behav Brain Res |volume=482 |issue= |article-number=115460 |date=March 2025 |pmid=39889830 |doi=10.1016/j.bbr.2025.115460 |url=}}</ref><ref name="Sechi2019">{{cite journal |vauthors=Sechi E, Flanagan EP |title=Diagnosis and Management of Autoimmune Dementia |journal=Curr Treat Options Neurol |volume=21 |issue=3 |article-number=11 |date=February 2019 |pmid=30809732 |doi=10.1007/s11940-019-0550-9 |url=}}</ref>
===Childhood dementias=== There are many childhood dementias, most of which have a genetic cause.<ref name="Elvidge">{{cite journal |vauthors=Elvidge KL, Christodoulou J, Farrar MA, Tilden D, Maack M, Valeri M, Ellis M, Smith NJ |title=The collective burden of childhood dementia: a scoping review |journal=Brain |volume=146 |issue=11 |pages=4446–4455 |date=November 2023 |pmid=37471493 |pmc=10629766 |doi=10.1093/brain/awad242 |url=}}</ref>
===Early onset dementia=== Around 7% of people over the age of 65 have dementia, with slightly higher rates (up to 10% of those over 65) in places with relatively high life expectancy.<ref name="Gale2018">{{cite journal |vauthors=Gale SA, Acar D, Daffner KR |title=Dementia |journal=Am J Med |volume=131 |issue=10 |pages=1161–1169 |date=October 2018 |pmid=29425707 |doi=10.1016/j.amjmed.2018.01.022 |s2cid=240122313}}</ref> Dementia can develop before the age of 65 when it is known as early onset dementia or young-onset dementia.<ref name="ADUK">{{cite web |title=What causes young-onset dementia? {{!}} Alzheimer's Society |url=https://www.alzheimers.org.uk/about-dementia/types-dementia/what-causes-young-onset-dementia |website=alzheimers.org.uk |access-date=January 10, 2022 |language=en}}</ref>
Less than 1% of those with early-onset Alzheimer's dementia have genetic mutations that cause a much earlier onset, around the age of 45.<ref name="Masters_2015">{{cite journal | vauthors = Masters CL, Bateman R, Blennow K, Rowe CC, Sperling RA, Cummings JL | title = Alzheimer's disease | language = English | journal = Nature Reviews. Disease Primers | volume = 1 | article-number = 15056 | date = October 2015 | pmid = 27188934 | doi = 10.1038/nrdp.2015.56 | s2cid = 20844163 }}</ref>
===Later onset dementia=== A type of dementia has been classified as limbic-predominant age-related TDP-43 encephalopathy (LATE). It can only be diagnosed on autopsy when clusters of TDP-43 are found in the brain. It usually has a late onset typically affecting those over 80, and can also be found alongside Alzheimer's disease. <ref name="NIA2026B">{{cite web |title=What Is Limbic-Predominant Age-Related TDP-43 Encephalopathy (LATE)? |url=https://www.nia.nih.gov/health/alzheimers-and-dementia/what-limbic-predominant-age-related-tdp-43-encephalopathy-late |website=National Institute on Aging |access-date=27 January 2026 |language=en |date=24 February 2023}}</ref>
==Secondary dementias== Secondary dementias are those that develop from another condition, and include chronic traumatic encephalopathy,<ref name="McKee2023">{{cite journal |vauthors=McKee AC, Stein TD, Huber BR, Crary JF, Bieniek K, Dickson D, Alvarez VE, Cherry JD, Farrell K, Butler M, Uretsky M, Abdolmohammadi B, Alosco ML, Tripodis Y, Mez J, Daneshvar DH |title=Chronic traumatic encephalopathy (CTE): criteria for neuropathological diagnosis and relationship to repetitive head impacts |journal=Acta Neuropathol |volume=145 |issue=4 |pages=371–394 |date=April 2023 |pmid=36759368 |pmc=10020327 |doi=10.1007/s00401-023-02540-w |url=}}</ref> Huntington's disease dementia, HIV-associated neurocognitive disorder, prion diseases, and alcohol use disorder.
=== Huntington's disease === {{Main|Huntington's disease}}
Huntington's disease is a neurodegenerative disease caused by mutations in a single gene ''HTT'', that encodes for huntingtin protein. Symptoms include cognitive impairment that usually declines further into dementia. Other symptoms include chorea (jerky movements), memory lapses, depression, stumbling and clumsiness, mood swings, and behavior changes such as impulsivity and irritability that can become more aggressive in later stages.<ref name=Frank2014>{{cite journal | vauthors = Frank S | title = Treatment of Huntington's disease | journal = Neurotherapeutics | volume = 11 | issue = 1 | pages = 153–160 | date = January 2014 | pmid = 24366610 | pmc = 3899480 | doi = 10.1007/s13311-013-0244-z}}</ref>
=== HIV === {{Main|HIV-associated neurocognitive disorder}}
HIV-associated neurocognitive disorder (HAND) results as a late stage from HIV infection, and mostly affects younger people. The essential features of HAND are disabling cognitive impairment accompanied by motor dysfunction, speech problems and behavioral change. Cognitive impairment is characterised by mental slowness, trouble with memory and poor concentration. Motor symptoms include a loss of fine motor control leading to clumsiness, poor balance and tremors. Behavioral changes may include apathy, lethargy and diminished emotional responses and spontaneity. HAND is the predominant form, and HIV-associated dementia is rare.<ref name="Saylor2016">{{cite journal |vauthors=Saylor D, Dickens AM, Sacktor N, Haughey N, Slusher B, Pletnikov M, Mankowski JL, Brown A, Volsky DJ, McArthur JC |title=HIV-associated neurocognitive disorder--pathogenesis and prospects for treatment |journal=Nat Rev Neurol |volume=12 |issue=4 |pages=234–48 |date=April 2016 |pmid=26965674 |pmc=4937456 |doi=10.1038/nrneurol.2016.27 |url=}}</ref>
=== Prion diseases=== Prion diseases typically cause dementia that worsens over weeks to months. Prion diseases are very rare and include Creutzfeldt–Jakob disease, Gerstmann–Sträussler–Scheinker syndrome, and fatal familial insomnia. Prions are misfolded proteins, that cause other proteins to misfold, and build up in the brain.<ref name="Gao2024">{{cite journal |vauthors=Gao LP, Tian TT, Xiao K, Chen C, Zhou W, Liang DL, Cao RD, Shi Q, Dong XP |title=Updated global epidemiology atlas of human prion diseases |journal=Front Public Health |volume=12 |issue= |article-number=1411489 |date=2024 |pmid=38939567 |doi=10.3389/fpubh.2024.1411489 |doi-access=free|pmc=11208307 |bibcode=2024FrPH...1211489G |url=}}</ref>
=== Alcohol-related dementia=== {{Main|Alcohol-related dementia}}
Alcohol-related dementia, occurs as a result of alcohol-related brain damage due to alcoholism. Different factors can be involved in this development including thiamine deficiency and age vulnerability. A degree of brain damage is seen in more than 70% of cases of alcoholism. Brain regions affected are similar to those that are affected by aging, and also by Alzheimer's. Regions showing loss of volume include the frontal, temporal, and parietal lobes, as well as the cerebellum, thalamus, and hippocampus. This loss can be more notable, with greater cognitive impairments seen in those aged 65 years and over.<ref name=Nunes>{{cite book |vauthors=Nunes PT, Kipp BT, Reitz NL, Savage LM |title=Late Aging Associated Changes in Alcohol Sensitivity, Neurobehavioral Function, and Neuroinflammation |chapter=Aging with alcohol-related brain damage: Critical brain circuits associated with cognitive dysfunction |series=International Review of Neurobiology |volume=148 |pages=101–168 |date=2019 |pmid=31733663 |pmc=7372724 |doi=10.1016/bs.irn.2019.09.002 |isbn=978-0-12-817530-9 }}</ref>
===Conditions with dementia-like symptoms=== Autoimmune dementias of autoimmune disorder origin can mimic subtypes of dementia. They are potentially treatable if recognized and can have a good response to immunotherapy.<ref name="Sechi2019" />
Cases of easily reversible dementia include hormone and vitamin deficiencies, and infections such as Lyme disease, and neurosyphilis.<ref name="Bransfield2018">{{cite journal |vauthors=Bransfield RC |title=Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist's Clinical Practice |journal=Healthcare |volume=6 |issue=3 |date=August 2018 |page=104 |pmid=30149626 |pmc=6165408 |doi=10.3390/healthcare6030104 |doi-access=free|url=}}</ref>
Congenital genetic disorders that can also cause symptoms of dementia are known as inborn errors of metabolism.<ref name="Ferreira2019">{{cite book |vauthors=Ferreira CR, van Karnebeek CD |chapter=Inborn errors of metabolism |title=Neonatal Neurology |series=Handbook of Clinical Neurology |volume=162 |pages=449–481 |date=2019 |pmid=31324325 |pmc=11755387 |doi=10.1016/B978-0-444-64029-1.00022-9 |isbn=978-0-444-64029-1 |url=}}</ref>
== Diagnosis == {{See also|Executive dysfunction#Testing and measurement}} The symptoms of dementia may vary depending on the underlying subtype, and between individuals, particularly in the early stages but at the end stage of all types they are similar. Diagnosis by symptoms alone is difficult, made more so when there is more than one type.<ref name="NIAinfographic2025"/> A medical history will be taken, and cognitive testing carried out.<ref name="NHS2023"/> Blood tests can rule out possible treatable causes such as vitamin deficiencies and hormone imbalances, or rule in probable Alzheimer's. One or more types of scan may also be needed.<ref name="Chouliaras2023"/> The DSM5 (2013) published by the American Psychiatric Association gives the diagnostic criteria for a primary dementia as the recognition of a significant decline in one or more cognitive domains that interfere with the ability to carry out everyday activities; the cognitive deficits are not exclusive to delirium, and are not explained by mental disorders such as schizophrenia, and major depressive disorder.<ref name="ASHA2026"/><ref name="DSM5a"/>
A number of brief cognitive tests (5–15 minutes) are available that are reasonably reliable but results need to take into account the influence of a person's educational level.<ref name="NHS2023">{{cite web |title=Tests for diagnosing dementia |url=https://www.nhs.uk/conditions/dementia/symptoms-and-diagnosis/tests/#:~:text=People%20with%20symptoms%20of%20dementia,Assessment%20of%20Cognition%20(GPCOG). |website=nhs.uk |access-date=12 March 2026 |language=en |date=18 August 2023}}</ref> The mini–mental state examination (MMSE) is the best studied and most commonly used test.<ref name="GDS"/> This is useful in diagnosis if the results are interpreted along with an assessment of a person's personality, their ability to perform activities of daily living, and their behavior.<ref name=Creavin>{{cite journal | vauthors = Creavin ST, Wisniewski S, Noel-Storr AH, Trevelyan CM, Hampton T, Rayment D, Thom VM, Nash KJ, Elhamoui H, Milligan R, Patel AS, Tsivos DV, Wing T, Phillips E, Kellman SM, Shackleton HL, Singleton GF, Neale BE, Watton ME, Cullum S | title = Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 1 | article-number = CD011145 | date = January 2016 | pmid = 26760674 | pmc = 8812342 | doi = 10.1002/14651858.CD011145.pub2 | hdl-access = free | hdl = 1983/00876aeb-2061-43f5-b7e1-938c666030ab }}</ref> Other cognitive tests include the abbreviated mental test score (AMTS), the modified mini–mental state examination (3MS),<ref name="niddk">{{cite web |title=Mini mental state examination |url=https://repository.niddk.nih.gov/media/studies/cric/Forms/MMSE_V3.0.20131211.pdf |website=niddk.nih.org |access-date=9 February 2026}}</ref> the Cognitive Abilities Screening Instrument (CASI),<ref name="Tureson2023">{{cite journal |last1=Tureson |first1=Kayla N |last2=Beam |first2=Christopher R. |last3=Medina |first3=Luis Daniel |last4=D'Orazio |first4=Lina M |last5=Ringman |first5=John M |title=Utility of Cognitive Abilities Screening Instrument (CASI) subscores in detecting early impairment in autosomal dominant Alzheimer's disease (ADAD) |journal=Alzheimer's & Dementia |date=December 2023 |volume=19 |issue=S18 |article-number=e080775 |doi=10.1002/alz.080775}}</ref> the Trail-making test,<ref name="Linari2022">{{cite journal |vauthors=Linari I, Juantorena GE, Ibáñez A, Petroni A, Kamienkowski JE |title=Unveiling Trail Making Test: visual and manual trajectories indexing multiple executive processes |journal=Sci Rep |volume=12 |issue=1 |article-number=14265 |date=August 2022 |pmid=35995786 |pmc=9395513 |doi=10.1038/s41598-022-16431-9 |arxiv=2109.15255 |bibcode=2022NatSR..1214265L |url=}}</ref> and the clock drawing test.<ref name="AHR2020">{{cite web |last1=Patnode |first1=Carrie D. |last2=Perdue |first2=Leslie A. |last3=Rossom |first3=Rebecca C. |last4=Rushkin |first4=Megan C. |last5=Redmond |first5=Nadia |last6=Thomas |first6=Rachel G. |last7=Lin |first7=Jennifer S. |title=Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force |url=https://www.ncbi.nlm.nih.gov/books/NBK554654/ |publisher=Agency for Healthcare Research and Quality (US) |access-date=17 March 2026 |date=2020}}</ref>The Montreal Cognitive Assessment (MoCA) is a reliable screening test and is freely available online in many languages.<ref name="MoCA2026">{{cite web |title={{!}} MoCA Test |url=https://mocacognition.com/the-moca-test/ |website=mocacognition.com |access-date=9 February 2026}}</ref> The MoCA has also been shown to be somewhat better at detecting mild cognitive impairment than the MMSE.<ref name="Pinto2019">{{cite journal |vauthors=Pinto TC, Machado L, Bulgacov TM, Rodrigues-Júnior AL, Costa ML, Ximenes RC, Sougey EB |title=Is the Montreal Cognitive Assessment (MoCA) screening superior to the Mini-Mental State Examination (MMSE) in the detection of mild cognitive impairment (MCI) and Alzheimer's Disease (AD) in the elderly? |journal=Int Psychogeriatr |volume=31 |issue=4 |pages=491–504 |date=April 2019 |pmid=30426911 |doi=10.1017/S1041610218001370 |url=}}</ref> An adapted version is available, suitable for those with hearing loss, that avoids the need for people to listen and respond to questions.<ref>{{cite journal | vauthors = Dawes P, Reeves D, Yeung WK, Holland F, Charalambous AP, Côté M, David R, Helmer C, Laforce R, Martins RN, Politis A, Pye A, Russell G, Sheikh S, Sirois MJ, Sohrabi HR, Thodi C, Gallant K, Nasreddine Z, Leroi I | title = Development and validation of the Montreal cognitive assessment for people with hearing impairment (MoCA-H) | journal = Journal of the American Geriatrics Society | volume = 71 | issue = 5 | pages = 1485–1494 | date = May 2023 | pmid = 36722180 | doi = 10.1111/jgs.18241 | s2cid = 256457783 | doi-access = free }}</ref> RUDAS, the Rowland Universal Dementia Assessment Scale, is a short dementia screening test for use in diverse multi-ethnic communities designed to overcome language and cultural differences.<ref name="Cambridge">{{cite web |title=RUDAS scale |url=https://static.cambridge.org/content/id/urn:cambridge.org:id:article:S1041610204000043/resource/name/-IPG16_1sup-RUDAS_Scale_Web.pdf |website=cambridge.org |access-date=19 January 2026}}</ref> An integrated cognitive assessment (CognICA) is a five-minute test that is highly sensitive to the early stages of dementia, and uses a mobile app deliverable to an iPad.<ref name="Bee">{{cite news | vauthors = Bee P |title=The five-minute test that can tell if you're on the road to dementia |url=https://www.thetimes.com/uk/healthcare/article/dementia-test-integrated-cognitive-awareness-cognica-x2tqx0jhd |access-date=January 1, 2022 |language=en}}</ref><ref name="FDA"/> Previously in use in the UK, in 2021 CognICA was given FDA approval for its commercial use as a medical device.<ref name="FDA">{{cite web |title=FDA Clears 5-Minute Test for Early Dementia |url=https://www.medscape.com/viewarticle/961277 |website=Medscape |access-date=January 1, 2022 |language=en}}</ref>
Informant-based questionnaires are also widely used to gain a better understanding of the types and severity of cognitive decline, and also of behavioral changes. Possibly the best known is the Informant Questionnaire on Cognitive Decline in the Elderly.<ref name="Burton">{{cite journal | vauthors = Burton JK, Stott DJ, McShane R, Noel-Storr AH, Swann-Price RS, Quinn TJ | title = Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the early detection of dementia across a variety of healthcare settings | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 7 | article-number = CD011333 | date = July 2021 | pmid = 34275145 | pmc = 8406787 | doi = 10.1002/14651858.CD011333.pub3 }}</ref> A well-established one used to capture behavioral changes is the Neuropsychiatric Inventory (NPI).<ref name="Cummings">{{cite journal |vauthors=Cummings J |title=The Neuropsychiatric Inventory: Development and Applications |journal=J Geriatr Psychiatry Neurol |volume=33 |issue=2 |pages=73–84 |date=March 2020 |pmid=32013737 |pmc=8505128 |doi=10.1177/0891988719882102 |url=}}</ref> A similar scale based on the NPI is the Cambridge Behavioural Inventory which has been shown to be able to differentiate the neurodegenerative disorders by grouping common behavioral symptoms.<ref name="Wear">{{cite journal |vauthors=Wear HJ, Wedderburn CJ, Mioshi E, Williams-Gray CH, Mason SL, Barker RA, Hodges JR |title=The Cambridge Behavioural Inventory revised |journal=Dement Neuropsychol |volume=2 |issue=2 |pages=102–107 |date=2008 |pmid=29213551 |pmc=5619578 |doi=10.1590/S1980-57642009DN20200005 |url=}}</ref> The General Practitioner Assessment Of Cognition combines a patient assessment with an informant interview, designed for use in the primary care setting. The AD-8, an informant assessment for dementia screening questionnaire using eight items, is used to assess changes in function related to cognitive decline and is potentially useful, but is not diagnostic, is variable, and has risk of bias.<ref>{{cite journal | vauthors = Hendry K, Green C, McShane R, Noel-Storr AH, Stott DJ, Anwer S, Sutton AJ, Burton JK, Quinn TJ | title = AD-8 for detection of dementia across a variety of healthcare settings | journal = The Cochrane Database of Systematic Reviews | volume = 3 | issue = 3 | article-number = CD011121 | date = March 2019 | pmid = 30828783 | pmc = 6398085 | doi = 10.1002/14651858.CD011121.pub2 }}</ref>
