What Is Dementia?

What Is Dementia?

Dementia is an all-encompassing term used to describe various signs and symptoms related to cognitive declines, such as memory loss. Dementia is not a single disorder but rather a general term used to describe symptoms of memory impairment, forgetfulness, and loss of concentration. 

Dementia Signs and Symptoms

Signs and symptoms can vary greatly from person to person. Some of the common ones that can be present in all stages of dementia include:

• Asking the same questions over and over again
• Getting lost in familiar places
• Not being able to follow instructions
• Becoming confused about time, people, and places
• Personality changes such as depression, aggression, and anxiety
• Inability to remember names or recognize familiar faces
• Forgetting where you placed everyday items such as keys, wallet, and checkbooks
• Leaving the stove on or forgetting to lock the house or car
• Apathy or loss of interest in hobbies
• Difficulty completing everyday tasks such as banking, grocery shopping, and house chores
• Confusion
• Sleep disturbances

Stages of Dementia

Dementia progresses in stages known as mild dementia, moderate dementia, and severe dementia. 

Mild Dementia

Individuals can usually function independently but will experience memory lapses that affect daily life, such as forgetting words or where things are among the following symptoms:

• Memory loss of recent events
• Changes in personality
• Getting lost or misplacing objects
• Difficulty with complex tasks such as managing finances 
• Trouble organizing thoughts 

Moderate Dementia

Individuals with moderate dementia will need some assistance in their daily lives as it becomes harder to perform tasks and self-care routines independently. People dealing with moderate dementia might exhibit the following:

• Increased confusion 
• Memory loss of more distant events 
• Requiring assistance with everyday tasks, such as getting dressed, bathing, and grooming
• Significant personality and behavior changes, often caused by agitation and unfounded suspicion
• Changes in sleep patterns, such as sleeping during the day and feeling restless at night

Severe Dementia

Individuals with severe dementia will most likely require a full-time caretaker who has experience with dementia. These individuals will not only have further mental decline, but their physical capabilities will also worsen once the disease progresses into the severe stage. This stage presents the following symptoms:

• Increased memory loss
• The loss of ability to communicate 
• Requiring full-time daily assistance with tasks, such as eating and dressing
• Loss of physical capabilities (e.g., walking, sitting, holding one’s head up, swallowing, bowel function)
• Bladder and/or bowel incontinence
• Increased susceptibility to infections such as pneumonia
• Hallucinations, delusions, or paranoia

Causes

Different types of dementia result from damage to the brain cells in different parts of the brain. For example, when the part of the brain that controls memory is damaged, normal function is impeded.

Researchers are still learning what contributes to the damage of these cells. Genetics are thought to play a role in the development of dementia; however, it's still possible to be diagnosed even if it doesn't run in your family.

Diagnosis

Dementia is diagnosed based on history, psychological and neurological assessments, laboratory tests, and brain imaging. Patients or their loved ones will often present to a healthcare professional concerns of memory problems, personality changes, and confusion.

Many individuals with early signs of dementia may hide their confusion or make excuses for their symptoms. If you are a loved one, it is essential to not allow this to deter you from seeking medical advice and treatment.

A thorough history and physical examination are the first steps in diagnosing dementia. Laboratory tests will be ordered to rule out any underlying medical conditions that could resemble dementia (such as hypothyroidism and vitamin deficiencies).

Cognitive and neuropsychological tests such as the mini-mental status examination are administered to measure thinking skills, such as memory, concentration, orientation, reasoning and judgment, language skills, and attention.

A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the brain is ordered to assess for tumors, brain bleeds, strokes, brain infections, or specific signs of dementia. These signs include amyloid plaques, neurofibrillary tangles, and cortical atrophy, which is the degeneration of the brain's cortex (outer layer).

In turn, it can take months or years for healthcare professionals to make a diagnosis. For this reason, family members and loved ones must continue to document signs and symptoms and advocate for the patient. 

Types

Alzheimer’s disease is the most common type of dementia, making up 60% to 80% of dementia cases.

Other subtypes of dementia include:

• Lewy body dementia: Deposits damage the brain cells over time and lead to a decline in thinking, reasoning, and independent functioning
• Vascular dementia: Oxygen flow to the brain becomes blocked, causing a decline in thinking skills
• Frontotemporal dementia: A group of disorders caused by nerve cell loss in the brain's frontal lobes or temporal lobes
• Parkinson’s disease dementia: Decline in thinking and reasoning skills experienced by some people who are diagnosed with Parkinson's disease for at least one year
• Huntington’s disease: A defective gene causes changes to the brain that affect mood, movement, and thinking
• Creutzfeldt-Jakob disease: A fatal brain disorder that progresses very quickly
• Normal pressure hydrocephalus: Excess cerebrospinal fluid in the brain causes a decline in thinking, walking, and bladder control
• Korsakoff syndrome: Severe deficiency of thiamine leads to this chronic memory disorder
• Posterior cortical atrophy: Degeneration of the cortex and posterior part of the brain
• Mixed dementia: The brain experiences changes due to more than one type of dementia

It is important to note that dementia is not a part of normal aging because dementia results in impaired daily activity and living. 

