Dementia and Cognitive Disorders

What is dementia?

Dementia is an umbrella term for conditions that involve a progressive loss of cognitive abilities. Memory, thinking, orientation, language and judgment are affected. The symptoms are pronounced enough to impair everyday life.

Not every instance of forgetfulness is dementia. Mild cognitive impairment (MCI) can be an early stage but does not necessarily progress to dementia.

Symptoms

Early signs

  • Increasing forgetfulness (especially for recent events)
  • Difficulty finding words
  • Orientation problems in unfamiliar places
  • Difficulty with complex tasks (finances, cooking)
  • Misplacing objects

Advanced symptoms

  • Disorientation as to time and place
  • Personality changes
  • Lack of drive or restlessness
  • Impoverishment of language
  • Loss of independence in everyday life

Causes

  • Alzheimer’s dementia – most common form (approx. 60–70%), deposition of amyloid plaques and tau fibrils in the brain
  • Vascular dementia – caused by circulatory disorders of the brain (e.g. after strokes)
  • Lewy body dementia – with Parkinson’s-like symptoms and visual hallucinations
  • Frontotemporal dementia – with early personality and behavioral changes
  • Secondary dementias – due to treatable causes: hypothyroidism, vitamin B12 deficiency, normal pressure hydrocephalus, depression (pseudodementia)

Diagnostics

  • Detailed medical history – with relatives, symptom progression, everyday competence
  • Cognitive screening tests – MMSE (Mini-Mental State Examination), DemTect, MOCA, PANDA
  • Neurological examination – assessment of motor function, reflexes, gait pattern
  • EEG – can provide clues to the severity of brain dysfunction and rule out other causes (e.g. epilepsy)
  • Laboratory tests – thyroid values, vitamin B12, folic acid, blood count, liver/kidney values
  • Lumbar puncture – measurement of dementia biomarkers (amyloid-beta, tau protein) in the cerebrospinal fluid
  • Imaging – MRI of the head (referral)

Treatment

Drug therapy

  • Cholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine) – for mild to moderate Alzheimer’s dementia
  • Memantine – for moderate to severe Alzheimer’s dementia
  • Treatment of vascular risk factors – for vascular dementia (blood pressure, cholesterol, blood sugar)
  • Treatment of secondary causes – thyroid hormone replacement, vitamin B12 administration

Non-drug therapy

  • Cognitive training and memory exercises
  • Occupational therapy (maintaining everyday competence)
  • Physiotherapy (fall prevention, mobility)
  • Structured daily routine
  • Social activities and participation
  • Counseling and support for relatives

Disease monitoring

  • Regular cognitive testing to assess progression
  • Adjustment of medication
  • Advice on care level, health care power of attorney, advance directive

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Last updated: 2026-07-04