Depressive cognitive disorders (previously known as pseudodementias) include symptoms of depression, commonly found in dementia, and delirium. In contrast to dementia, cognitive dysfunction in delirium is marked by a sudden onset with a much shorter duration.<ref>{{cite journal | vauthors = Caplan JP, Rabinowitz T | title = An approach to the patient with cognitive impairment: delirium and dementia | journal = The Medical Clinics of North America | volume = 94 | issue = 6 | pages = 1103–1116, ix | date = November 2010 | pmid = 20951272 | doi = 10.1016/j.mcna.2010.08.004 }}</ref> Machine learning and artificial intelligence have the potential to enhance assessment.<ref name="Javeed2023"/>
Individuals diagnosed with dementia, particularly in the early stages, may face an elevated risk of suicide. The risk of suicide is significantly higher within the first three months and up to a year after a dementia diagnosis, especially among those diagnosed before the age of 65.<ref name="Mohamad">{{cite journal |vauthors=Mohamad MA, Leong Bin Abdullah MF, Shari NI |title=Similarities and differences in the prevalence and risk factors of suicidal behavior between caregivers and people with dementia: a systematic review |journal=BMC Geriatr |volume=24 |issue=1 |article-number=254 |date=March 2024 |pmid=38486186 |pmc=10941364 |doi=10.1186/s12877-024-04753-4 |doi-access=free |url=}}</ref>
=== Imaging === Neuroimaging techniques are commonly used to rule out reversible causes of dementia such as normal pressure hydrocephalus (a build up of cerebrospinal fluid in the ventricles). Scans can also show if the cause is a tumor, or show evidence of a stroke which would indicate vascular dementia.<ref name="Chouliaras2023">{{cite journal |vauthors=Chouliaras L, O'Brien JT |title=The use of neuroimaging techniques in the early and differential diagnosis of dementia |journal=Mol Psychiatry |volume=28 |issue=10 |pages=4084–4097 |date=October 2023 |pmid=37608222 |pmc=10827668 |doi=10.1038/s41380-023-02215-8 |url=}}</ref> PET-CT scans (functioning and structural, respectively) are useful in differentiating types of dementia.<ref name="Chouliaras2023"/> A PET scan that uses a radiotracer, commonly FDG can highlight areas of low glucose metabolism in the brain. A pattern of reduced glucose metabolism shown in the temporal and parietal lobes is indicative of Alzheimer's, other patterns are particular to FTD or to LBD.<ref name="Chouliaras2023"/> Amyloid imaging (amyloid PET) uses a radiotracer that binds to amyloid plaques (large numbers are a hallmark feature of Alzheimer's) to provide detailed images of the distribution of amyloid. This can show up years, even decades, before the onset of symptoms. Serial amyloid imaging shows amyloid beta deposits firstly in the anterior temporal areas that then spread to the frontal and medial parietal regions, the associative neocortex, and then to the primary sensorimotor areas and subcortical regions.<ref name="Chouliaras2023"/><ref name="Chapleau2022">{{cite journal |vauthors=Chapleau M, Iaccarino L, Soleimani-Meigooni D, Rabinovici GD |title=The Role of Amyloid PET in Imaging Neurodegenerative Disorders: A Review |journal=J Nucl Med |volume=63 |issue=Suppl 1 |pages=13S–19S |date=June 2022 |pmid=35649652 |doi=10.2967/jnumed.121.263195 |url=|pmc=9165727 }}</ref>
==Prevention== {{Main|Prevention of dementia}}
===Risk factors{{anchor|Causes}}=== In a global report of 2017, nine risk factors for dementia were recognized. These were, lower levels of education, high blood pressure, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact.<ref name="Livingstone2020">{{cite journal |vauthors=Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, Brayne C, Burns A, Cohen-Mansfield J, Cooper C, Costafreda SG, Dias A, Fox N, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Ogunniyi A, Orgeta V, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N |title=Dementia prevention, intervention, and care: 2020 report of the Lancet Commission |journal=Lancet |volume=396 |issue=10248 |pages=413–446 |date=August 2020 |pmid=32738937 |pmc=7392084 |doi=10.1016/S0140-6736(20)30367-6 |bibcode=2020Lanc..396..413L |url=}}</ref> In 2020 the reviewed report added three more – excessive alcohol use, traumatic brain injury and air pollution.<ref name="Livingstone2020" /> The 2024 report added two more of untreated visual impairment, and high LDL cholesterol.<ref name="Livingston-2024a"/> Other psychological features, including certain personality traits (high neuroticism, and low conscientiousness), low purpose in life, and feeling lonely, are also risk factors.<ref>{{cite journal | vauthors = Aschwanden D, Strickhouser JE, Luchetti M, Stephan Y, Sutin AR, Terracciano A | title = Is personality associated with dementia risk? A meta-analytic investigation | journal = Ageing Research Reviews | volume = 67 | article-number = 101269 | date = May 2021 | pmid = 33561581 | pmc = 8005464 | doi = 10.1016/j.arr.2021.101269 }}</ref><ref>{{cite journal | vauthors = Sutin AR, Aschwanden D, Luchetti M, Stephan Y, Terracciano A | title = Sense of Purpose in Life Is Associated with Lower Risk of Incident Dementia: A Meta-Analysis | journal = Journal of Alzheimer's Disease | volume = 83 | issue = 1 | pages = 249–258 | year = 2021 | pmid = 34275900 | pmc = 8887819 | doi = 10.3233/JAD-210364 }}</ref><ref>{{cite web |title=Loneliness linked to dementia risk in large-scale analysis |url=https://www.nia.nih.gov/news/loneliness-linked-dementia-risk-large-scale-analysis |website=National Institute on Aging |access-date=7 February 2026 |language=en |date=16 January 2025}}</ref> For example, based on the English Longitudinal Study of Ageing (ELSA), research found that loneliness (but not social isolation) in older people can increase the risk of dementia by one-third. Living alone can double the risk of dementia but this may be reduced by having two or more closer relationships.<ref>{{Cite journal |date=May 27, 2020 |title=Loneliness, but not social isolation, predicts development of dementia in older people |url=https://evidence.nihr.ac.uk/alert/loneliness-but-not-social-isolation-predicts-development-of-dementia-in-older-people/ |journal=NIHR Evidence |type=Plain English summary |language=en |doi=10.3310/alert_40330|s2cid=241649845 |url-access=subscription }}</ref><ref>{{cite journal | vauthors = Rafnsson SB, Orrell M, d'Orsi E, Hogervorst E, Steptoe A | title = Loneliness, Social Integration, and Incident Dementia Over 6 Years: Prospective Findings From the English Longitudinal Study of Ageing | journal = The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences | volume = 75 | issue = 1 | pages = 114–124 | date = January 2020 | pmid = 28658937 | pmc = 6909434 | doi = 10.1093/geronb/gbx087 | veditors = Carr D }}</ref> Multi-risk factor burden is higher in lower income countries, and in lower socioeconomic groups resulting in earlier development of dementia.<ref name="Livingston-2024a"/> Some of the risk factors such as diabetes and high blood pressure may also be present as comorbidities.<ref name="GOVUK">{{cite web |title=Dementia: comorbidities in patients – data briefing |url=https://www.gov.uk/government/publications/dementia-comorbidities-in-patients/dementia-comorbidities-in-patients-data-briefing |access-date=November 22, 2020 |website=GOV.UK |language=en}}</ref>
Many of the risk factors are potentially modifiable. They include some that may be only partially causal but if they were all addressed nearly a half of dementia cases could be prevented. And a decreased risk is also possible for those with a genetic risk.<ref name="Livingston-2024a"/> Depression may be seen as a prodromal symptom or as a modifiable risk factor.<ref name="eClinical">{{cite journal |last1=Brain |first1=Jacob |last2=Alshahrani |first2=Maha |last3=Kafadar |first3=Aysegul Humeyra |last4=Tang |first4=Eugene YH |last5=Burton |first5=Elissa |last6=Greene |first6=Leanne |last7=Turnbull |first7=Deborah |last8=Myers |first8=Bronwyn |last9=Naheed |first9=Aliya |last10=Siervo |first10=Mario |last11=Tully |first11=Phillip J. |last12=Stephan |first12=Blossom CM |title=Temporal dynamics in the association between depression and dementia: an umbrella review and meta-analysis |journal=eClinicalMedicine |language=English |doi=10.1016/j.eclinm.2025.103266 |date=1 June 2025 |volume=84 |article-number=103266 |pmid=40687743 |pmc=12273843 }}</ref> The two most modifiable risk factors for dementia are physical inactivity and lack of cognitive stimulation.<ref name="Cheng">{{cite journal | vauthors = Cheng ST | title = Cognitive Reserve and the Prevention of Dementia: the Role of Physical and Cognitive Activities | journal = Current Psychiatry Reports | volume = 18 | issue = 9 | article-number = 85 | date = September 2016 | pmid = 27481112 | pmc = 4969323 | doi = 10.1007/s11920-016-0721-2 }}</ref> Physical activity, in particular aerobic exercise, is associated with a reduction in age-related brain tissue loss, and neurotoxic factors. Cognitive activity strengthens neural plasticity and together they help to support cognitive reserve.<ref name="Cheng"/> Multicomponent therapy (MCT) including aerobics, balance training, and strength training, has been shown to improve independence for activities of daily living and quality of life. MCT also helps to minimize the risk of falls.<ref name="Borges-Machado">{{cite journal |vauthors=Borges-Machado F, Silva N, Farinatti P, Poton R, Ribeiro Ó, Carvalho J |title=Effectiveness of Multicomponent Exercise Interventions in Older Adults With Dementia: A Meta-Analysis |journal=Gerontologist |volume=61 |issue=8 |pages=e449–e462 |date=November 2021 |pmid=32652005 |pmc=8599205 |doi=10.1093/geront/gnaa091 |url=}}</ref>
Impaired vision and hearing in later life, are modifiable risk factors.<ref name="Nagarajan">{{cite journal |vauthors=Nagarajan N, Assi L, Varadaraj V, Motaghi M, Sun Y, Couser E, Ehrlich JR, Whitson H, Swenor BK |title=Vision impairment and cognitive decline among older adults: a systematic review |journal=BMJ Open |volume=12 |issue=1 |article-number=e047929 |date=January 2022 |pmid=34992100 |pmc=8739068 |doi=10.1136/bmjopen-2020-047929 |doi-access=free |url=}}</ref><ref name="NIHR2026">{{Cite journal |date=19 February 2025 |title=What impact does hearing loss have on dementia risk? |url=https://evidence.nihr.ac.uk/alert/what-impact-does-hearing-loss-have-on-dementia-risk/ |journal=NIHR Evidence}}</ref> These impairments may precede cognitive symptoms by many years.<ref name="Panza">{{cite journal | vauthors = Panza F, Lozupone M, Sardone R, Battista P, Piccininni M, Dibello V, La Montagna M, Stallone R, Venezia P, Liguori A, Giannelli G, Bellomo A, Greco A, Daniele A, Seripa D, Quaranta N, Logroscino G | title = Sensorial frailty: age-related hearing loss and the risk of cognitive impairment and dementia in later life | journal = Therapeutic Advances in Chronic Disease | volume = 10 | article-number = 2040622318811000 | date = 2019 | pmid = 31452865 | pmc = 6700845 | doi = 10.1177/2040622318811000 | doi-access = free }}</ref> Hearing loss may lead to another risk factor of social isolation which negatively affects cognition.<ref name="Ford"/><ref name="Panza"/> Age-related hearing loss is characterised by slowed central processing of auditory information.<ref name="Panza"/> Worldwide, mid-life hearing loss may account for around 9% of dementia cases.<ref name="Ford">{{cite journal | vauthors = Ford AH, Hankey GJ, Yeap BB, Golledge J, Flicker L, Almeida OP | title = Hearing loss and the risk of dementia in later life | journal = Maturitas | volume = 112 | pages = 1–11 | date = June 2018 | pmid = 29704910 | doi = 10.1016/j.maturitas.2018.03.004 | s2cid = 13998812 }}</ref> Hearing loss is not a recognised risk factor for vascular dementia.<ref name="NIHR2026"/>
Sarcopenia (age-related muscle loss) and resulting frailty may increase the risk of cognitive decline, and dementia, and the inverse also holds of cognitive impairment increasing the risk of frailty. Prevention of frailty may help to prevent cognitive decline.<ref name="Waite2021">{{cite journal |vauthors=Waite SJ, Maitland S, Thomas A, Yarnall AJ |title=Sarcopenia and frailty in individuals with dementia: A systematic review |journal=Arch Gerontol Geriatr |volume=92 |issue= |article-number=104268 |date=2021 |pmid=33011431 |doi=10.1016/j.archger.2020.104268 |url=https://eprint.ncl.ac.uk/271233}}</ref>
There are no medications available that can prevent cognitive decline and dementia.<ref name="Pharmacologic Interventions to Prev">{{cite journal | vauthors = Fink HA, Jutkowitz E, McCarten JR, Hemmy LS, Butler M, Davila H, Ratner E, Calvert C, Barclay TR, Brasure M, Nelson VA, Kane RL | title = Pharmacologic Interventions to Prevent Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer-Type Dementia: A Systematic Review | journal = Annals of Internal Medicine | volume = 168 | issue = 1 | pages = 39–51 | date = January 2018 | pmid = 29255847 | doi = 10.7326/M17-1529 | s2cid = 24193907 }}</ref> An economic model (of 2024) has proposed that population-level interventions in England that target dementia risk factors such as high blood pressure, smoking and obesity, could save money and give people extra years in good health. For example, reduced salt in food, to address hypertension, could give 39,433 quality-adjusted life-years and save £2.4 billion.<ref name="Mukadam">{{cite journal |vauthors=Mukadam N, Anderson R, Walsh S, Wittenberg R, Knapp M, Brayne C, Livingston G |title=Benefits of population-level interventions for dementia risk factors: an economic modelling study for England |journal=Lancet Healthy Longev |volume=5 |issue=9 |article-number=100611 |date=September 2024 |pmid=39096915 |doi=10.1016/S2666-7568(24)00117-X |url=}}</ref>
===Diet=== {{See also|Nutrition}} A modifiable risk factor for dementia is diet. The Mediterranean and DASH diets are both associated with less cognitive decline. A different approach has been to incorporate elements of both of these diets into one known as the MIND diet.<ref name=Acta1>{{cite journal |vauthors=Dominguez LJ, Barbagallo M |title=Nutritional prevention of cognitive decline and dementia |journal= Acta Bio Medica: Atenei Parmensis |volume=89 |issue=2 |pages=276–290 |date=June 2018 |pmid=29957766 |pmc=6179018 |doi=10.23750/abm.v89i2.7401}}</ref> These diets are generally low in saturated fats while providing a good source of carbohydrates, mainly those of a low glycemic index that help stabilize blood sugar and insulin levels.<ref>{{Cite web| vauthors = Goodman B |title=Diet Affects Markers of Alzheimer's Disease|url=https://www.webmd.com/alzheimers/news/20110613/diet-affects-markers-of-alzheimers-disease|access-date=December 13, 2020|website=WebMD|language=en}}</ref> The MIND diet may be more protective but further studies are needed. The Mediterranean diet seems to be more protective against Alzheimer's than DASH but there are no consistent findings against dementia in general.<ref name=Acta1/> The role of olive oil needs further study as it may be one of the most important components in reducing the risk of cognitive decline and dementia.<ref name=Omar>{{cite journal |vauthors=Omar SH |title=Mediterranean and MIND Diets Containing Olive Biophenols Reduces the Prevalence of Alzheimer's Disease |journal=Int J Mol Sci |volume=20 |issue=11 |date=June 2019 |page=2797 |pmid=31181669 |pmc=6600544 |doi=10.3390/ijms20112797 |doi-access=free }}</ref>
Nutritional factors associated with the proposed diets for reducing dementia risk include unsaturated fatty acids, vitamin E, vitamin C, flavonoids, vitamin B, and vitamin D.<ref name = "Cao_2016">{{cite journal | vauthors = Cao L, Tan L, Wang HF, Jiang T, Zhu XC, Lu H, Tan MS, Yu JT | title = Dietary Patterns and Risk of Dementia: a Systematic Review and Meta-Analysis of Cohort Studies | journal = Molecular Neurobiology | volume = 53 | issue = 9 | pages = 6144–6154 | date = November 2016 | pmid = 26553347 | doi = 10.1007/s12035-015-9516-4 | s2cid = 8188716 | oclc = 6947867710 }}</ref><ref>{{cite journal | vauthors = Canevelli M, Lucchini F, Quarata F, Bruno G, Cesari M | title = Nutrition and Dementia: Evidence for Preventive Approaches? | journal = Nutrients | volume = 8 | issue = 3 | page = 144 | date = March 2016 | pmid = 26959055 | pmc = 4808873 | doi = 10.3390/nu8030144 | publisher = MDPI | oclc = 8147564576 | doi-access = free }}</ref> Omega-3 fatty acids may help in treating the common symptom of depression, and a potential risk factor for dementia.<ref name="Firth">{{cite journal |vauthors=Firth J, Teasdale SB, Allott K, Siskind D, Marx W, Cotter J, Veronese N, Schuch F, Smith L, Solmi M, Carvalho AF, Vancampfort D, Berk M, Stubbs B, Sarris J |title=The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials |journal=World Psychiatry |volume=18 |issue=3 |pages=308–324 |date=October 2019 |pmid=31496103 |pmc=6732706 |doi=10.1002/wps.20672}}</ref><ref name="Livingston-2024a"/>
====Dental health==== Poor oral health has not been identified as a known risk factor for dementia but there is evidence for its association with cognitive decline. Different factors have been proposed including tooth infections that may have an inflammatory effect, and tooth loss that impairs proper chewing of food, impacting diet and quality of life.<ref name="CDC2025">{{cite journal |last1=Alshanbari |first1=Mohammed H. |title=The Impact of Oral Health and Dental Services on the Prevalence of Subjective Cognitive Decline Among Middle-Aged and Older US Adults: Behavioral Risk Factor Surveillance System, 2022 |url=https://www.cdc.gov/pcd/issues/2025/25_0083.htm |journal=Preventing Chronic Disease |access-date=9 February 2026 |language=en-us |doi=10.5888/pcd22.250083 |date=2025 |volume=22 |article-number=250083 |pmid=40907543 |pmc=12416401 }}</ref> Oral health declines with advancing cognitive impairment, due in part to an increased inability to maintain daily self-care, and also barriers to dental care access. Increasing evidence indicates that poor oral health may be more than just a result of dementia and could be a causative factor.<ref name="Nakamura">{{cite journal |vauthors=Nakamura T, Zou K, Shibuya Y, Michikawa M |title=Oral dysfunctions and cognitive impairment/dementia |journal=J Neurosci Res |volume=99 |issue=2 |pages=518–528 |date=February 2021 |pmid=33164225 |doi=10.1002/jnr.24745 |url=}}</ref><ref name="Scambler2023">{{cite journal |vauthors=Scambler S, Curtis S, Manthorpe J, Samsi K, Rooney YM, Gallagher JE |title=The mouth and oral health in the field of dementia |journal=Health (London) |volume=27 |issue=4 |pages=540–558 |date=July 2023 |pmid=34727785 |pmc=10197156 |doi=10.1177/13634593211049891 |url=}}</ref>