Dementia Treatment

Although there is no cure for dementia, certain medications and lifestyle changes can help slow down the symptoms and disease progression. A physician may prescribe treatment for Alzheimer's disease if they believe Alzheimer's is among the contributing conditions to a person's dementia.

Medications

The Food and Drug Administration (FDA) approved the intravenous therapy Aduhelm (aducanumab) to treat mild cognitive impairment (MCI) or the mild dementia stage of Alzheimer's. It targets and removes amyloid plaques, which are thought to contribute to cognitive decline.

Some patients who've received Aduhelm had improved memory and language ability as well as improvements with doing tasks independently. However, a doctor must first determine a patient's eligibility with a cerebral spinal fluid analysis or positron emission tomography (PET).

Side effects of Aduhelm included microhemorrhages (blood in the brain tissue), superficial siderosis (excess iron in the brain and spinal cord), headache, fall, diarrhea, altered mental statuses, and amyloid related imaging abnormalities (ARIA). ARIA involves temporary swelling of the brain.

Other medications, such as cholinesterase inhibitors, may reduce symptoms of Alzheimer’s disease. The most commonly prescribed include:

• Razadyne (galantamine)
• Aricept (donepezil)
• Exelon (rivastigmine)

Razadyne and Exelon are approved to treat mild to moderate Alzheimer's, while Aricept is approved to treat all stages. Cholinesterase inhibitors may help improve memory, language, judgment, and thinking skills for a limited period of time.

Namenda (memantine) is a glutamate regulator approved for moderate to severe Alzheimer's to treat cognitive symptoms. It may help improve memory, attention, the ability to reason, language, and the ability to do simple tasks.

A combination of a cholinesterase inhibitor and a glutamate regulator may be prescribed. Namzaric (donepezil and memantine) is approved to treat moderate to severe Alzheimer's.

Side effects of these medications may include nausea, vomiting, dizziness, loss of appetite, headache, confusion, and increased frequency of bowel movements.

Another medication, Belsomra (orexin receptor antagonist), is approved to treat insomnia in people with mild to moderate Alzheimer's disease. Side effects may include impaired alertness and motor coordination, worsened depression or suicidal ideation, sleep-walking, sleep paralysis, and compromised respiratory function.

Therapy

Reminiscence therapy uses all of the senses (sight, touch, taste, smell, and sound) to help individuals with dementia remember events, people, and places from their lives.

This process may include talking about their hometown, their primary school days, work-life, favorite hobbies; looking at old pictures; eating favorite foods; and listening to music from past experiences. 

The goal is to practice language, communication, and concentration skills in a group setting. 

Reality orientation training is a type of training that goes over basic information such as name, birthdate, and family members.

This training can make many individuals frustrated, especially when they are asked to repeat their name and age constantly. This type of therapy may not be for everyone with dementia. 

Lifestyle Changes

Although medications and therapy modalities are the mainstay treatment choices for dementia, lifestyle changes are important as well!

There are changes you can make to ensure someone with dementia is safe. For instance, you can make sure that any dangerous items (like sharp objects) aren't easily accessible so accidents are avoided.

Monitoring the basic health of someone with dementia is important. For instance, you can check for hunger, thirst, urge to use the bathroom, and fatigue to be sure their needs are being met. These checks can help manage their emotional state throughout the day.

Be extra aware of triggering situations for someone with dementia. A trigger might be a change in their environment, such as moving to a nursing home or getting a new caregiver. If you find that certain things affect a loved one with dementia, take note of them so you can be prepared or try handling the situation differently.

Instead of arguing with a person with dementia over facts or memories that they don't remember, try to listen to them patiently.

Prevention

There is no guaranteed method of preventing dementia. However, research shows that a healthy lifestyle may lower a person's risk of developing dementia later in life. Some of these lifestyle changes include:

• Staying physically active
• Eating a healthy, balanced diet
• Maintaining a healthy weight
• Avoiding tobacco and alcohol

Coping

Living with dementia is difficult, not only for the individual but also for their loved ones. There are support groups for family members and caregivers of those with dementia; you can find local groups through the Alzheimer's Association.

In addition to seeking support from a community resource, you can try meditative techniques like breathing exercises, which can help relax you. Take breaks when you can and remember to carve out personal time to engage in self-care.

Keep in close contact with the doctor caring for your loved one so you can anticipate future challenges and understand how to cope. If a loved one is diagnosed with Alzheimer's, you may encourage them to put legal and financial plans into place in advance to be better prepared for the future as well.

A Word From Verywell

Dementia can be intimidating to face, whether you have it or you are caring for a loved one who does. Remember, you're not alone. A caregiver can help you develop systems and lifestyle changes that can make your daily life easier. If you are a caregiver, there are resources that can help you cope as well to prevent burnout.