Complaints & connections · borters.ch
First the treatable imitators, then the form — and what arises within hours to days is not decline but an emergency.
Also known as: dementia · cognitive decline
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Dementia is an umbrella term, not a single illness. What is meant is an acquired loss of memory and thinking that interferes with everyday life — and behind it stand different causes that differ markedly at the beginning. In the Alzheimer form it begins with short-term memory. In the vascular form unsteady walking and slowing often appear before the forgetfulness, and the course goes more in steps. In the Lewy body form alertness fluctuates from day to day, elaborate visual hallucinations appear, and dreams are acted out in sleep — here caution with certain sedatives is vital. In the frontotemporal form behaviour and language are noticed first, memory for a long time not. Two things always belong at the start. First the treatable imitators: thyroid, vitamin B12, depression, sleep apnoea, hearing, alcohol and above all the medication list. Second the distinction from delirium — a confusion that develops within hours to days and fluctuates is not dementia but an emergency. And as long as the capacity to decide remains, there is time for what nobody can arrange later. Fitness to drive is also among the topics discussed at diagnosis — it can be limited at an early stage.
Remedies for a weak bladder, older allergy medicines, sleeping pills and sedatives and some stomach drugs measurably dampen thinking. Gathering all the packets once and having them gone through is the single most effective step.
Thyroid, B12, sodium, calcium, depression, sleep apnoea, alcohol — and hearing and sight. Someone who hears badly seems more confused than they are; a hearing aid is no small matter here.
A delirium almost always has a graspable cause — a urine infection, pneumonia, pain, too little drinking, constipation, a new medicine. Treat it and things clear again.
A power of attorney and an advance directive, authorisations, handling of finances and the conversation about driving. It is uncomfortable and nonetheless the greatest service one can do oneself and one’s relatives — later it is no longer possible.
Which form it is changes the treatment and the warnings — especially the Lewy body form, which can react severely to certain sedatives and often comes with Parkinson signs.
Hearing aids, daily movement, sleep, blood pressure and regular encounters are the areas where most can be moved — for the course and for the everyday life of relatives.
Below sixty-five dementia is rare; from eighty-five about one person in three or four is affected. Fifteen to twenty years lie between the first changes in the brain and the first noticeable signs — that is the window in which blood pressure, hearing and movement still count.
Cholinesterase inhibitors and memantine do not change the course — they lift the level for a time, on average six to twelve months, and the decline continues underneath. They are judged after three to six months, by everyday life rather than a test. What works more clearly in studies than any of these drugs is hearing, sight, movement, sleep and company: uncorrected hearing loss speeds the decline measurably.
Among the things that can actually be influenced, regular movement is one of the best studied. It prevents nothing with certainty; it shifts probabilities — and it acts at the same time on blood pressure, blood sugar, sleep and mood, which also play a part here.
Moaning, calling out, altered breathing, a tense face, resistance during washing: that is what the validated observation scales ask about — so that pain is treated and not read as "behaviour".
Someone who complains strongly about their own memory while relatives notice little more often has a depression. The other way round — relatives worry, the person does not — speaks more for decline. This reversal is one of the most useful clues of all.
Then it is a delirium and not dementia: fluctuating attention, often worse in the evening, triggered by infection, medicines, pain, dehydration or constipation. It is treatable and belongs looked at at once — even with known dementia.
Small-stepped, unsteady walking, slowing and newly appeared urinary urgency point to the vascular form or to a separate, treatable disorder of the fluid around the brain.
Detailed images of people or animals, with strongly fluctuating alertness and vigorous movements in dream sleep. This form reacts sensitively to certain sedatives — that belongs told to every doctor and every hospital.
Tactlessness, indifference, loss of empathy or a changed way of eating with memory still good, often before the age of sixty. This is long taken for a crisis or a depression.
An underactive thyroid causes slowing, lack of drive and forgetfulness — and is treatable. The first value of the workup.
A shortage can impair thinking and gait and is often overlooked in older age. In the grey zone the methylmalonic acid helps further.
A low sodium causes confusion, unsteadiness and falls — often from water tablets or certain antidepressants. It is among the most easily corrected causes.
A raised calcium causes tiredness, constipation and confusion and has a cause of its own, often correctable, in the parathyroid gland.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
Observational studies show slower decline.
The best-documented single factor for preserving mental performance in later life.
AWMF 038-013 · S3 · 2026-03 — in force
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checked 2026-09