==Management== {{Main|Dementia caregiving}} ===Medications=== thumb|upright=1.15|Donepezil There are limited pharmacological options and several non-pharmacological options for treating dementia, and no available options to delay the onset or stop the progression. Some types of medication are used to address the symptoms in different subtypes but the benefit is small.<ref>{{cite journal | vauthors = Hafdi M, Hoevenaar-Blom MP, Richard E | title = Multi-domain interventions for the prevention of dementia and cognitive decline | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 11 | article-number = CD013572 | date = November 2021 | pmid = 34748207 | pmc = 8574768 | doi = 10.1002/14651858.CD013572.pub2 | s2cid = 243846602 }}</ref>
Donepezil is a cholinesterase inhibitor (ChEI) that acts to increase the amount of the neurotransmitter acetylcholine. In treating the symptoms of Alzheimer's moderate quality evidence shows that it provides small improvements in cognition, daily functioning, and global clinical state, with higher doses slightly increasing benefit but also adverse events.<ref name="Birks-2018">{{Cite journal |last1=Birks |first1=Jacqueline S. |last2=Harvey |first2=Richard J. |date=2018-06-18 |title=Donepezil for dementia due to Alzheimer's disease |journal=The Cochrane Database of Systematic Reviews |volume=2018 |issue=6 |article-number=CD001190 |doi=10.1002/14651858.CD001190.pub3 |issn=1469-493X |pmc=6513124 |pmid=29923184}}</ref> Rivastigmine another ChEI is recommended for treating symptoms in Parkinson's disease dementia.<ref name="Arvanitakis-2019" />
Memantine provides a small but consistent benefit for moderate-to-severe Alzheimer's disease, and can be used together with a cholinesterase inhibitor, but shows no clear benefit in mild Alzheimer's and may increase adverse events, with limited evidence for other dementias.<ref name="McShane2019">{{cite journal |vauthors=McShane R, Westby MJ, Roberts E, Minakaran N, Schneider L, Farrimond LE, Maayan N, Ware J, Debarros J |title=Memantine for dementia |journal=Cochrane Database Syst Rev |volume=3 |issue=3 |article-number=CD003154 |date=March 2019 |pmid=30891742 |pmc=6425228 |doi=10.1002/14651858.CD003154.pub6 |url=}}</ref>
Medications that have anticholinergic effects increase all-cause mortality in people with dementia, although the effect of these medications on cognitive function remains uncertain, according to a systematic review published in 2021.<ref>{{cite journal | vauthors = Wang K, Alan J, Page AT, Dimopoulos E, Etherton-Beer C | title = Anticholinergics and clinical outcomes amongst people with pre-existing dementia: A systematic review | journal = Maturitas | volume = 151 | pages = 1–14 | date = September 2021 | pmid = 34446273 | doi = 10.1016/j.maturitas.2021.06.004 | publisher = Elsevier BV | url = https://ro.ecu.edu.au/ecuworkspost2013/10673 }}</ref>
Before prescribing antipsychotic (neuroleptic) medication in the elderly, an assessment for an underlying cause of the behavior is needed.<ref name="AGSantipsychotic" /> Severe and life-threatening reactions occur in almost half of people with Lewy body dementia,<ref name= Taylor2020/><ref name= Walker2015>{{cite journal |vauthors=Walker Z, Possin KL, Boeve BF, Aarsland D |title=Lewy body dementias |journal=Lancet |volume=386 |issue=10004 |pages=1683–1697 |date=October 2015 |pmid=26595642 |pmc=5792067 |doi=10.1016/S0140-6736(15)00462-6 |type=Review}}</ref> can be fatal after a single dose,<ref name= Boot2015>{{cite journal |vauthors=Boot BP |title=Comprehensive treatment of dementia with Lewy bodies |journal=Alzheimers Res Ther |volume=7 |issue=1 |article-number=45 |date=2015 |pmid=26029267 |pmc=4448151 |doi=10.1186/s13195-015-0128-z |type=Review |doi-access=free }}</ref> and can give a risk for developing neuroleptic malignant syndrome, a rare life-threatening illness.<ref name= Gomperts2016>{{cite journal |vauthors=Gomperts SN |title=Lewy body dementias: Dementia with Lewy bodies and Parkinson disease dementia |journal=Continuum (Minneap Minn) |volume=22 |issue=2 Dementia |pages=435–463 |date=April 2016 |pmid=27042903 |pmc=5390937 |doi=10.1212/CON.0000000000000309 |type=Review}}</ref> Antipsychotic drugs are used to treat dementia only if non-drug therapies have not worked, and the person's actions threaten themselves or others.<ref name=NICEUK2018>{{cite web |title=Dementia: assessment, management and support for people living with dementia and their carers {{!}} Guidance and guidelines {{!}} NICE |url=https://www.nice.org.uk/guidance/ng97/chapter/Recommendations#managing-non-cognitive-symptoms |website=NICE |date=June 20, 2018 |access-date=December 18, 2018}}</ref><ref>{{cite journal | vauthors = Dyer SM, Laver K, Pond CD, Cumming RG, Whitehead C, Crotty M | title = Clinical practice guidelines and principles of care for people with dementia in Australia | journal = Australian Family Physician | volume = 45 | issue = 12 | pages = 884–889 | date = December 2016 | pmid = 27903038 | url = https://search.informit.com.au/documentSummary;dn=577322425689666;res=IELHEA }}</ref> Aggressive behavior changes are sometimes the result of other solvable problems, that could make treatment with antipsychotics unnecessary.<ref name="AGSantipsychotic"/> Because people with dementia can be aggressive, resistant to their treatment, and otherwise disruptive, sometimes antipsychotic drugs are considered as a therapy in response.<ref name="AGSantipsychotic">{{Cite journal |author1 = American Geriatrics Society |author1-link = American Geriatrics Society |title = Five Things Physicians and Patients Should Question |journal = Choosing Wisely: An Initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/american-geriatrics-society/ |access-date = August 1, 2013 |url-status = live |archive-url = https://web.archive.org/web/20130901100140/http://www.choosingwisely.org/doctor-patient-lists/american-geriatrics-society/ |archive-date = September 1, 2013 }}</ref> These drugs have risky adverse effects, including increasing the person's chance of stroke and death.<ref name="AGSantipsychotic"/> Given these adverse events and small benefit antipsychotics are avoided whenever possible.<ref name=Dyer2017/> Generally, stopping antipsychotics for people with dementia does not cause problems, even in those who have been on them a long time.<ref>{{cite journal |vauthors=Van Leeuwen E, Petrovic M, van Driel ML, De Sutter AI, Vander Stichele R, Declercq T, Christiaens T |title=Withdrawal versus continuation of long-term antipsychotic drug use for behavioural and psychological symptoms in older people with dementia |journal=Cochrane Database Syst Rev |volume=3 |issue=3 |article-number=CD007726 |date=April 2018 |pmid=29605970 |pmc=8407230 |doi=10.1002/14651858.CD007726.pub3 |url=}}</ref>
An extract of ''Ginkgo biloba'' known as EGb 761 has been widely used for treating mild to moderate dementia and other neuropsychiatric disorders.<ref name=Kandia>{{cite journal | vauthors = Kandiah N, Ong PA, Yuda T, Ng LL, Mamun K, Merchant RA, Chen C, Dominguez J, Marasigan S, Ampil E, Nguyen VT, Yusoff S, Chan YF, Yong FM, Krairit O, Suthisisang C, Senanarong V, Ji Y, Thukral R, Ihl R | title = Treatment of dementia and mild cognitive impairment with or without cerebrovascular disease: Expert consensus on the use of Ginkgo biloba extract, EGb 761 | journal = CNS Neuroscience & Therapeutics | volume = 25 | issue = 2 | pages = 288–298 | date = February 2019 | pmid = 30648358 | pmc = 6488894 | doi = 10.1111/cns.13095 }}</ref> Its use is approved throughout Europe.<ref name=McKeage>{{cite journal | vauthors = McKeage K, Lyseng-Williamson KA | title = ''Ginkgo biloba'' extract EGb 761 in the symptomatic treatment of mild-to-moderate dementia: a profile of its use | journal = Drugs & Therapy Perspectives | volume = 34 | issue = 8 | pages = 358–366 | date = 2018 | pmid = 30546253 | pmc = 6267544 | doi = 10.1007/s40267-018-0537-8 }}</ref> The World Federation of Biological Psychiatry guidelines lists EGb 761 with the same weight of evidence (level B) given to acetylcholinesterase inhibitors, and memantine. EGb 761 is the only one that showed improvement of symptoms in both AD and vascular dementia. EGb 761 is seen as being able to play an important role either on its own or as an add-on particularly when other therapies prove ineffective.<ref name=Kandia/> EGb 761 is seen to be neuroprotective; it is a free radical scavenger, improves mitochondrial function, and modulates serotonin and dopamine levels. Many studies of its use in mild to moderate dementia have shown it to significantly improve cognitive function, activities of daily living, neuropsychiatric symptoms, and quality of life.<ref name=Kandia/><ref name=Wang>{{cite journal | vauthors = Wang M, Peng H, Peng Z, Huang K, Li T, Li L, Wu X, Shi H| title = Efficacy and safety of ginkgo preparation in patients with vascular dementia: A protocol for systematic review and meta-analysis | journal = Medicine | volume = 99 | issue = 37 | article-number = e22209 | date = September 2020 | pmid = 32925798 | pmc = 7489658 | doi = 10.1097/MD.0000000000022209 }}</ref>
There is a complex interplay between the use of antidepressants, the severity of dementia, and the degree of cognitive decline, particularly with the use of SSRIs that warrants further research. The use of antidepressants is associated with a faster rate of cognitive decline. Greater cognitive decline is in line with the severity of dementia. Also higher doses are associated with greater cognitive decline and with the risk of severe dementia, and fractures.<ref name="Borges de Souza">{{cite journal |vauthors=Borges de Souza P, Rodrigues AL, De Felice FG |title=Shared Mechanisms in Dementia and Depression: The Modulatory Role of Physical Exercise |journal=J Neurochem |volume=169 |issue=8 |article-number=e70185 |date=August 2025 |pmid=40757845 |pmc=12320575 |doi=10.1111/jnc.70185 |url=}}</ref>
No evidence supports the use of vitamin or mineral supplements including B vitamins to improve cognitive impairment.<ref name="McCleery">{{cite journal |vauthors=McCleery J, Abraham RP, Denton DA, Rutjes AW, Chong LY, Al-Assaf AS, Griffith DJ, Rafeeq S, Yaman H, Malik MA, Di Nisio M, Martínez G, Vernooij RW, Tabet N |title=Vitamin and mineral supplementation for preventing dementia or delaying cognitive decline in people with mild cognitive impairment |journal=Cochrane Database Syst Rev |volume=11 |issue=11 |article-number=CD011905 |date=November 2018 |pmid=30383288 |pmc=6378925 |doi=10.1002/14651858.CD011905.pub2 |url=}}</ref> No evidence supports the use of statins to prevent dementia.<ref name="Cochrane2016">{{cite journal |vauthors=McGuinness B, Craig D, Bullock R, Passmore P |title=Statins for the prevention of dementia |journal=Cochrane Database Syst Rev |volume=2016 |issue=1 |article-number=CD003160 |date=January 2016 |pmid=26727124 |pmc=9346344 |doi=10.1002/14651858.CD003160.pub3 |url=}}</ref> There is insufficient evidence for the use of antihypertensives to prevent cognitive decline, and dementia.<ref name="Cunningham">{{cite journal |vauthors=Cunningham EL, Todd SA, Passmore P, Bullock R, McGuinness B |title=Pharmacological treatment of hypertension in people without prior cerebrovascular disease for the prevention of cognitive impairment and dementia |journal=Cochrane Database Syst Rev |volume=2021 |issue=5 |article-number=CD004034 |date=May 2021 |pmid=34028812 |pmc=8142793 |doi=10.1002/14651858.CD004034.pub4 |url=}}</ref> Medications for other health conditions may need to be managed differently for someone with dementia; the MATCH-D tool may be used for this. <ref>{{cite journal | vauthors = Page AT, Potter K, Clifford R, McLachlan AJ, Etherton-Beer C | title = Medication appropriateness tool for co-morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel | journal = Internal Medicine Journal | volume = 46 | issue = 10 | pages = 1189–1197 | date = October 2016 | pmid = 27527376 | pmc = 5129475 | doi = 10.1111/imj.13215 }}</ref>
===Non-pharmacological options=== More than half of people with dementia may experience neuropsychiatric (psychological or behavioral) symptoms such as agitation, sleep problems, aggression, and psychosis. Treatment for these symptoms is aimed at reducing the person's distress and keeping them safe. The most promising non-pharmacological approach for evaluating neuropsychiatric symptoms is the DICE interaction - Describe, Investigate, Create, and Evaluate followed by caregiver training.<ref name="Tampi2022"/> Severe behavioral symptoms might result in a hospital admission for psychiatric assessment, care and treatment.<ref>{{Cite journal |last1=Crowther |first1=George |last2=Dunning |first2=Rebecca |last3=Russell |first3=Gregor |last4=Wolverson |first4=Emma |last5=Underwood |first5=Benjamin R. |date=2024-07-01 |title=Dementia in-patient units in psychiatric hospitals: research priority setting |journal=BJPsych Bulletin |volume=49 |issue=4 |language=en |pages=228–234 |doi=10.1192/bjb.2024.42 |issn=2056-4694|doi-access=free |pmid=38949259 |pmc=12314415 }}</ref><ref>{{Cite journal |last1=Wolverson |first1=Emma |last2=Dunning |first2=Rebecca |last3=Crowther |first3=George |last4=Russell |first4=Gregor |last5=Underwood |first5=Benjamin R |date=2024-10-19 |title=The Characteristics and Outcomes of People with Dementia in Inpatient Mental Health Care: A Review |url=https://www.tandfonline.com/doi/full/10.1080/07317115.2022.2104145 |journal=Clinical Gerontologist |language=en |volume=47 |issue=5 |pages=684–703 |doi=10.1080/07317115.2022.2104145 |pmid=35897148 |issn=0731-7115}}</ref>
Cognitive and behavioral interventions rather than medication appear to be better for agitation and aggression.<ref>{{cite journal | vauthors = Watt JA, Goodarzi Z, Veroniki AA, Nincic V, Khan PA, Ghassemi M, Thompson Y, Tricco AC, Straus SE| title = Comparative Efficacy of Interventions for Aggressive and Agitated Behaviors in Dementia: A Systematic Review and Network Meta-analysis | journal = Annals of Internal Medicine | volume = 171 | issue = 9 | pages = 633–642 | date = November 2019 | pmid = 31610547 | doi = 10.7326/M19-0993 | s2cid = 204699972 }}</ref> Cognitive rehabilitation may be effective in helping those with mild to moderate dementia in managing their daily activities.<ref>{{Cite journal |last1=Kudlicka |first1=Aleksandra |last2=Martyr |first2=Anthony |last3=Bahar-Fuchs |first3=Alex |last4=Sabates |first4=Julieta |last5=Woods |first5=Bob |last6=Clare |first6=Linda |date=June 29, 2023 |editor-last=Cochrane Dementia and Cognitive Improvement Group |title=Cognitive rehabilitation for people with mild to moderate dementia |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=6 |article-number=CD013388 |doi=10.1002/14651858.CD013388.pub2 |pmc=10310315 |pmid=37389428}}</ref>
Other non-pharmacological interventions for use in nursing homes include Montessori-based programmes.<ref name="Yan">{{cite journal |vauthors=Yan Z, Traynor V, Alananzeh I, Drury P, Chang HR |title=The impact of montessori-based programmes on individuals with dementia living in residential aged care: A systematic review |journal=Dementia (London) |volume=22 |issue=6 |pages=1259–1291 |date=August 2023 |pmid=37177991 |pmc=10336713 |doi=10.1177/14713012231173817 |url=}}</ref> Indicators for depression may use a Cornell Scale for Depression in Dementia (CSDD)<ref name="Jeon">{{cite journal |vauthors=Jeon YH, Li Z, Low LF, Chenoweth L, O'Connor D, Beattie E, Liu Z, Brodaty H |title=The clinical utility of the Cornell Scale for Depression in Dementia as a routine assessment in nursing homes |journal=The American Journal of Geriatric Psychiatry |volume=23 |issue=8 |pages=784–793 |date=August 2015 |pmid=25256214 |doi=10.1016/j.jagp.2014.08.013}}</ref><ref name="pmid27538349">{{cite journal |vauthors=Jeon YH, Liu Z, Li Z, et al. |title=Development and Validation of a Short Version of the Cornell Scale for Depression in Dementia for Screening Residents in Nursing Homes |journal=The American Journal of Geriatric Psychiatry |volume=24 |issue=11 |pages=1007–1016 |date=November 2016 |pmid=27538349 |doi=10.1016/j.jagp.2016.05.012|hdl=1959.4/unsworks_39417 |url=https://unsworks.unsw.edu.au/bitstreams/de316361-79bd-4823-a0dc-a4659509cc2d/download |hdl-access=free }}</ref> Exercise programs are beneficial with respect to activities of daily living.<ref name="Forb2015">{{cite journal | vauthors = Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S | title = Exercise programs for people with dementia | journal = The Cochrane Database of Systematic Reviews | volume = 132 | issue = 4 | article-number = CD006489 | date = April 2015 | pmid = 25874613 | doi = 10.1002/14651858.CD006489.pub4 | pmc = 9426996 | type = Submitted manuscript }}</ref> Massage and touch therapy may improve agitation and behavioral problems with hand, head and foot massage showing a significant improvement in agitation.<ref name="Liu2025">{{cite journal |vauthors=Liu X, Zang L, Lu Q, Zhang Y, Meng Q |title=Effect of Massage and Touch on Agitation in Dementia: A Meta-Analysis |journal=J Clin Nurs |volume=34 |issue=5 |pages=1948–1964 |date=May 2025 |pmid=39902611 |doi=10.1111/jocn.17674 |url=}}</ref> There are mixed findings in the use of cannabinoids in treating some of the symptoms of dementia.<ref name="Tampi2022"/>
