What Is Dementia?

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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

This article covers the signs and symptoms of dementia, its stages and types, and treatment options. Signs and symptoms can vary greatly from person to person.

Many individuals with early-stage dementia may try to hide their signs and symptoms, making it more difficult to reach the diagnosis.

Below are common signs and symptoms that can be present in all stages of dementia:

  • 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
  • Unable 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
  • Hallucinations

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 these 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 daily 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:

  • 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)
  • Increased susceptibility to infections such as pneumonia

Causes

Disorders grouped under the general term “dementia,” are caused by abnormal brain changes that trigger a decline in memory, concentration, organizational skills, and personality changes.

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 with concerns of memory problems, personality changes, and confusion.

It is essential to keep a timeline of when these symptoms began and whether they have become worse over time. The healthcare professional will be interested in the severity and duration of symptoms and behaviors.

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 (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 CT or 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).

Unfortunately, there is no single test to diagnose dementia, and therefore doctors will need a lot of information to solve the puzzle. 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
  • Vascular dementia
  • Frontotemporal lobe dementia (Pick’s disease)
  • Parkinson’s dementia
  • Huntington’s disease

Other types of dementia may be reversible and are caused by nutritional deficiencies, specifically B12 deficiency, chronic alcohol use disorder, infections, and medical disorders such as thyroid disease and normal pressure hydrocephalus.

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. 

Medications

Some medications can reduce symptoms of Alzheimer’s disease. There are four drugs, called cholinesterase inhibitors, approved for use in the U.S.:

  • Donepezil (brand name Aricept)
  • Galantamine (Reminyl)
  • Rivastigmine (Exelon)
  • Tacrine (Cognex)

A different kind of drug, memantine (Namenda), an NMDA receptor antagonist, may also be used, alone or in combination with a cholinesterase inhibitor.

Cholinesterase inhibitors can also help with the behavioral elements of Parkinson’s disease.

Antidepressants, anti-anxiety medications, and antipsychotics may be prescribed to help curb the mood changes, depression, anxiety, and paranoia that commonly occur with dementia. 

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

Cognitive stimulation therapy is a structured therapy program for individuals with mild to moderate dementia that focuses on playing word games, discussing current events, or cooking dinner from a recipe. 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 can make many individuals frustrated, especially when they are asked to repeat their name and age constantly, and therefore this type of therapy may 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! Balanced lifestyle changes can make for a safer living environment and can potentially slow down cognitive decline.

Some lifestyle changes include:

  • Staying physically active
  • Engaging in social activities
  • Eating a healthy balanced diet, full of brain-rich foods (nuts, olive oil, berries, beans, leafy vegetables, and poultry). 
  • Practicing good sleep hygiene
  • Avoiding tobacco and alcohol
  • Treating any underlying medical conditions such as high blood pressure and diabetes. 
  • Challenging the brain (e.g., listening to music, playing the piano, and reading a book)
  • Staying organized: set alarms and have calendar reminders around the house to remember upcoming events and plans.
  • Removing any clutter, hiding dangerous items such as knives and sharp objects, and removing the gas stove.

Coping

Living with dementia is difficult, not only for the individual but also for their loved ones. Fortunately, there are many resources that can help along the way. Besides medications, therapy, and lifestyle changes, there are plenty of online tools and resources that can help the family cope.

There are also informative books, blogs, and support groups that can help you form a sense of community with others who are also experiencing this. If you are the primary caretaker for your loved one who is living with dementia, it is essential that you take care of yourself and seek therapy or a support group if you are feeling overwhelmed.

Dementia is a long journey but thankfully there are many ways to cope and find the community and support that you need.

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