Often overlooked in treating and managing dementia is the role of the caregiver and what is known about how they can support multiple interventions. Healthcare workers do not have sufficient tools or clinical guidance for the behavioral and psychological symptoms of dementia along with medication use.<ref>{{cite journal | vauthors = Harper AE, Rouch S, Leland NE, Turner RL, Mansbach WE, Day CE, Terhorst L | title = A Systematic Review of Tools Assessing the Perspective of Caregivers of Residents With Dementia | journal = Journal of Applied Gerontology | volume = 41 | issue = 4 | pages = 1196–1208 | date = April 2022 | pmid = 34229505 | doi = 10.1177/07334648211028692 | s2cid = 235758241 }}</ref> Simple measures like talking to people about their interests can improve the quality of life for care home residents and may reduce symptoms of agitation and depression. They also needed fewer GP visits and hospital admissions, which also meant that the programme was cost-saving.<ref>{{Cite journal |date=November 26, 2020 |title=The WHELD programme for people with dementia helps care home staff deliver person-centred care |url=https://evidence.nihr.ac.uk/alert/wheld-dementia-care-homes-person-centred-care/ |journal=NIHR Evidence |type=Plain English summary |language=en |doi=10.3310/alert_42713|s2cid=240719455 |url-access=subscription }}</ref><ref>{{cite journal | vauthors = Ballard C, Orrell M, Moniz-Cook E, Woods R, Whitaker R, Corbett A, Aarsland D, Murray J, Lawrence V, Testad I, Knapp M, Romeo R, Zala D, Stafford J, Hoare Z, Garrod L, Sun Y, McLaughlin E, Woodward-Carlton B, Williams G, Fossey J | title = Improving mental health and reducing antipsychotic use in people with dementia in care homes: the WHELD research programme including two RCTs | journal = Programme Grants for Applied Research | volume = 8 | issue = 6 | pages = 1–98 | date = July 2020 | pmid = 32721145 | doi = 10.3310/pgfar08060 | s2cid = 225489651 | doi-access = free }}</ref>
===Psychological and psychosocial therapies=== {{main|Psychological therapies for dementia}}
Psychological therapies for dementia include some limited evidence for reminiscence therapy (namely, some positive effects in the areas of quality of life, cognition, communication and mood – the first three particularly in care home settings),<ref name="Reminiscence therapy for dementia">{{cite journal | vauthors = Woods B, O'Philbin L, Farrell EM, Spector AE, Orrell M | title = Reminiscence therapy for dementia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | article-number = CD001120 | date = March 2018 | issue = 3 | pmid = 29493789 | pmc = 6494367 | doi = 10.1002/14651858.CD001120.pub3 }}</ref> some benefit for cognitive reframing for caretakers,<ref>{{cite journal | vauthors = Vernooij-Dassen M, Draskovic I, McCleery J, Downs M | title = Cognitive reframing for carers of people with dementia | journal = The Cochrane Database of Systematic Reviews | issue = 11 | article-number = CD005318 | date = November 2011 | pmid = 22071821 | doi = 10.1002/14651858.CD005318.pub2 | pmc = 12536931 | hdl = 2066/97731 | arxiv = 0706.4406 | s2cid = 205178315 }}</ref> unclear evidence for validation therapy<ref name=":Liao">{{cite journal |vauthors=Liao Y, Adams DR, Owens CM, Jensen JD |title=Empathy, Validation, and Branding: Testing the Theory of Empathetic Suffering |journal=J Broadcast Electron Media |volume=69 |issue=1–2 |pages=65–84 |date=2025 |pmid=40417184 |pmc=12097526 |doi=10.1080/08838151.2025.2462598 |url=}}</ref> and tentative evidence for mental exercises, such as cognitive stimulation programs for people with mild to moderate dementia.<ref>{{cite journal | vauthors = Woods B, Aguirre E, Spector AE, Orrell M | title = Cognitive stimulation to improve cognitive functioning in people with dementia | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 2 | article-number = CD005562 | date = February 2012 | pmid = 22336813 | doi = 10.1002/14651858.CD005562.pub2 | s2cid = 7086782 }}</ref> Offering personally tailored activities may help reduce challenging behavior and may improve quality of life.<ref name="Möhler2023">{{cite journal | vauthors = Möhler R, Calo S, Renom A, Renom H, Meyer G | title = Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 3 | article-number = CD009812 | date = March 2023 | pmid = 36930048 | pmc = 10010156 | doi = 10.1002/14651858.CD009812.pub3 }}</ref>
Dementia impairs normal communication and agitated behavior is often used to indicate pain, illness, or overstimulation.<ref name="Weitzel 2011">{{cite journal | vauthors = Weitzel T, Robinson S, Barnes MR, et al. | title = The special needs of the hospitalized patient with dementia | journal = Medsurg Nursing | volume = 20 | issue = 1 | pages = 13–18; quiz 19 | year = 2011 | pmid = 21446290 }}</ref> The strongest evidence for non-pharmacological therapies for the management of changed behaviors in dementia is for using such approaches.<ref name=Dyer2017>{{cite journal | vauthors = Dyer SM, Harrison SL, Laver K, Whitehead C, Crotty M | title = An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia | journal = International Psychogeriatrics | volume = 30 | issue = 3 | pages = 295–309 | date = March 2018 | pmid = 29143695 | doi = 10.1017/S1041610217002344 | doi-access = free | hdl = 2328/38234 | hdl-access = free }}</ref> Low quality evidence suggests that regular (at least five sessions of) music therapy may help institutionalized residents. It may reduce depressive symptoms and improve overall behaviors. It may also supply a beneficial effect on emotional well-being and quality of life, as well as reduce anxiety.<ref>{{Cite journal |last1=van der Steen |first1=Jenny T. |last2=van der Wouden |first2=Johannes C. |last3=Methley |first3=Abigail M. |last4=Smaling |first4=Hanneke J. A. |last5=Vink |first5=Annemieke C. |last6=Bruinsma |first6=Manon S. |date=2025-03-07 |title=Music-based therapeutic interventions for people with dementia |journal=The Cochrane Database of Systematic Reviews |volume=2025 |issue=3 |article-number=CD003477 |doi=10.1002/14651858.CD003477.pub5 |issn=1469-493X |pmc=11884930 |pmid=40049590 }}</ref> In 2003, The Alzheimer's Society in the UK introduced 'Singing for the Brain', establishing a model for group singing of well-known songs (for those with dementia and their carers) that also incorporates vocal exercises for the improvement of brain activity and well-being.<ref name="SFTB">{{cite web |title=Singing for the Brain {{!}} Alzheimer's Society |url=https://www.alzheimers.org.uk/get-support/dementia-support-services/your-local-services/singing-for-the-brain |website=www.alzheimers.org.uk |access-date=31 March 2026 |language=en}}</ref>
Some London hospitals found that using color, designs, pictures and lights helped people with dementia adjust to being at the hospital. These adjustments to the layout of the dementia wings at these hospitals helped patients by preventing confusion.<ref>{{Cite news|url=https://www.economist.com/britain/2018/09/15/british-hospitals-are-having-a-dementia-friendly-makeover|title=British hospitals are having a dementia-friendly makeover|newspaper=The Economist|access-date=September 19, 2018}}</ref>
Life story work as part of reminiscence therapy, and video biographies have been found to address the needs of clients and their caregivers in various ways, offering the client the opportunity to leave a legacy and enhance their personhood and also benefitting youth who participate in such work. Such interventions can be more beneficial when undertaken at a relatively early stage of dementia. They may also be problematic in those who have difficulties in processing past experiences.<ref name="Johnston2016">{{cite journal |vauthors=Johnston B, Narayanasamy M |date=April 2016 |title=Exploring psychosocial interventions for people with dementia that enhance personhood and relate to legacy – an integrative review |journal=BMC Geriatrics |volume=16 |article-number=77 |doi=10.1186/s12877-016-0250-1 |pmc=4820853 |pmid=27044417 |doi-access=free}}</ref>
Animal-assisted therapy particularly with the use of dogs, has been found to be helpful.<ref name="Johnston2016"/>
Occupational therapy also addresses psychological and psychosocial needs of patients with dementia through improving daily occupational performance and caregivers' competence.<ref name="ajot.aota.org">{{cite journal | vauthors = Raj SE, Mackintosh S, Fryer C, Stanley M | title = Home-Based Occupational Therapy for Adults With Dementia and Their Informal Caregivers: A Systematic Review | journal = The American Journal of Occupational Therapy | volume = 75 | issue = 1 | pages = 7501205060p1–7501205060p27 | date = January 1, 2021 | pmid = 33399054 | doi = 10.5014/ajot.2020.040782 | s2cid = 230618534 | url = https://ro.ecu.edu.au/ecuworkspost2013/9720 }}</ref> When compensatory intervention strategies are added to their daily routine, the level of performance is enhanced and reduces the burden commonly placed on their caregivers.<ref name="ajot.aota.org"/> Occupational therapists can also work with other disciplines to create a client centered intervention.<ref name="Frankenstein_2020">{{Cite journal| vauthors = Frankenstein LL, Jahn G |date=April 20, 2020|title=Behavioral and Occupational Therapy for Dementia Patients and Caregivers |url=https://econtent.hogrefe.com/doi/10.1024/1662-9647/a000225 |journal=GeroPsych |volume=33 |issue=2 |pages=85–100 |doi=10.1024/1662-9647/a000225 |s2cid=219081899 |issn=1662-9647|url-access=subscription }}</ref> To manage cognitive disability, and coping with behavioral and psychological symptoms of dementia, combined occupational and behavioral therapies can support patients with dementia even further.<ref name="Frankenstein_2020" />
=== Palliative care === Palliative care, the total care given by a team of health care providers can be helpful to both the individual and the caregiver.<ref name="EoLNHS2026">{{cite web |title=Dementia and end of life planning |url=https://www.nhs.uk/conditions/dementia/living-with-dementia/palliative-care/ |website=nhs.uk |access-date=25 January 2026 |language=en |date=18 August 2023}}</ref> It aims to improve quality of life, at all stages.<ref>{{Cite web |date=5 August 2020 |title=Palliative care |url=https://www.who.int/news-room/fact-sheets/detail/palliative-care |access-date=2025-04-19 |website=World Health Organization (WHO) |language=en}}</ref> It can help people with dementia and their caregivers to understand what to expect, deal with loss of physical and mental abilities, support the person's wishes and goals including surrogate decision making, and discuss wishes for or against CPR and life support.<ref name="pmid24997202">{{cite journal |vauthors=Van den Block L |date=October 2014 |title=The need for integrating palliative care in ageing and dementia policies |journal=European Journal of Public Health |volume=24 |issue=5 |pages=705–706 |doi=10.1093/eurpub/cku084 |pmid=24997202 |doi-access=free}}</ref> Palliative care interventions may lead to improvements in the quality of life, management of symptoms, and comfort in dying, but it is not yet known how it can be best used to support people dying with advanced dementia and their families.<ref name="Walsh" />
Because there is uncertainty around how and when people with dementia decline, and because most people prefer to allow the person with dementia to make their own decisions, palliative care involvement before the late stages of dementia is recommended.<ref name="Nakanishi">{{cite journal |vauthors=Nakanishi M, Martins Pereira S, Van den Block L, Parker D, Harrison-Dening K, Di Giulio P, In der Schmitten J, Larkin PJ, Mimica N, Sudore RL, Holmerová I, Korfage IJ, van der Steen JT |title=Future policy and research for advance care planning in dementia: consensus recommendations from an international Delphi panel of the European Association for Palliative Care |journal=Lancet Healthy Longev |volume=5 |issue=5 |pages=e370–e378 |date=May 2024 |pmid=38608695 |pmc=11262782 |doi=10.1016/S2666-7568(24)00043-6 |url=}}</ref> In the early stages of dementia, palliative care can involve advocacy around establishing goals of care in the future, reassurance of continued support, planning for future scenarios of care and establishing long-term relationships with care providers.<ref>{{Cite journal |last1=de Sola-Smith |first1=Karen |last2=Gilissen |first2=Joni |last3=van der Steen |first3=Jenny T. |last4=Mayan |first4=Inbal |last5=Van den Block |first5=Lieve |last6=Ritchie |first6=Christine S. |last7=Hunt |first7=Lauren J. |date=4 July 2024 |title=Palliative Care in Early Dementia |journal=Journal of Pain and Symptom Management |language=en |volume=68 |issue=3 |pages=e206–e227 |doi=10.1016/j.jpainsymman.2024.05.028|pmid=38848792 |pmc=12060741 }}</ref> In later stages, a palliative approach to dementia care may have specific benefit to goals of care and end-of-life conversations, symptom management, prescribing practices and emergency department visits.<ref>{{Cite journal |last1=Senderovich |first1=Helen |last2=Retnasothie |first2=Sivarajini |date=18 November 2019 |title=A systematic review of the integration of palliative care in dementia management |url=https://www.cambridge.org/core/product/identifier/S1478951519000968/type/journal_article |journal=Palliative and Supportive Care |language=en |volume=18 |issue=4 |pages=495–506 |doi=10.1017/S1478951519000968 |pmid=31736452 |issn=1478-9515|url-access=subscription }}</ref>
Towards the end of life, without palliative care, people often present to the emergency department.<ref>{{Cite journal |last1=Vieira Silva |first1=Sara |last2=Conceição |first2=Paulo |last3=Antunes |first3=Bárbara |last4=Teixeira |first4=Carla |date=27 January 2025 |title=Emergency department use and responsiveness to the palliative care needs of patients with dementia at the end of life: A scoping review |journal=Palliative and Supportive Care |language=en |volume=23 |article-number=e51 |doi=10.1017/S1478951524001627 |pmid=39865850 |issn=1478-9515|doi-access=free |pmc=13166383 }}</ref> Community palliative care is associated without this need.<ref>{{Cite journal |last1=Williamson |first1=Lesley E. |last2=Evans |first2=Catherine J. |last3=Cripps |first3=Rachel L. |last4=Leniz |first4=Javiera |last5=Yorganci |first5=Emel |last6=Sleeman |first6=Katherine E. |date=14 July 2021 |title=Factors Associated With Emergency Department Visits by People With Dementia Near the End of Life: A Systematic Review |journal=Journal of the American Medical Directors Association |language=en |volume=22 |issue=10 |pages=2046–2055.e35 |doi=10.1016/j.jamda.2021.06.012|pmid=34273269 |doi-access=free }}</ref> End-of-life care outcomes at home, such as neuropsychiatric symptoms may be improved.<ref name="Miranda-2019">{{Cite journal |last1=Miranda |first1=Rose |last2=Bunn |first2=Frances |last3=Lynch |first3=Jennifer |last4=Van den Block |first4=Lieve |last5=Goodman |first5=Claire |date=6 May 2019 |title=Palliative care for people with dementia living at home: A systematic review of interventions |journal=Palliative Medicine |language=en |volume=33 |issue=7 |pages=726–742 |doi=10.1177/0269216319847092 |issn=0269-2163 |pmc=6620864 |pmid=31057088}}</ref>
People with advanced dementia may not readily receive specialist palliative care input.<ref name="Mataqi-2020">{{Cite journal |last1=Mataqi |first1=Mona |last2=Aslanpour |first2=Zoe |date=2020-05-27 |title=Factors influencing palliative care in advanced dementia: a systematic review |url=https://spcare.bmj.com/lookup/doi/10.1136/bmjspcare-2018-001692 |journal=BMJ Supportive & Palliative Care |language=en |volume=10 |issue=2 |pages=145–156 |doi=10.1136/bmjspcare-2018-001692 |pmid=30944119 |issn=2045-435X|hdl=2299/21347 |hdl-access=free }}</ref> Reasons for this are varied but may include lack of agreement of when to refer people with dementia,<ref>{{Cite journal |last1=Mo |first1=Li |last2=Geng |first2=Yimin |last3=Chang |first3=Yuchieh Kathryn |last4=Philip |first4=Jennifer |last5=Collins |first5=Anna |last6=Hui |first6=David |date=2 March 2021 |title=Referral criteria to specialist palliative care for patients with dementia: A systematic review |journal=Journal of the American Geriatrics Society |language=en |volume=69 |issue=6 |pages=1659–1669 |doi=10.1111/jgs.17070 |issn=0002-8614 |pmc=8211371 |pmid=33655535}}</ref> and a lack of coordination across care settings, communication challenges, limited training opportunities for healthcare staff and because dementia is considered to be a life-limiting condition.<ref name="Mataqi-2020" /> Dementia is often thought to be a normal ageing process and not recognized as a terminal condition.<ref>{{Cite journal |last1=Erel |first1=Meira |last2=Marcus |first2=Esther-Lee |last3=Dekeyser-Ganz |first3=Freda |date=2017-10-01 |title=Barriers to palliative care for advanced dementia: a scoping review |url=http://apm.amegroups.com/article/view/15568/15677 |journal=Annals of Palliative Medicine |volume=6 |issue=4 |pages=365–379 |doi=10.21037/apm.2017.06.13|doi-access=free |pmid=28754048 }}</ref> Further research is needed to determine the appropriate palliative care interventions and how they can be implemented.<ref name="Miranda-2019" /><ref name="Walsh">{{cite journal |vauthors=Walsh SC, Murphy E, Devane D, Sampson EL, Connolly S, Carney P, O'Shea E |title=Palliative care interventions in advanced dementia |journal=Cochrane Database Syst Rev |volume=2021 |issue=9 |article-number=CD011513 |date=September 2021 |pmid=34582034 |doi=10.1002/14651858.CD011513.pub3 |pmc=8478014 |url=}}</ref>
===Person-centered care=== thumb|upright=1.5|IPOS-Dem subscales used in assessments of symptoms and concerns in advanced dementia care
Person-centered care (different from patient participation), takes into account the individual's needs, preferences, experiences, and values, by building up a personal relationship.<ref name="Fazio-2018">{{Cite journal |last1=Fazio |first1=Sam |last2=Pace |first2=Douglas |last3=Flinner |first3=Janice |last4=Kallmyer |first4=Beth |date=2018-01-18 |title=The Fundamentals of Person-Centered Care for Individuals With Dementia |url=http://academic.oup.com/gerontologist/article/58/suppl_1/S10/4816735 |journal=The Gerontologist |language=en |volume=58 |issue=suppl_1 |pages=S10–S19 |doi=10.1093/geront/gnx122 |pmid=29361064 |issn=0016-9013}}</ref> This is especially important as the approach aims to maintain the dignity of people with dementia and sense of identity throughout the course of their illness.<ref name="MitchellAgnelli20152">{{cite journal |vauthors=Mitchell G, Agnelli J |date=October 2015 |title=Person-centred care for people with dementia: Kitwood reconsidered |journal=Nursing Standard |volume=30 |issue=7 |pages=46–50 |doi=10.7748/ns.30.7.46.s47 |pmid=26463810}}</ref> Person-centered care interventions could not only reduce agitation, neuropsychiatric symptoms, and depression but also help improve the quality of life for people with dementia.<ref>{{Cite journal |last1=Kim |first1=Sun Kyung |last2=Park |first2=Myonghwa |date=17 February 2017 |title=Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis |journal=Clinical Interventions in Aging |language=English |volume=12 |pages=381–397 |doi=10.2147/CIA.S117637 |doi-access=free |pmc=5322939 |pmid=28255234}}</ref> Moreover, the potential benefits of a person-centered care approach for dementia care workers have been reported, indicating its effectiveness in reducing stress, burnout, and job dissatisfaction.<ref name="Fazio-2018"/><ref>{{Cite journal |last1=Barbosa |first1=Ana |last2=Sousa |first2=Liliana |last3=Nolan |first3=Mike |last4=Figueiredo |first4=Daniela |date=2015 |title=Effects of Person-Centered Care Approaches to Dementia Care on Staff: A Systematic Review |journal=American Journal of Alzheimer's Disease & Other Dementias |language=en |volume=30 |issue=8 |pages=713–722 |doi=10.1177/1533317513520213 |issn=1533-3175 |pmc=10852733 |pmid=24449039}}</ref>
Person-centered outcome measures (PCOMs) are standardized, validated questionnaires that measure people's opinions of their own health and well-being. They emphasize person-centered care by focusing on the symptoms and concerns that are most important to people and their families.<ref name="Aworinde">{{Cite journal |last1=Aworinde |first1=Jesutofunmi |last2=Ellis-Smith |first2=Clare |last3=Gillam |first3=Juliet |last4=Roche |first4=Moïse |last5=Coombes |first5=Lucy |last6=Yorganci |first6=Emel |last7=Evans |first7=Catherine J. |date=January 2022 |title=How do person-centered outcome measures enable shared decision-making for people with dementia and family carers?—A systematic review |journal=Alzheimer's & Dementia: Translational Research & Clinical Interventions |language=en |volume=8 |issue=1 |article-number=e12304 |doi=10.1002/trc2.12304 |issn=2352-8737 |pmc=9169867 |pmid=35676942}}</ref><ref name="Chen2024">{{Cite journal |last1=Chen |first1=Linghui |last2=Sleeman |first2=Katherine E. |last3=Bradshaw |first3=Andy |last4=Sakharang |first4=Wilailak |last5=Mo |first5=Yihan |last6=Ellis-Smith |first6=Clare |date=August 2024 |title=The Use of Person-Centered Outcome Measures to Support Integrated Palliative Care for Older People: A Systematic Review |journal=Journal of the American Medical Directors Association |language=en |volume=25 |issue=8 |article-number=105036 |doi=10.1016/j.jamda.2024.105036|pmid=38796168 |doi-access=free }}</ref> PCOMs may be self-reported (when the person with dementia completes the questionnaire) or proxy-reported (when the questionnaire is completed by someone who knows them well). Proxy-reported PCOMs are used in more advanced stages of dementia when the person is no longer able to self report.<ref name="Aworinde"/> Used in routine care, PCOMs support systematic assessment and monitoring of an individual's health and wellbeing, enable shared decision-making, enable changes in care provision (such as improved communication or referral to other services), improve outcomes (such as improved symptom management) and enable evaluation of care provision.<ref name="Aworinde"/> The Integrated Palliative Care Outcome Scale for Dementia (IPOS-Dem) is a comprehensive palliative dementia PCOM, used to measure symptoms and concerns for people with dementia and their family.<ref name="BMC2025">{{cite journal |vauthors=Spichiger F, Meichtry A, Larkin P, Koppitz A |title=Internal consistency and structural validity of the Swiss easy-read Integrated Palliative Care Outcome Scale for People with dementia: a secondary exploratory factor analysis |journal=BMC Palliat Care |volume=24 |issue=1 |article-number=49 |date=February 2025 |pmid=39987038 |pmc=11846360 |doi=10.1186/s12904-025-01691-9 |doi-access=free |url=}}</ref>
Adult daycare centers as well as special care units in nursing homes often provide specialized care. Daycare centers offer supervision, recreation, meals, and limited health care to participants, as well as providing respite for caregivers. In addition, home care can provide one-to-one support and care in the home allowing for more individualized attention that is needed as the disorder progresses.<ref name="AgeUK2026">{{cite web |title=Dementia support services and groups |url=https://www.ageuk.org.uk/services/in-your-area/dementia-support/ |website=Age UK |access-date=3 April 2026}}</ref><ref name="www.nadsa.org">{{Cite web|url=http://www.nadsa.org/learn-more/about-adult-day-services/|title=About Adult Day Services – NADSA: adult day care services|website=www.nadsa.org|access-date=2016-05-16}}</ref>
=== Sleep disturbances === Over 40% of people with dementia report sleep problems.<ref name="Wilfling_2023" /> Approaches to treating these sleep problems include medications and non-pharmacological approaches.<ref name="Wilfling_2023">{{cite journal | vauthors = Wilfling D, Calo S, Dichter MN, Meyer G, Möhler R, Köpke S | title = Non-pharmacological interventions for sleep disturbances in people with dementia | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | article-number = CD011881 | date = January 2023 | pmid = 36594432 | pmc = 9808594 | doi = 10.1002/14651858.CD011881.pub2 }}</ref> The use of medications to alleviate sleep disturbances has not been well researched, even for medications that are commonly prescribed.<ref name="McCleery_2020">{{cite journal | vauthors = McCleery J, Sharpley AL | title = Pharmacotherapies for sleep disturbances in dementia | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 11 | article-number = CD009178 | date = November 2020 | pmid = 33189083 | pmc = 8094738 | doi = 10.1002/14651858.CD009178.pub4 }}</ref> In 2012 the American Geriatrics Society recommended that benzodiazepines such as diazepam, and non-benzodiazepine sleeping pills, be avoided for people with dementia due to the risks of increased cognitive impairment and falls.<ref name="Beers2012">{{cite journal | vauthors = ((American Geriatrics Society 2012 Beers Criteria Update Expert Panel)) | title = American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults | journal = Journal of the American Geriatrics Society | volume = 60 | issue = 4 | pages = 616–631 | date = April 2012 | pmid = 22376048 | pmc = 3571677 | doi = 10.1111/j.1532-5415.2012.03923.x }}</ref> Benzodiazepines are also known to promote delirium.<ref name="Tisher">{{cite journal | vauthors = Tisher A, Salardini A | title = A Comprehensive Update on Treatment of Dementia | journal = Seminars in Neurology | volume = 39 | issue = 2 | pages = 167–178 | date = April 2019 | pmid = 30925610 | doi = 10.1055/s-0039-1683408 | s2cid = 88474685 }}</ref> Additionally, little evidence supports the effectiveness of benzodiazepines in this population.<ref name="McCleery_2020" /> No clear evidence shows that melatonin or ramelteon improves sleep for people with dementia due to Alzheimer's,<ref name="McCleery_2020" /> but it is used to treat REM sleep behavior disorder in dementia with Lewy bodies.<ref name="Taylor2020" /> Limited evidence suggests that a low dose of trazodone may improve sleep, however more research is needed.<ref name="McCleery_2020" />
Non-pharmacological approaches have been suggested but there is no strong evidence or firm conclusions on the effectiveness of different types of interventions, especially for those who are living in an institutionalized setting such as a nursing home or long-term care home.<ref name="Wilfling_2023" /> A sleep management programme may be useful that includes sleep hygiene education, exercise and tailored activities.<ref name=NICEUK2018/>
===Pain=== {{See also|Pain#Assessment_in_non-verbal_people|l1=Assessment in nonverbal patients|Pain Assessment in Advanced Dementia}} Pain in those with moderate to severe dementia is often overlooked and poorly assessed since they become incapable of communicating their pain.<ref name="Smrke2025">{{cite journal |vauthors=Smrke U, Milošič A, Mlakar I, Kadiš M, Mulej Bratec S |title=Pain Cues in People With Dementia: Scoping Review |journal=JMIR Ment Health |volume=12 |issue= |pages=e75671 |date=November 2025 |article-number=v12i2e75671 |pmid=41313209 |pmc=12661616 |doi=10.2196/75671 |doi-access=free |url=}}</ref> Nearly 80% of those with dementia in nursing homes may experience pain that is difficult to communicate, and it may be expressed as a behavioral symptom.<ref name="Helvik2023">{{Cite journal |last1=Helvik |first1=Anne-S. |last2=Bergh |first2=Sverre |last3=Tevik |first3=Kjerstin |date=2023-10-10 |title=A systematic review of prevalence of pain in nursing home residents with dementia |journal=BMC Geriatrics |language=en |volume=23 |issue=1 |page=641 |doi=10.1186/s12877-023-04340-z |doi-access=free |issn=1471-2318 |pmc=10566134 |pmid=37817061}}</ref><ref name="Cravello2019">{{cite journal |vauthors=Cravello L, Di Santo S, Varrassi G, Benincasa D, Marchettini P, de Tommaso M, Shofany J, Assogna F, Perotta D, Palmer K, Paladini A, di Iulio F, Caltagirone C |title=Chronic Pain in the Elderly with Cognitive Decline: A Narrative Review |journal=Pain Ther |volume=8 |issue=1 |pages=53–65 |date=June 2019 |pmid=30666612 |pmc=6513941 |doi=10.1007/s40122-019-0111-7 |url=}}</ref> Persistent pain has functional implications, it can lead to decreased mobility, depression, sleep disturbances, impaired appetite, exacerbation of cognitive impairment and contribute to falls.<ref name="Smrke2025"/> Caregivers can learn to recognize and assess the pain cues.<ref name="Smrke2025"/> The use of a Pain Assessment in Advanced Dementia scale, can help healthcare workers in their care of those with advanced dementia.<ref>{{Cite journal |last1=Felton |first1=Nansi |last2=Lewis |first2=Jennifer S. |last3=Cockburn |first3=Sarah-Jane |last4=Hodgson |first4=Margot |last5=Dawson |first5=Shoba |date=2021-10-19 |title=Pain Assessment for Individuals with Advanced Dementia in Care Homes: A Systematic Review |journal=Geriatrics |language=en |volume=6 |issue=4 |page=101 |doi=10.3390/geriatrics6040101 |doi-access=free |issn=2308-3417 |pmc=8544573 |pmid=34698157}}</ref>
=== Communication === The ability of people with dementia to speak or otherwise communicate may become impaired, and they may seem unable to understand what is said to them and have trouble communicating their needs.<ref>{{cite web |date=November 30, 2015|title=Alzheimer's Disease Symptoms|url=http://www.caringkindnyc.org/alzheimers-symptoms/|access-date=September 18, 2017|website=CaringKindNYC.org|publisher=Caring Kind}}</ref><ref name="Norbergh-2006">{{cite journal |vauthors=Norbergh KG, Helin Y, Dahl A, Hellzén O, Asplund K|date=May 2006|title=Nurses' attitudes towards people with dementia: the semantic differential technique|journal=Nursing Ethics|volume=13|issue=3|pages=264–274|doi=10.1191/0969733006ne863oa|pmid=16711185|s2cid=12327034}}</ref> Communication challenges affect not only the administration of pain medication but also hydration, nutrition, and all aspects of physical and emotional care.'''<ref name="Chenoweth-2021">{{cite journal |vauthors=Chenoweth L, Cook J, Williams A|date=September 2021|title=Perceptions of Care Quality during an Acute Hospital Stay for Persons with Dementia and Family/Carers|journal=Healthcare|volume=9|issue=9|page=1176|doi=10.3390/healthcare9091176|pmc=8469973|pmid=34574951|doi-access=free}}</ref>''' Formal caregivers may also find it hard to form relationships with those they care for because of the communication barrier.<ref name="Norbergh-2006" />
For people with dementia who have lost their speech, nonverbal communication can be used. Paying attention to eye movements, facial expressions, and body movements can help caregivers understand them better. As each person is affected by dementia differently, a unique form of communication may need to be established.<ref>{{cite journal |vauthors=Ellis M, Astell A|date=August 1, 2017|title=Communicating with people living with dementia who are nonverbal: The creation of Adaptive Interaction|journal=PLOS ONE|volume=12|issue=8|article-number=e0180395|bibcode=2017PLoSO..1280395E|doi=10.1371/journal.pone.0180395|pmc=5538738|pmid=28763445|doi-access=free}}</ref> People with dementia living in long-term care homes typically have high rates of hearing loss which can further impair communication between them and staff. However, various barriers, including a lack of knowledge and time pressure, often prevent staff from providing adequate hearing care.<ref>{{Cite journal |last1=Cross|first1=Hannah|last2=Armitage|first2=Christopher J.|last3=Dawes|first3=Piers|last4=Leroi|first4=Iracema|last5=Millman|first5=Rebecca E.|date=2024-03-06|title=Improving the Provision of Hearing Care to Long-Term Care Home Residents with Dementia: Developing a Behaviour Change Intervention for Care Staff|url=https://journal.ilpnetwork.org/articles/10.31389/jltc.260/|journal=Journal of Long Term Care|language=en|pages=122–138|doi=10.31389/jltc.260|issn=2516-9122}}</ref>
=== Exercise === {{Further|Neurobiological effects of physical exercise}} thumb |upright=1.3|Modulatory effects of physical exercise on depression and dementia Exercise programs may improve the ability of people with dementia to perform daily activities, but the best type of exercise is still unclear.<ref name="Forb2015"/>
=== Assistive technology and digital health === Assistive technologies may be used to improve the quality of life for individuals with dementia, support their independence, and assist caregivers.<ref>{{Cite journal |last1=Pappadà|first1=Alessandro|last2=Chattat|first2=Rabih|last3=Chirico|first3=Ilaria|last4=Valente|first4=Marco|last5=Ottoboni|first5=Giovanni|date=2021-03-24|title=Assistive Technologies in Dementia Care: An Updated Analysis of the Literature|journal=Frontiers in Psychology|language=English|volume=12|article-number=644587|doi=10.3389/fpsyg.2021.644587|doi-access=free|pmid=33841281|issn=1664-1078|hdl=11585/820952|hdl-access=free|pmc=8024695}}</ref> These technologies include home automation systems, digital assistive tools, and wearable sensors.<ref>{{Cite web |title=What is assistive technology? {{!}} Alzheimer's Society|url=https://www.alzheimers.org.uk/get-support/staying-independent/what-assistive-technology|access-date=2025-02-27|website=www.alzheimers.org.uk|language=en}}</ref> Virtual reality is also being explored as a powerful technology to elicit memories and to improve wellbeing.<ref>{{Cite journal |last1=Meek |first1=H. |last2=Rooker |first2=S. |last3=Malik |first3=H. |last4=Baldaro-Booth |first4=R. |last5=Courtney |first5=J. |last6=Jackson |first6=S. |last7=Raycraft |first7=A. |last8=Ibáñez |first8=A. |last9=Mathew |first9=R. K. |date=2025-02-17 |title=Inclusive Futures: Harnessing Virtual Reality for Dementia Care |url=https://eprints.whiterose.ac.uk/223478/ |access-date=2025-03-05 |website=eprints.whiterose.ac.uk |language=en |doi=10.48785/100/313}}</ref>
Technology has the potential to be a valuable intervention for alleviating loneliness and promoting social connections.<ref>{{cite journal | vauthors = Anderson M, Menon R, Oak K, Allan L | title = The use of technology for social interaction by people with dementia: A scoping review | journal = PLOS Digital Health | volume = 1 | issue = 6 | article-number = e0000053 | date = June 2022 | pmid = 36812560 | pmc = 9931370 | doi = 10.1371/journal.pdig.0000053 | doi-access = free }}</ref> It could facilitate activities of daily living, and provide ways to connect people that are geographically distant.<ref>{{Cite journal |last1=Pappadà |first1=Alessandro |last2=Chattat |first2=Rabih |last3=Chirico |first3=Ilaria |last4=Valente |first4=Marco |last5=Ottoboni |first5=Giovanni |date=2021-03-24 |title=Assistive Technologies in Dementia Care: An Updated Analysis of the Literature |journal=Frontiers in Psychology |volume=12 |article-number=644587 |doi=10.3389/fpsyg.2021.644587 |doi-access=free |issn=1664-1078 |pmc=8024695 |pmid=33841281}}</ref>
Other types of developed technologies to aid services include telehealth or telemedicine services, using digital communication for delivery of health-related services and information through phone calls, mobile apps, and video conferencing.<ref name="Yi-2021">{{Cite journal |last1=Yi |first1=Julie S. |last2=Pittman |first2=Corinne A. |last3=Price |first3=Carrie L. |last4=Nieman |first4=Carrie L. |last5=Oh |first5=Esther S. |date=2021-04-19 |title=Telemedicine and Dementia Care: A Systematic Review of Barriers and Facilitators |journal=Journal of the American Medical Directors Association |language=en |volume=22 |issue=7 |pages=1396–1402.e18 |doi=10.1016/j.jamda.2021.03.015 |pmc=8292189 |pmid=33887231}}</ref>
Telemedicine has given results for cognitive assessment and diagnosis that are similar to in-person visits, and it has also helped improve outcomes after rehabilitation. Telemedicine is often well received by people affected by dementia who can rely on the support of staff and family to navigate the technology. While it has potential to widen access to services, those with sensory impairment may be excluded.<ref name="Yi-2021" />
Digital health interventions can play a role in supporting family caregivers of people with dementia, by offering a source of support from connective platforms, with 24/7 accessibility, as well as opportunity for remote monitoring.<ref>{{Cite journal |last1=Borges do Nascimento|first1=Israel Júnior|last2=Abdulazeem|first2=Hebatullah Mohamed|last3=Weerasekara|first3=Ishanka|last4=Sharifan|first4=Amin|last5=Grandi Bianco|first5=Victor|last6=Kularathne|first6=Indunil|last7=Cunningham|first7=Ciara|last8=Sathian|first8=Brijesh|last9=Deeken|first9=Genevieve|last10=Østengaard|first10=Lasse|last11=Frederique-Djurdjevic|first11=Rachel|last12=Hoof|first12=Joost van|last13=Lazeri|first13=Ledia|last14=Redlich|first14=Cassie|last15=Marston|first15=Hannah R|date=2025-11-06|title=An Overview of Reviews on Telemedicine and Telehealth in Dementia Care: Mixed Methods Synthesis|journal=JMIR Mental Health|language=en|volume=12|pages=e75266|article-number=v12i11e75266|doi=10.2196/75266|doi-access=free|issn=2368-7959|pmc=12975415|pmid=41194522}}</ref><ref name="Yi-2021" /> However, challenges such as the digital divide, privacy concerns and the need for greater personalisation for individual users are recognised issues.<ref name="Yi-2021" />
Remotely delivered interventions including support, training and information may reduce the burden for the informal caregiver and improve their depressive symptoms.<ref name="González-Fraile_2021">{{cite journal |vauthors=González-Fraile E, Ballesteros J, Rueda JR, Santos-Zorrozúa B, Solà I, McCleery J |date=January 2021 |title=Remotely delivered information, training and support for informal caregivers of people with dementia |journal=The Cochrane Database of Systematic Reviews |volume=1 |issue=1 |article-number=CD006440 |doi=10.1002/14651858.cd006440.pub3 |pmc=8094510 |pmid=33417236}}</ref>
In several localities in Japan, digital surveillance may be made available to family members, if a person with dementia is prone to wandering and going missing.<ref>{{Cite news |date=February 2, 2022 |title=Where a Thousand Digital Eyes Keep Watch Over the Elderly |url=https://www.nytimes.com/2022/02/02/business/japan-elderly-surveillance.html |access-date=February 6, 2022 |work=The New York Times |language=en-US |issn=0362-4331 |vauthors=Dooley B, Ueno H}}</ref>
== Epidemiology == {{owidslider |start = 2021 |list = Template:OWID/dementia death rates#gallery |location = commons |caption = |title = |language = |file = link=|thumb|upright=1.6|Dementia death rates |startingView = World }}
[[Image:Alzheimer and other dementias world map - DALY - WHO2004.svg|thumb|upright=1.3|Disability-adjusted life year for Alzheimer and other dementias per 100,000 inhabitants in 2004 {{Col-begin}} {{Col-break}} {{legend|#ffff65|<100}} {{legend|#fff200|100–120}} {{legend|#ffdc00|120–140}} {{legend|#ffc600|140–160}} {{legend|#ffb000|160–180}} {{legend|#ff9a00|180–200}} {{Col-break}} {{legend|#ff8400|200–220}} {{legend|#ff6e00|220–240}} {{legend|#ff5800|240–260}} {{legend|#ff4200|260–280}} {{legend|#ff2c00|280–300}} {{legend|#cb0000|>300}} {{col-end}}]]
The number of cases of dementia worldwide in 2021 was estimated at 57 million, with close to 10 million new cases each year.<ref name="WHO2026"/> This number is estimated to double every 20 years.<ref name="A and D2026"/> Another estimate gives the number of people worldwide with dementia to reach over 150 million by 2050.<ref>{{cite journal | vauthors = Nichols E, Steinmetz JD, Vollset SE, Fukutaki K, Chalek J, Abd-Allah F, etal | collaboration = GBD 2019 Dementia Forecasting Collaborators | title = Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019 | language = English | journal = The Lancet. Public Health | volume = 7 | issue = 2 | pages = e105–e125 | date = February 2022 | pmid = 34998485 | pmc = 8810394 | doi = 10.1016/S2468-2667(21)00249-8 }}</ref> Over 60% live in low and middle income countries, with women being more impacted.<ref name="WHO2026"/> Globally, the fastest increase in serious health-related suffering by 2060 is expected to occur among people with dementia.<ref name="Sleeman">{{cite journal |vauthors=Sleeman KE, de Brito M, Etkind S, Nkhoma K, Guo P, Higginson IJ, Gomes B, Harding R |title=The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions |journal=Lancet Glob Health |volume=7 |issue=7 |pages=e883–e892 |date=July 2019 |pmid=31129125 |pmc=6560023 |doi=10.1016/S2214-109X(19)30172-X |url=}}</ref>
In 2021 there were 1.8 million deaths from dementia making it the seventh leading cause of death.<ref name="Topten2026">{{cite web |title=The top 10 causes of death |url=https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death |website=www.who.int |access-date=18 May 2026 |language=en}}</ref> This is expected to increase to 4.91 million by 2050.<ref name="Li-2024">{{cite journal |vauthors=Li Z, Yang N, He L, Wang J, Yang Y, Ping F, Xu L, Zhang H, Li W, Li Y |title=Global Burden of Dementia Death from 1990 to 2019, with Projections to 2050: An Analysis of 2019 Global Burden of Disease Study |journal=J Prev Alzheimers Dis |volume=11 |issue=4 |pages=1013–1021 |date=2024 |pmid=39044512 |doi=10.14283/jpad.2024.21 |pmc=12275824 |url=}}</ref> In Europe, Finland has the highest mortality rate from dementia in the world.<ref name="Eiser">{{cite journal |vauthors=Eiser AR |title=Why does Finland have the highest dementia mortality rate? Environmental factors may be generalizable |journal=Brain Res |volume=1671 |issue= |pages=14–17 |date=September 2017 |pmid=28687259 |doi=10.1016/j.brainres.2017.06.032 |url=}}</ref>
Around 7% of people over the age of 65 have dementia, with rates up to 10%, in places with relatively high life expectancy.<ref name="Gale2018"/> The prevalence of dementia differs in different world regions; in 2015, there were an estimated 10.4 million cases in Europe; 9.4 million cases in the Americas; 4 million in Africa, and 22.9 million in Asia.<ref name="Alzheimer's Disease International_2015">{{Cite web |url=https://www.alz.co.uk/research/WorldAlzheimerReport2015.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://www.alz.co.uk/research/WorldAlzheimerReport2015.pdf |archive-date=October 9, 2022 |url-status=live|title=World Alzheimer Report 2015|last=Alzheimer's Disease International|date=Sep 2015|access-date=October 30, 2018}}</ref>
Almost half of new dementia cases occur in Asia, followed by Europe (25%), the Americas (18%) and Africa (8%). The incidence of dementia increases exponentially with age, doubling with every 6.3-year increase in age.<ref name="Alzheimer's Disease International_2015" /> The disease trajectory is varied and the median time from diagnosis to death depends strongly on age at diagnosis, from 6.7 years for people diagnosed aged 60–69 to 1.9 years for people diagnosed at 90 or older.<ref name="Walsh" />
=== Inequalities === {{See also|Health equity}}
Inequalities are observed in the risk of developing dementia, in its timely diagnosis, in access to care, and in support.<ref name="OHE2024">{{Cite web |date=2024-06-26 |title=Inequalities in Dementia: Unveiling the Evidence and Forging a Path Towards Greater Understanding |url=https://www.ohe.org/publications/inequalities-in-dementia |access-date=2025-04-19 |website=Office of Health Economics (OHE)}}</ref> There is also less funding available for dementia research, and less support for the carers.<ref name="OHE2024" />
On a global level, people in low-and middle-income countries have fewer available facilities and services, and have greater difficulties accessing these than people living in high-income countries.<ref>{{Cite journal |last1=Chen|first1=Frank|last2=Hu|first2=Zhiwei|last3=Li|first3=Quan|last4=Zheng|first4=Xuan|last5=Li|first5=Meizhi|last6=Salcher-Konrad|first6=Maximilian|last7=Comas-Herrera|first7=Adelina|last8=Knapp|first8=Martin|last9=Shi|first9=Cheng|last10=The STRiDE consortium|date=27 February 2025|title=Effectiveness of Interventions to Support Carers of People With Dementia in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis|journal=International Journal of Geriatric Psychiatry|language=en|volume=40|issue=3|article-number=e70054 |doi=10.1002/gps.70054|issn=0885-6230|pmc=11867927|pmid=40015952}}</ref><ref>{{Cite journal |last1=Seeher|first1=Katrin|last2=Cataldi|first2=Rodrigo|last3=Dua|first3=Tarun|last4=Kestel|first4=Devora|date=2023-03-15|title=Inequitable Access to Dementia Diagnosis and Care in Low-Resource Settings – A Global Perspective|url=https://www.tandfonline.com/doi/full/10.1080/07317115.2022.2054391|journal=Clinical Gerontologist|language=en|volume=46|issue=2|pages=133–137|doi=10.1080/07317115.2022.2054391|issn=0731-7115|pmid=35672953}}</ref> Low socioeconomic status has a greater risk burden for the development of dementia and is also associated with earlier cognitive decline.<ref name="Livingston-2024a" /> In the most deprived areas of a country more hospitalisations, and emergency department visits are noted. Inappropriate medications may be prescribed and there is a higher one year mortality rate.<ref name="Godard-Sebillotte">{{Cite journal |last1=Godard-Sebillotte |first1=Claire |last2=Arsenault-Lapierre |first2=Geneviève |last3=Sourial |first3=Nadia |last4=Navani |first4=Sanjna |last5=Quesnel-Vallée |first5=Amélie |last6=Rochette |first6=Louis |last7=Massamba |first7=Victoria |last8=Vedel |first8=Isabelle |date=March 2025 |title=Examining equity in service use across socioeconomic status in people with dementia |journal=Alzheimer's & Dementia: Behavior & Socioeconomics of Aging |language=en |volume=1 |issue=1 |article-number=e70006 |doi=10.1002/bsa3.70006 |issn=2997-3805|doi-access=free }}</ref><ref name="Leniz2019">{{Cite journal |last1=Leniz |first1=Javiera |last2=Higginson |first2=Irene J |last3=Stewart |first3=Robert |last4=Sleeman |first4=Katherine E |date=2019-09-01 |title=Understanding which people with dementia are at risk of inappropriate care and avoidable transitions to hospital near the end-of-life: a retrospective cohort study |url=https://academic.oup.com/ageing/article/48/5/672/5499172 |journal=Age and Ageing |language=en |volume=48 |issue=5 |pages=672–679 |doi=10.1093/ageing/afz052 |pmid=31135024 |issn=0002-0729|doi-access=free }}</ref>
On a national level, people with dementia might have unequal access to care based on where they live. This can manifest on a regional level, with people in rural areas facing more difficulties than those in urban areas. Inequalities can also affect smaller local units as well, for example people living in the same city might receive different or less frequent care based on their postcodes or the street they live in.<ref name="Giebel">{{cite journal |vauthors=Giebel C, Readman MR, Godfrey A, Gray A, Carton J, Polden M |title=Geographical inequalities in dementia diagnosis and care: A systematic review |journal=Int Psychogeriatr |volume=37 |issue=3 |article-number=100051 |date=June 2025 |pmid=39986949 |pmc=12149024 |doi=10.1016/j.inpsyc.2025.100051 |url=}}</ref>
A diagnosis of dementia is difficult for the individual and the carers, and post-diagnostic support is often variable, and care options difficult to navigate.<ref>{{Cite journal |last1=Bamford |first1=Claire |last2=Wheatley |first2=Alison |last3=Brunskill |first3=Greta |last4=Booi |first4=Laura |last5=Allan |first5=Louise |last6=Banerjee |first6=Sube |last7=Harrison Dening |first7=Karen |last8=Manthorpe |first8=Jill |last9=Robinson |first9=Louise |last10=on behalf of the PriDem study team |date=2021-12-20 |editor-last=Shahabi |editor-first=Saeed |title=Key components of post-diagnostic support for people with dementia and their carers: A qualitative study |journal=PLOS ONE |language=en |volume=16 |issue=12 |article-number=e0260506 |doi=10.1371/journal.pone.0260506 |doi-access=free |issn=1932-6203 |pmc=8687564 |pmid=34928972|bibcode=2021PLoSO..1660506B }}</ref><ref>{{Cite journal |last1=Wei |first1=Grace |last2=McDonald |first2=Skye |last3=Kelly |first3=Michelle |last4=Ballard |first4=Kirrie J |last5=Kumfor |first5=Fiona |date=2025-04-24 |title=Post-diagnostic care pathways in dementia: Experiences and needs of family carers and considerations for interventions |journal=Dementia |volume=25 |issue=3 |article-number=14713012251337230 |language=en |doi=10.1177/14713012251337230 |pmid=40272843 |issn=1471-3012|doi-access=free |pmc=13002931 }}</ref> There is often a perceived disparity in care between dementia and other life-limiting conditions.<ref>{{Cite journal |last1=Williamson |first1=Lesley E. |last2=Sleeman |first2=Katherine E. |last3=Evans |first3=Catherine J. |date=24 July 2023 |title=Exploring access to community care and emergency department use among people with dementia: A qualitative interview study with people with dementia, and current and bereaved caregivers |url=https://onlinelibrary.wiley.com/doi/10.1002/gps.5966 |journal=International Journal of Geriatric Psychiatry |language=en |volume=38 |issue=7 |article-number=e5966 |doi=10.1002/gps.5966 |pmid=37485729 |issn=0885-6230}}</ref><ref>{{Cite journal |last1=Dooley |first1=Jemima |last2=Webb |first2=Joe |last3=James |first3=Roy |last4=Davis |first4=Harry |last5=Read |first5=Sandy |date=2025-01-28 |title=Exploring experiences of dementia post-diagnosis support and ideas for improving practice: A co-produced study |url=https://journals.sagepub.com/doi/10.1177/14713012241312845 |journal=Dementia |volume=24 |issue=7 |article-number=14713012241312845 |language=en |doi=10.1177/14713012241312845 |pmid=39876088 |issn=1471-3012|url-access=subscription |hdl=1983/ea30fdba-1f3f-4dd5-be9d-2a6250895487 |hdl-access=free }}</ref><ref>{{Cite journal |last1=Harrison |first1=Krista L. |last2=Hunt |first2=Lauren J. |last3=Ritchie |first3=Christine S. |last4=Yaffe |first4=Kristine |date=25 March 2019 |title=Dying With Dementia: Underrecognized and Stigmatized |journal=Journal of the American Geriatrics Society |language=en |volume=67 |issue=8 |pages=1548–1551 |doi=10.1111/jgs.15895 |issn=0002-8614 |pmc=6684346 |pmid=30908605}}</ref> Social stigma is commonly perceived by those with the condition, and also by their caregivers.<ref name="WHO2026" />
Significant differences in dementia incidence, risk, and care exist in racial and ethnic minorities. These groups are often more affected by dementia risk factors, for example having high blood pressure.<ref>{{Cite journal |last1=Kornblith |first1=Erica |last2=Bahorik |first2=Amber |last3=Boscardin |first3=W. John |last4=Xia |first4=Feng |last5=Barnes |first5=Deborah E. |last6=Yaffe |first6=Kristine |date=2022-04-19 |title=Association of Race and Ethnicity With Incidence of Dementia Among Older Adults |journal=JAMA |language=en |volume=327 |issue=15 |pages=1488–1495 |doi=10.1001/jama.2022.3550 |issn=0098-7484 |pmc=9020215 |pmid=35438728}}</ref><ref>{{Cite journal |last1=Shiekh |first1=Suhail Ismail |last2=Cadogan |first2=Sharon Louise |last3=Lin |first3=Liang-Yu |last4=Mathur |first4=Rohini |last5=Smeeth |first5=Liam |last6=Warren-Gash |first6=Charlotte |date=2021-03-09 |editor-last=Ikram |editor-first=M. Arfan |title=Ethnic Differences in Dementia Risk: A Systematic Review and Meta-Analysis |journal=Journal of Alzheimer's Disease |volume=80 |issue=1 |pages=337–355 |doi=10.3233/JAD-201209 |pmc=8075390 |pmid=33554910}}</ref><ref>{{Cite book |last=Koffman |first=Jonathan |url=https://raceequalityfoundation.org.uk/wp-content/uploads/2022/10/REF-Better-Health-451-1.pdf |title=Dementia and end of life care for black, Asian and minority ethnic communities |date=June 2018 |publisher=Race Equality Foundation |series=Better Health Briefing 45}}</ref><ref>{{Cite journal |last1=Zabihi |first1=Sedigheh |last2=Bestwick |first2=Jonathan P |last3=Jitlal |first3=Mark |last4=Bothongo |first4=Phazha LK |last5=Zhang |first5=Qiqi |last6=Carter |first6=Christine |last7=Roche |first7=Moïse |last8=Morgan-Trimmer |first8=Sarah |last9=Birks |first9=Yvonne |last10=Wilberforce |first10=Mark |last11=Dobson |first11=Ruth |last12=Noyce |first12=Alastair J |last13=Robson |first13=John |last14=Walter |first14=Fiona M |last15=Cooper |first15=Claudia |date=February 2025 |title=Early presentations of dementia in a diverse population |journal=Alzheimer's & Dementia |language=en |volume=21 |issue=2 |article-number=e14578 |doi=10.1002/alz.14578 |issn=1552-5260 |pmc=11863067 |pmid=40008622}}</ref> Those coming from a minority background often receive lower quality dementia care, they are less likely to get anti-dementia medications compared to their White counterparts. Furthermore, when they are prescribed medication, they are less likely to adhere to the treatment due to various factors and barriers such as the quality of interaction with healthcare providers, distrust in doctors, worries about retaining personal autonomy, stigmas and different beliefs.<ref name="Aguzzoli-2026">{{Cite journal |last1=Aguzzoli|first1=Elisa|last2=Walbaum|first2=Magdalena|last3=Knapp|first3=Martin|date=2026-02-16|title=Access to healthcare services and adherence to treatments for people with dementia among ethnic minority groups: a scoping review|url=https://researchonline.lse.ac.uk/id/eprint/137295/|journal=Frontiers in Dementia|volume=5|article-number=1735266|doi=10.3389/frdem.2026.1735266|issn=2813-3919|pmc=12950575|pmid=41777856|url-access=|doi-access=free}}</ref>
Globally, women are much more impacted by dementia than men. Two in three people with dementia are women.<ref>{{Cite journal |last1=Aguzzoli |first1=Elisa |last2=Walbaum |first2=Magdalena |last3=Knapp |first3=Martin |last4=Castro-Aldrete |first4=Laura |last5=Santuccione Chadha |first5=Antonella |last6=Cyhlarova |first6=Eva |date=2025-05-29 |title=Sex and gender differences in access, quality of care, and effectiveness of treatment in dementia: a scoping review of studies up to 2024 |journal=Archives of Public Health |language=en |volume=83 |issue=1 |article-number=139 |doi=10.1186/s13690-025-01626-z |doi-access=free |issn=2049-3258 |pmc=12121192 |pmid=40442851}}</ref><ref name="ARUK2022">{{cite web |title=Why women are bearing more of the impact of dementia |url=https://www.alzheimersresearchuk.org/news/why-women-are-bearing-more-of-the-impact-of-dementia/?_gl=1%2A1xpm5ed%2A_gcl_au%2AMTc3MDkwMTMyMy4xNzY5MjU3MjQx%2AFPAU%2AMTc3MDkwMTMyMy4xNzY5MjU3MjQx%2A_ga%2AMjIzNzMwNTMuMTc2OTI1NzIzOQ..%2A_ga_TR76MGPH49%2AczE3NzQ1MTA3NDQkbzYkZzEkdDE3NzQ1MTA3NjAkajQ0JGwwJGgw%2A_fplc%2ARmpXdVBYall0aVBLN2hmdEhIM1ZrSUxTZFUwWFd1RFFMT2ZjZXNwcGVoUDIzRkE3RWROdllCcXF6MiUyQkdPbUNRdnpGeTB6cVM4a2VRWUZ5VjJaa3ZBMW1sck1ZbXZhcyUyQjVXTDhMR25ZU2JxTjJYZXVGakhmTGYzbE0za3ZpZyUzRCUzRA.. |website=Alzheimer's Research UK |access-date=26 March 2026}}</ref> Yet, medical data from women are lacking compared to men. Women are more likely to care for another person with dementia (in the workforce and informally).<ref name="ARUK2022" /> The proportion of women caregivers in low and middle income countries is higher.<ref>{{Cite book |last1=Erol |first1=Rosie |url=https://www.alzint.org/u/Women-and-Dementia.pdf |title=Women and Dementia. A global research review |last2=Brooker |first2=Dawn |last3=Peel |first3=Elizabeth |date=June 2015 |publisher=Alzheimer's Disease International}}</ref><ref name="ARUK2022" /> Gender disparities exist towards the end-of-life in caregiving experiences.<ref>{{Cite journal |last1=Wong |first1=Annette D. |last2=Phillips |first2=Susan P. |date=January 2023 |title=Gender Disparities in End of Life Care: A Scoping Review |journal=Journal of Palliative Care |language=en |volume=38 |issue=1 |pages=78–96 |doi=10.1177/08258597221120707 |issn=0825-8597 |pmc=9667103 |pmid=35996340}}</ref>
=== By country ===
==== United Kingdom ==== Estimates show that in 2024 there were nearly a million people living with dementia in the UK, with more than 800 000 in England.<ref name=":1">{{Cite web |date=2024|title=The Economic Impact of Dementia – Module 1|url=https://www.alzheimers.org.uk/sites/default/files/2024-05/the-annual-costs-of-dementia.pdf|access-date=17 May 2026|website=The Economic Impact of Dementia – Module 1}}</ref> This is expected to rise to 1.4 million by 2040,<ref>{{Cite web |title=Prevalence and incidence|url=https://dementiastatistics.org/about-dementia/prevalence-and-incidence/|access-date=2026-05-15|website=Dementia Statistics Hub|language=en-GB}}</ref> with numbers doubling in England.<ref name=":0">{{Cite journal |last1=Wittenberg|first1=Raphael|last2=Hu|first2=Bo|last3=Jagger|first3=Carol|last4=Kingston|first4=Andrew|last5=Knapp|first5=Martin|last6=Comas-Herrera|first6=Adelina|last7=King|first7=Derek|last8=Rehill|first8=Amritpal|last9=Banerjee|first9=Sube|date=2020-02-27|title=Projections of care for older people with dementia in England: 2015 to 2040|url=https://academic.oup.com/ageing/article/49/2/264/5661652|journal=Age and Ageing|language=en|volume=49|issue=2|pages=264–269|doi=10.1093/ageing/afz154|issn=0002-0729|pmc=7047814|pmid=31808792}}</ref>
In 2022 and 2023, dementia was the leading cause of death in England and Wales.<ref name="Dementia UKg" />
==== United States ==== Deaths from dementia in the U.S. tripled in the period from 1999-2020, rising from around 150,000 in 1999 to over 450,000 in 2020, and the likelihood of dying from dementia increased across all demographic groups.<ref>{{Cite journal |last1=Ali |first1=Mohsan |last2=Talha |first2=Muhammad |last3=Naseer |first3=Bisal |last4=Jaka |first4=Sanobar |last5=Gunturu |first5=Sasidhar |date=2024-08-13 |title=Divergent Mortality Patterns Associated With Dementia in the United States: 1999–2020 |url=https://www.psychiatrist.com/pcc/divergent-mortality-patterns-associated-with-dementia-united-states-1999-2020/ |journal=The Primary Care Companion for CNS Disorders |language=English |volume=26 |issue=4 |page=56364 |doi=10.4088/PCC.24m03724 |pmid=39178013 |issn=2155-7780|url-access=subscription }}</ref> In 2024 dementia was the fifth leading cause of death in the U.S.<ref name="A and D2026" />
The genetic and environmental risk factors for dementia disorders vary by ethnicity.<ref>{{cite journal |vauthors=Brijnath B, Croy S, Sabates J, Thodis A, Ellis S, de Crespigny F, Moxey A, Day R, Dobson A, Elliott C, Etherington C, Geronimo MA, Hlis D, Lampit A, Low LF, Straiton N, Temple J |date=2022 |title=Including ethnic minorities in dementia research: Recommendations from a scoping review |journal=Alzheimer's & Dementia |volume=8 |issue=1 |article-number=e12222 |doi=10.1002/trc2.12222 |pmc=9053375 |pmid=35505899}}</ref><ref>{{cite journal |vauthors=Sabayan B, Wyman-Chick KA, Sedaghat S |date=February 2023 |title=The Burden of Dementia Spectrum Disorders and Associated Comorbid and Demographic Features |journal=Clinics in Geriatric Medicine |volume=39 |issue=1 |pages=1–14 |doi=10.1016/j.cger.2022.07.001 |pmid=36404023 |s2cid=253068389}}</ref> For instance, Alzheimer's disease among Hispanic/Latino and African American subjects exhibit lower risks associated with gene changes in the apolipoprotein E gene than do non-Hispanic white subjects.<ref>{{Cite journal |author1=Ariana M. Stickel |author2=Andrew C. McKinnon |author3=Stephanie Matijevik |author4=Matthew D. Grilli |author5=John Ruiz |author6=Lee Ryam |date=February 26, 2021 |title=Apolipoprotein E ε4 Allele-Based Differences in Brain Volumes Are Largely Uniform Across Late Middle Aged and Older Hispanic/Latino- and Non-Hispanic/Latino Whites Without Dementia |journal=Frontiers in Aging Neuroscience |volume=13 |article-number=627322 |doi=10.3389/fnagi.2021.627322 |pmc=7952627 |pmid=33716715 |doi-access=free}}</ref>
In the United States in 2017, over 37% of dementia cases were associated with cardiometabolic conditions, though the risk varies across regions. The eight key contributors were diabetes, heart failure, atrial fibrillation, coronary artery disease, heart attacks, strokes, hypertension and high cholesterol. Among these, stroke was the most significant factor, doubling the risk of developing dementia (2.2 times higher), followed closely by heart failure (2.1 times) and hypertension (78% increased risk). In contrast, high cholesterol had the weakest correlation, associated with a 27% increased risk. However, there were also geographic disparities, and individuals living in the U.S. South faced a higher likelihood of dementia related to cardiovascular conditions and diabetes.<ref>{{Cite web |last=Thompson |first=Dennis |date=2025-05-29 |title=Dementia Tied To Heart, Metabolic Diseases |url=https://www.healthday.com/health-news/neurology/dementia-tied-to-heart-metabolic-diseases |access-date=2025-06-01 |website=www.healthday.com |language=en}}</ref><ref>{{Cite journal |last1=Karway |first1=George K. |last2=Krzyzanowski |first2=Brittany |last3=Killion |first3=Jordan A. |last4=Faust |first4=Irene M. |last5=Laurido-Soto |first5=Osvaldo J. |last6=Sabbagh |first6=Marwan N. |last7=Racette |first7=Brad A. |date=2025 |title=Regional variability of the impact of cardiometabolic diseases on incident dementia in United States Medicare beneficiaries |journal=Alzheimer's & Dementia |language=en |volume=21 |issue=5 |article-number=e70199 |doi=10.1002/alz.70199 |issn=1552-5279 |pmc=12100501 |pmid=40407074}}</ref>
====Australia==== In Australia in 2024 there were an estimated 425,000 cases of dementia. In 2023 dementia was the leading cause of death for women, and the second leading for men. In 2023 there were 17,400 deaths which rose to 17,847 in 2024.<ref name="AIHW">{{cite web |title=Dementia in Australia |url=https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/how-many-people-have-dementia |website=www.aihw.gov.au |access-date=18 May 2026}}</ref>
==History== {{more citations needed section|date=November 2015}} {{See also|History of neuroscience}} Until the end of the 19th century, dementia was a much broader clinical concept. It included mental illness and any type of psychosocial incapacity, including reversible conditions.<ref name=Berr>{{cite journal | vauthors = Berrios GE | title = Dementia during the seventeenth and eighteenth centuries: a conceptual history | journal = Psychological Medicine | volume = 17 | issue = 4 | pages = 829–837 | date = November 1987 | pmid = 3324141 | doi = 10.1017/S0033291700000623 | s2cid = 8262492 }}</ref> ''Dementia'' at this time simply referred to anyone who had lost the ability to reason, and was applied equally to psychosis, organic diseases like syphilis that destroy the brain, and to the senile dementia associated with old age. thumb|left|upright=0.7|A 19th-century drawing of a woman diagnosed with dementia Dementia has been referred to in medical texts since antiquity. One of the earliest known allusions to dementia is attributed to the 7th-century BC Greek philosopher Pythagoras, who divided the human lifespan into six distinct phases: 0–6 (infancy), 7–21 (adolescence), 22–49 (young adulthood), 50–62 (middle age), 63–79 (old age), and 80–death (advanced age). The last two he described as the "senium", a period of mental and physical decay, and that the final phase was when "the scene of mortal existence closes after a great length of time that very fortunately, few of the human species arrive at, where the mind is reduced to the imbecility of the first epoch of infancy".<ref name="Berchtold">{{cite journal |vauthors=Berchtold NC, Cotman CW |title=Evolution in the conceptualization of dementia and Alzheimer's disease: Greco-Roman period to the 1960s |journal=Neurobiol Aging |volume=19 |issue=3 |pages=173–89 |date=1998 |pmid=9661992 |doi=10.1016/s0197-4580(98)00052-9 |url=}}</ref> In 550 BC, the Athenian statesman and poet Solon argued that the terms of a man's will might be invalidated if he exhibited loss of judgement due to advanced age. Chinese medical texts made allusions to the condition as well, and the characters for "dementia" translate literally to "foolish old person".<ref>{{Cite book |title=Diagnosis and treatment of senile dementia |vauthors=Bergener M, Reisberg B |date=1989 |publisher=Springer-Verlag |isbn=0-387-50800-7 |location=Berlin, Germany |oclc=19455117}}</ref>
Athenian philosophers Aristotle and Plato discussed the mental decline that can come with old age and predicted that this affects everyone who becomes old and nothing can be done to stop this decline from taking place. Plato specifically talked about how the elderly should not be in positions that require responsibility because, "There is not much acumen of the mind that once carried them in their youth, those characteristics one would call judgement, imagination, power of reasoning, and memory. They see them gradually blunted by deterioration and can hardly fulfill their function."<ref>{{Cite book | vauthors = Xihua J |title=Diagnosis and Treatment of Senile Dementia: Research Methods and Perspective |year=1989 |isbn=93-80615-34-5 |page=38 |publisher=Madhav Books (P) Limited, a unit of Serials Publications |language=English}}</ref>
For comparison, the Roman statesman Cicero held a view much more in line with modern-day medical wisdom that loss of mental function was not inevitable in the elderly and "affected only those old men who were weak-willed". He spoke of how those who remained mentally active and eager to learn new things could stave off dementia. However, Cicero's views on aging, although progressive, were largely ignored in a world that would be dominated for centuries by Aristotle's medical writings. Physicians during the Roman Empire, such as Galen and Celsus, simply repeated the beliefs of Aristotle while adding few new contributions to medical knowledge.
Byzantine physicians sometimes wrote of dementia. It is recorded that at least seven emperors whose lifespans exceeded 70 years displayed signs of cognitive decline. In Constantinople, special hospitals housed those diagnosed with dementia or insanity, but these did not apply to the emperors, who were above the law and whose health conditions could not be publicly acknowledged.
Poets, playwrights, and other writers made frequent allusions to the loss of mental function in old age. William Shakespeare notably mentions it in the plays ''Hamlet'' and ''King Lear''.
During the 19th century, doctors generally came to believe that elderly dementia was the result of cerebral atherosclerosis, although opinions fluctuated between the idea that it was due to blockage of the major arteries supplying the brain or small strokes within the vessels of the cerebral cortex.
In 1907, Bavarian psychiatrist Alois Alzheimer was the first to identify and describe the characteristics of progressive dementia in the brain of 51-year-old Auguste Deter.<ref name="Zilka">Zilka, N., & Novak, M. (2006). The tangled story of Alois Alzheimer. ''Bratislavske lekarske listy'', ''107''(9–10), 343–345.</ref> Deter had begun to behave uncharacteristically, including accusing her husband of adultery, neglecting household chores, exhibiting difficulties writing and engaging in conversations, heightened insomnia, and loss of directional sense.<ref name="Yang-2016">{{cite journal | vauthors = Yang HD, Kim DH, Lee SB, Young LD | title = History of Alzheimer's Disease | journal = Dementia and Neurocognitive Disorders | volume = 15 | issue = 4 | pages = 115–121 | date = December 2016 | pmid = 30906352 | pmc = 6428020 | doi = 10.12779/dnd.2016.15.4.115 }}</ref> At one point, Deter was reported to have "dragged a bed sheet outside, wandered around wildly, and cried for hours at midnight".<ref name="Yang-2016"/> Alzheimer began treating Deter when she entered a Frankfurt mental hospital on November 25, 1901.<ref name="Yang-2016"/> During her ongoing treatment, Deter and her husband struggled to afford the cost of the medical care, and Alzheimer agreed to continue her treatment in exchange for Deter's medical records and donation of her brain upon death.<ref name="Yang-2016"/> Deter died on April 8, 1906, after succumbing to sepsis and pneumonia.<ref name="Yang-2016"/> Alzheimer conducted the brain biopsy using the Bielschowsky stain method, which was a new development at the time, and he observed senile plaques, neurofibrillary tangles, and atherosclerotic alteration.<ref name="Zilka"/> At the time, the consensus among medical doctors had been that senile plaques were generally found in older patients, and the occurrence of neurofibrillary tangles was an entirely new observation at the time.<ref name="Yang-2016"/> Alzheimer presented his findings at the 37th psychiatry conference of southwestern Germany in Tübingen on April 11, 1906; however, the information was poorly received by his peers.<ref name="Yang-2016"/> By 1910, Alois Alzheimer's teacher, Emil Kraepelin, published a book in which he coined the term "Alzheimer's disease" in an attempt to acknowledge the importance of Alzheimer's discovery.<ref name="Zilka"/><ref name="Yang-2016"/>
By the 1960s, the link between neurodegenerative diseases and age-related cognitive decline had become more established. By the 1970s, the medical community maintained that vascular dementia was rarer than previously thought and Alzheimer's disease caused the vast majority of old age mental impairments. More recently however, it is believed that dementia is often a mixture of conditions.
In 1976, neurologist Robert Katzmann suggested a link between senile dementia and Alzheimer's disease. He suggested that much of the senile dementia occurring (by definition) after the age of 65, was pathologically identical with Alzheimer's disease occurring in people under 65 and therefore should not be treated differently. Katzmann proposed that Alzheimer's disease, if taken to occur over age 65, is actually common, not rare, and was the fourth- or fifth leading cause of death, even though rarely reported on death certificates in 1976.<ref name="Ballenger2025">{{cite journal |title=History and the Challenges of Dementia - Ballenger - 2025 - Hastings Center Report - Wiley Online Library |journal=The Hastings Center Report |date=2025 |volume=55 Suppl 1 |pages=S41–S47 |doi=10.1002/hast.4991 |pmid=40966410 | vauthors = Ballenger JF }}</ref>
A helpful finding was that although the incidence of Alzheimer's disease increased with age (from 5–10% of 75-year-olds to as many as 40–50% of 90-year-olds), no threshold was found by which age all persons developed it. This is shown by documented supercentenarians (people living to 110 or more) who experienced no substantial cognitive impairment. Some evidence suggests that dementia is most likely to develop between ages 80 and 84 and individuals who pass that point without being affected have a lower chance of developing it.{{Citation needed|date=January 2025}} Women account for a larger percentage of dementia cases than men.<ref>{{Cite web|title=Prevalence by gender in the UK|url=https://www.dementiastatistics.org/statistics/prevalence-by-gender-in-the-uk/|access-date=October 4, 2021|website=Dementia Statistics Hub|language=en-GB}}</ref> This can be attributed in part to their longer overall lifespan and greater odds of attaining an age where the condition is likely to occur.<ref>{{Cite web |title=The Impact of Dementia on Women |url=https://www.alzheimersresearchuk.org/about-us/our-influence/policy-work/reports/the-impact-of-dementia-on-women/ |access-date=2025-01-19 |website=Alzheimer's Research UK |language=en-GB}}</ref>
Much like other diseases associated with aging, dementia was comparatively rare before the 20th century, because few people lived past 80. Conversely, syphilitic dementia was widespread in the developed world until it was largely eradicated by the use of penicillin after World War II. With significant increases in life expectancy thereafter, the number of people over 65 started rapidly climbing. While elderly persons constituted an average of 3–5% of the population prior to 1945, by 2010 many countries reached 10–14% and in Germany and Japan, this figure exceeded 20%. Public awareness of Alzheimer's Disease greatly increased in 1994 when former US president Ronald Reagan announced that he had been diagnosed with the condition.
In the 21st century, other types of dementia were differentiated from Alzheimer's disease and vascular dementias (the most common types). This differentiation is on the basis of pathological examination of brain tissues, by symptomatology, and by different patterns of brain metabolic activity in nuclear medical imaging tests such as SPECT and PET scans of the brain. The various forms have differing prognoses and differing epidemiologic risk factors.
===Terminology=== ''Dementia'' derives from ''demens'' meaning out of mind.<ref name="Ciurea2023">{{cite journal |vauthors=Ciurea VA, Covache-Busuioc RA, Mohan AG, Costin HP, Voicu V |title=Alzheimer's disease: 120 years of research and progress |journal=J Med Life |volume=16 |issue=2 |pages=173–177 |date=February 2023 |pmid=36937482 |pmc=10015576 |doi=10.25122/jml-2022-0111 |url=}}</ref> In the elderly it was once called '''senile dementia''' or '''senility''' which are now outdated terms. The condition was viewed as a normal and somewhat inevitable aspect of aging.<ref name="mednet">{{cite web | vauthors = Taylor DC |title=Dementia |url=https://www.medicinenet.com/dementia/article.htm |publisher=MedicineNet |access-date=August 6, 2018 |quote=Senile dementia ("senility") is a term that was once used to describe all dementias; this term is no longer used as a diagnosis.}}</ref>
By 1913–20 the term ''dementia praecox'' was introduced to suggest the development of senile-type dementia at a younger age. Eventually the two terms fused, so that until 1952 physicians used the terms ''dementia praecox'' (precocious dementia) and ''schizophrenia'' interchangeably. Since then, science has determined that dementia and schizophrenia are two different disorders, though they share some similarities.{{citation needed|date=January 2026}} The term ''precocious dementia'' for a mental illness suggested that a type of mental illness like schizophrenia (including paranoia and decreased cognitive capacity) could be expected to arrive normally in all persons with greater age (see paraphrenia). After about 1920, the beginning use of ''dementia'' for what is now understood as schizophrenia and senile dementia helped limit the word's meaning to "permanent, irreversible mental deterioration". This began the change to the later use of the term and researchers have seen a connection between those diagnosed with schizophrenia and patients who are diagnosed with dementia, finding a positive correlation between the two diseases.<ref>{{Cite web|title=The Relationship Between Schizophrenia and Dementia|url=https://www.psychologytoday.com/blog/demystifying-psychiatry/201603/the-relationship-between-schizophrenia-and-dementia|access-date=December 13, 2020|website=Psychology Today|language=en-US}}</ref>
The view that dementia must always be the result of a particular disease process led for a time to the proposed diagnosis of "senile dementia of the Alzheimer's type" (SDAT) in persons over the age of 65, with "Alzheimer's disease" diagnosed in persons younger than 65 who had the same pathology. Eventually, however, it was agreed that the age limit was artificial, and that ''Alzheimer's disease'' was the appropriate term for persons with that particular brain pathology, regardless of age.{{citation needed|date=January 2026}}
After 1952, mental illnesses including schizophrenia were removed from the category of ''organic brain syndromes'', and thus (by definition) removed from possible causes of "dementing illnesses" (dementias). At the same, however, the traditional cause of senile dementia – "hardening of the arteries" – now returned as a set of dementias of vascular cause (small strokes). These were now termed ''multi-infarct dementias'' or ''vascular dementias''.{{citation needed|date=January 2026}}
==Society and culture== The societal cost of dementia is high, especially for caregivers.<ref name="Costs2024" /> Research conducted in the UK shows that almost two out of three carers of people with dementia feel lonely. Most of the carers in the study were family members or friends.<ref name="Victor">{{cite journal | vauthors = Victor CR, Rippon I, Quinn C, Nelis SM, Martyr A, Hart N, Lamont R, Clare L | title = The prevalence and predictors of loneliness in caregivers of people with dementia: findings from the IDEAL programme | journal = Aging & Mental Health | volume = 25 | issue = 7 | pages = 1232–1238 | date = July 2021 | pmid = 32306759 | doi = 10.1080/13607863.2020.1753014 | s2cid = 216028843 | doi-access = free | hdl = 10454/17813 | hdl-access = free }}</ref> Informal carers are at higher risk of developing psychological and physical conditions.<ref name="Costs2024" />
Among people aged 60 years and over, dementia was ranked in 2010 as the 9th most burdensome condition.<ref name="Alzheimer's Disease International_2015" /> The World Health Organization's (WHO) global action plan on the public health response to dementia (2017-2025) set a target for 75% of WHO Member States (194 countries) to develop a policy or plan for dementia by 2025. These plans recognize that people can live well with dementia for years, as long as the right support and timely access to a diagnosis are available. However, in 2025, only 23% of Member States (45 countries) have a national policy for dementia.<ref>{{Cite book |url=https://www.alzint.org/u/From-Plan-to-Impact-VIII.pdf |title=From plan to impact VIII: Time to deliver |publisher=Alzheimer's Disease International |year=2025 |location=London}}</ref>
=== Financial costs === The financial costs of care in people with dementia are high and increase over the stages reached. Nursing home care, and informal care costs are among the highest cost components.<ref name="Costs2024" /> The estimated costs of care in low- and middle-income countries are lower than those in high-income countries with 42% met by direct care costs, and 58% met by informal care. These estimates are likely an under-representation, as there have been limited research studies in these countries, particularly in low-income countries.<ref>{{Cite journal |last1=Mattap |first1=Siti Maisarah |last2=Mohan |first2=Devi |last3=McGrattan |first3=Andrea Mary |last4=Allotey |first4=Pascale |last5=Stephan |first5=Blossom CM |last6=Reidpath |first6=Daniel D |last7=Siervo |first7=Mario |last8=Robinson |first8=Louise |last9=Chaiyakunapruk |first9=Nathorn |date=4 April 2022 |title=The economic burden of dementia in low- and middle-income countries (LMICs): a systematic review |journal=BMJ Global Health |language=en |volume=7 |issue=4 |article-number=e007409 |doi=10.1136/bmjgh-2021-007409 |issn=2059-7908 |pmc=8981345 |pmid=35379735}}</ref>
The global cost of dementia was around US$1.3 trillion in 2021.
In the USA total costs in 2025 was around US$384 billion not including the estimated US$413 billion in informal care costs. The lifetime cost of dementia care in 2024 was estimated at US$405,262.<ref name="Facts2025">{{cite journal |title=2025 Alzheimer's disease facts and figures |journal=Alzheimer's & Dementia |date=April 2025 |volume=21 |issue=4 |article-number=e70235 |doi=10.1002/alz.70235 |pmc=12040760 }}</ref>
In 2024 the annual cost per person with dementia in the United Kingdom ranged from £28,700 at the mild stage rising to £80,500 at the moderate stage.<ref name="Costs2024">{{cite web |title=The annual costs of dementia |url=https://www.alzheimers.org.uk/sites/default/files/2024-05/the-annual-costs-of-dementia.pdf |access-date=13 April 2026}}</ref> For the total population the annual estimated cost in 2024 was £42.5 billion which is expected to reach £90.3 billion by 2040.<ref name="Costs2024" /> More than 60% of these costs are paid by people with dementia and their family caregivers. People with dementia spend an average of £100,000 on their own care over their lifetime.<ref name=":12">{{Cite web |date=2024|title=The Economic Impact of Dementia – Module 1|url=https://www.alzheimers.org.uk/sites/default/files/2024-05/the-annual-costs-of-dementia.pdf|access-date=17 May 2026|website=The Economic Impact of Dementia – Module 1}}</ref>
=== Awareness === A worldwide study in 2019 showed that about 66% of the general public believe that dementia is a normal part of aging, and not a disorder, and 62% of healthcare professionals also held this view.<ref name="ADI">{{cite web |title=ADI - World's largest dementia study reveals two thirds of people still incorrectly think dementia is a normal part of ageing, rather than a medical condition |url=https://www.alzint.org/news-events/news/worlds-largest-dementia-study-reveals-two-thirds-of-people-still-incorrectly-think-dementia-is-a-normal-part-of-ageing-rather-than-a-medical-condition/ |access-date=29 January 2026 |language=en}}</ref> A follow-up study in 2024 showed that this figure had increased to 80% in the general public and to 65% among healthcare workers.<ref name="ADI2"/> In 2022, only 42% of surveyed public in England knew that dementia is a terminal condition, and over 90% were unaware that dementia was the leading cause of cause of death in their country.<ref>{{Cite web |last=Researcher |first=Dementia |date=2022-12-13 |title=9 in 10 of the public underestimate the impact of dementia |url=https://www.dementiaresearcher.nihr.ac.uk/9-in-10-of-the-public-underestimate-the-impact-of-dementia/ |access-date=2025-04-21 |website=Dementia Researcher |language=en-GB}}</ref> There is also persistent stigma, which can be a barrier for people seeking help for dementia and accessing care.<ref name="ADI2"/><ref>{{Cite journal |last1=Williamson |first1=Lesley E. |last2=Sleeman |first2=Katherine E. |last3=Evans |first3=Catherine J. |date=July 2023 |title=Exploring access to community care and emergency department use among people with dementia: A qualitative interview study with people with dementia, and current and bereaved caregivers |journal=International Journal of Geriatric Psychiatry |language=en |volume=38 |issue=7 |article-number=e5966 |doi=10.1002/gps.5966 |issn=0885-6230|doi-access=free |pmid=37485729 }}</ref> In 2024 88% of people living with dementia reported experiencing discrimination, an increase of 5% from 2019.<ref name="ADI2">{{Cite book |url=https://www.alzint.org/u/World-Alzheimer-Report-2024.pdf |title=World Alzheimer Report 2024. Global changes in attitudes to dementia |date=2024 |publisher=Alzheimer's Disease International |location=London, England}}</ref> Over 64% of the general public believe people with dementia are impulsive and unpredictable.<ref name="ADI2"/>
Many celebrities have used their platforms to champion awareness for Alzheimer's disease including actor Samuel L. Jackson, and editor-in-chief of ELLE Magazine Nina Garcia.<ref name="AACC2024">{{Cite web |title=Alzheimer's Association Celebrity Champions |url=https://www.alz.org/press/celebrity_champions |access-date=July 19, 2024 |website=Alzheimer's Association}}</ref> The former First Lady of California Maria Shriver is also an Alzheimer's champion.<ref>{{Cite web |date=2014-09-17 |title=Maria Shriver {{!}} My Brain {{!}} Alzheimer's Association |url=https://mybrain.alz.org/maria-shriver.asp |access-date=2025-04-21 |website=My Brain |language=en}}</ref> Additional dementia awareness has been raised through the diagnoses of high-profile persons, including actors Bruce Willis (diagnosed with frontotemporal dementia),<ref>{{Cite web |date=2023-02-13 |title=Willis Family Statement {{!}} AFTD |url=https://www.theaftd.org/mnlstatement23/ |access-date=2024-07-19 |language=en-US}}</ref> Robin Williams (diagnosis of dementia with Lewy bodies),<ref>{{Cite web |last=Rogers |first=Kristen |date=2022-07-01 |title=What Robin Williams' widow wants you to know about the future of Lewy body dementia |url=https://www.cnn.com/2022/07/01/health/lewy-body-dementia-robin-williams-life-itself-wellness/index.html |access-date=2024-07-19 |website=CNN |language=en}}</ref> actress Rita Hayworth,<ref>{{Cite web |last=Lerner |first=Barron H. |date=2006-11-20 |title=Rita Hayworth's misdiagnosed struggle |url=https://www.latimes.com/archives/la-xpm-2006-nov-20-he-myturn20-story.html |access-date=2025-04-16 |website=Los Angeles Times |language=en-US}}</ref> activist Rosa Parks,<ref>{{Cite web |date=September 22, 2004 |title=Doctor: Rosa Parks suffers from dementia |url=https://www.nbcnews.com/id/wbna6070417 |website=NBC}}</ref> former US President Ronald Reagan diagnosed with Alzheimer's disease,<ref>{{Cite web |title=Reagan's Letter Announcing his Alzheimer's Diagnosis |url=https://www.reaganlibrary.gov/reagans/ronald-reagan/reagans-letter-announcing-his-alzheimers-diagnosis |access-date=2024-07-19 |website=Ronald Reagan |language=en}}</ref> TV host Wendy Williams,diagnosed with frontotemporal dementia.<ref>{{Cite web |date=2024-02-22 |title=Wendy Williams |url=https://apnews.com/article/wendy-williams-dementia-diagnosis-d3cebb8c20f750a623f9d180a50c03e8 |access-date=2025-04-16 |website=AP News |language=en}}</ref> musicians Tony Bennett<ref>{{Cite web |date=2023-07-21 |title=What to know about Tony Bennett's health struggles, from Alzheimer's to addiction |url=https://www.today.com/health/tony-bennett-health-problems-rcna95522 |access-date=2024-07-19 |website=TODAY.com |language=en}}</ref> and Maureen McGovern, both diagnosed with Alzheimer's.<ref>{{Cite web |title=Maureen McGovern on Living with Alzheimer's Disease: 'You Go One Day at a Time' |url=https://people.com/health/maureen-mcgovern-living-with-alzheimers-disease/ |access-date=2024-07-19 |website=Peoplemag |language=en}}</ref>
=== Philanthropy === In 2015, Atlantic Philanthropies announced a $177 million gift aimed at understanding and reducing dementia. The recipient was the Global Brain Health Institute, a program co-led by the University of California, San Francisco and Trinity College Dublin.<ref name="Atlantic">{{cite web |title=The Irish-American Billionaire Who Gave Away His Fortune {{!}} Atlantic Philanthropies |url=https://www.atlanticphilanthropies.org/news/the-irish-american-billionaire-who-gave-away-his-fortune |website=The Atlantic Philanthropies |access-date=28 January 2026 |language=en |date=3 January 2017}}</ref>
In October 2020, the Caretaker's (James Leyland Kirby) last music release, ''Everywhere at the End of Time'', was popularized by TikTok users for its depiction of the stages of dementia. Kirby said that the use of the recordings could cause empathy among a younger public.<ref>{{Cite web |date=October 23, 2020 |title=Why Are TikTok Teens Listening to an Album About Dementia? |url=https://www.nytimes.com/2020/10/23/style/tiktok-caretaker-challenge-dementia.html |url-access=limited |url-status=live |archive-url=https://web.archive.org/web/20201023171008/https://www.nytimes.com/2020/10/23/style/tiktok-caretaker-challenge-dementia.html |archive-date=October 23, 2020 |access-date=April 21, 2021 |website=The New York Times |vauthors=Ezra M}}</ref>
On November 2, 2020, Scottish billionaire Tom Hunter donated £1 million, split between Alzheimer's society, and Music for dementia. This donation was prompted after watching a former music teacher with dementia, Paul Harvey, playing one of his own compositions on the piano in a video.<ref>{{cite news |date=November 2, 2020 |title=Paul Harvey: Composer with dementia inspires £1m donation |url=https://www.bbc.com/news/uk-54772218 |access-date=November 2, 2020 |work=BBC News}}</ref>
== Research directions == Efforts to facilitate research into people living with dementia include the development of the Dementia Enquirers Gold Standards for Co-Research, and for Ethical Research.<ref>{{Cite web |date=2023 |title=The Dementia Enquirers Gold Standards for Co-Research |url=https://dementiaenquirers.org.uk/wp-content/uploads/2023/02/gold-standard-for-co-research.pdf |access-date=24 November 2025 |website=Dementia Enquirers}}</ref><ref>{{Cite web |date=2023 |title=The Dementia Enquirers Gold Standards for Ethical Research |url=https://dementiaenquirers.org.uk/wp-content/uploads/2023/01/de-gold-standards-for-ethical-research.pdf |access-date=25 November 2025 |website=Dementia Enquirers}}</ref> Evidence-informed guidelines to involve people with impaired mental capacity nearing the end of life have also been published.<ref>{{Cite journal |last1=Evans |first1=C. J. |last2=Yorganci |first2=E. |last3=Lewis |first3=P. |last4=Koffman |first4=J. |last5=Stone |first5=K. |last6=Tunnard |first6=I. |last7=Wee |first7=B. |last8=Bernal |first8=W. |last9=Hotopf |first9=M. |last10=Higginson |first10=I. J. |last11=on behalf of MORECare_Capacity |last12=Tanner |first12=Deborah |last13=Henry |first13=Claire |last14=Grande |first14=Gunn |last15=Dewar |first15=Steve |date=22 July 2020 |title=Processes of consent in research for adults with impaired mental capacity nearing the end of life: systematic review and transparent expert consultation (MORECare_Capacity statement) |journal=BMC Medicine |language=en |volume=18 |issue=1 |article-number=221 |doi=10.1186/s12916-020-01654-2 |doi-access=free |issn=1741-7015 |pmc=7374835 |pmid=32693800}}</ref> And there are dedicated networks such as the UK-based EMPOWER Dementia Network+, which uses a co-productive approach to engage and include people from under-represented communities to tackle inequalities in dementia care and research.<ref>{{Cite web |date=2025 |title=Co-production Toolkit. A guide to working in co-production with people living with dementia |url=https://empowerdementia.co.uk/wp-content/uploads/2025/08/Online_For-Slides-Co-production-booklet-EMPOWER.pdf |access-date=21 November 2025 |website=EMPOWER Dementia Network+}}</ref> A 2026 ''Dementia Care and Caregiving Research Summit'', hosted by the National Institute of Aging will review progress made in research, identify unmet research needs, and highlight research that is promising, and innovative.<ref name="NIARes2026">{{cite web |title=2026 Dementia Care and Caregiving Research Summit |url=https://www.nia.nih.gov/2026-dementia-care-summit |website=National Institute on Aging |access-date=22 February 2026 |language=en}}</ref>
Artificial intelligence, and machine learning algorithms have the potential to improve early diagnosis and treatment planning for dementia.<ref name="Javeed2023">{{Cite journal |last1=Javeed |first1=Ashir |last2=Dallora |first2=Ana Luiza |last3=Berglund |first3=Johan Sanmartin |last4=Ali |first4=Arif |last5=Ali |first5=Liaqat |last6=Anderberg |first6=Peter |date=2023-02-01 |title=Machine Learning for Dementia Prediction: A Systematic Review and Future Research Directions |journal=Journal of Medical Systems |language=en |volume=47 |issue=1 |page=17 |doi=10.1007/s10916-023-01906-7 |issn=1573-689X |pmc=9889464 |pmid=36720727}}</ref>
Kynurenine is a metabolite of tryptophan that regulates microbiome signaling, immune cell response, and neuronal excitation. A disruption in the kynurenine pathway may be associated with the neuropsychiatric symptoms and cognitive prognosis in mild AD dementia; lower numbers of kynurenines are found in those with Alzheimer's.<ref name=Solvang>{{cite journal |vauthors=Solvang SH, Nordrehaug JE, Aarsland D, et al |title=Kynurenines, Neuropsychiatric Symptoms, and Cognitive Prognosis in Patients with Mild Dementia |journal=Int J Tryptophan Res |volume=12 |issue= |article-number=1178646919877883 |date=2019 |pmid=31632053 |pmc=6769202 |doi=10.1177/1178646919877883}}</ref> But more research is called for.<ref name="Choe2025">{{cite journal |vauthors=Choe K, Bakker L, van den Hove DL, Eussen SJ, Kenis G, Ramakers IH, Verhey FR, Rutten BP, Köhler S |title=Kynurenine pathway dysregulation in cognitive impairment and dementia: a systematic review and meta-analysis |journal=Geroscience |volume= |issue= |pages= |date=May 2025 |pmid=40338439 |doi=10.1007/s11357-025-01636-3 |url=}}</ref>
== References == {{Reflist}}
==Further reading== {{refbegin|30em}} * {{cite book |editor1-last=Husain |editor1-first=Masud |editor2-last=Schott |editor2-first=Jonathan M. |title=Oxford Textbook of Cognitive Neurology and Dementia |publisher=Oxford University Press |year=2016 |isbn=978-0-19-883108-2 |oclc=1081320148 |location=Oxford, England}} * {{cite book |last1=Lipton |first1=Anne M. |last2=Marshall |first2=Cindy D. |title=The Common Sense Guide to Dementia for Clinicians and Caregivers |publisher=Springer Publishing Company |year=2013 |isbn=978-1-4614-4162-5 |oclc=788253522 |location=New York}} * {{cite book |last1=Mace |first1=Nancy L. |last2=Rabins |first2=Peter V. |title=The 36-Hour Day |publisher=Johns Hopkins University Press |year=2021 |edition=7th |isbn=978-1-4214-4170-2 |oclc=1260687360 |location=Baltimore, Maryland}} *{{cite book |last1=Rahman |first1=Shibley |last2=Howard |first2=Robert |title=Essentials of Dementia |publisher=Jessica Kingsley Publishers |year=2019 |isbn=978-1-78450-754-1 |oclc=1019658233 |location=London, England}} {{refend}}
== External links == * [https://www.alz.org Alzheimer's Association] * [https://web.archive.org/web/20170729192300/https://www.nia.nih.gov/health/alzheimers National Institute on Aging – Alzheimer's disease] {{Medical condition classification and resources | ICD11 = {{ICD11|Dementia|546689346}} | ICD10 = {{ICD10|F00}}, {{ICD10|F01}}, {{ICD10|F02}}, {{ICD10|F03}} | ICD10CM = {{ICD10CM|F01}}, {{ICD10CM|F02}}, {{ICD10CM|F03}} | ICD9 = {{ICD9|290}}-{{ICD9|294}} | MedlinePlus = 000739 | DiseasesDB = 29283 |eMedicineSubj=article |eMedicineTopic=793247 | MeshID = D003704 }}
{{subject bar|auto=y|d=y|Medicine|Psychiatry|Psychology}} {{Diseases of the nervous system}} {{Mental and behavioural disorders|selected = neurological}}
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Category:Aging-associated diseases Category:Cognitive disorders Category:Dementia Category:Learning disabilities Category:Mental disorders due to brain damage Category:Wikipedia neurology articles ready to translate Category:Wikipedia medicine articles ready to translate