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Understanding Dementia

Signs, Symptoms, Types, and Treatment

Understanding Dementia In This ArticleWhen life’s challenges include memory loss or dementia, your perceptions, relationships, and priorities inevitably shift. However, certain types of dementia can be treated or reversed if caught in time. The first step is to understand what is and what isn't normal memory loss, the causes of cognitive decline, and how to identify the different types of dementia. The more you understand about dementia, the more you can do to improve your outcome and preserve your sense of control.

Signs and symptoms of dementia

Dementia is a collection of symptoms including memory loss, personality change, and impaired intellectual functions resulting from disease or trauma to the brain. These changes are not part of normal aging and are severe enough to impact daily living, independence, and relationships. While Alzheimer’s disease is the most common type of dementia, there are also many other forms, including vascular and mixed dementia.

With dementia, there will likely be noticeable decline in communication, learning, remembering, and problem solving. These changes may occur quickly or very slowly over time.

The progression and outcome of dementia vary, but are largely determined by the type of dementia and which area of the brain is affected. Diagnosis is possible through advanced brain imaging, clinical examinations, and diagnostic testing.

Common signs and symptoms of dementia include:

  • Memory loss
  • Impaired judgment
  • Difficulties with abstract thinking
  • Faulty reasoning
  • Inappropriate behavior
  • Loss of communication skills
  • Disorientation to time and place
  • Gait, motor, and balance problems
  • Neglect of personal care and safety
  • Hallucinations, paranoia, agitation

You might observe that a person with dementia:

  • repeatedly asks the same questions
  • becomes lost or disoriented in familiar places
  • is unable to follow directions
  • is disoriented as to the date or time of day
  • does not recognize and is confused about familiar people
  • has difficulty with routine tasks such as paying the bills
  • neglects personal safety, hygiene, and nutrition

Normal memory changes vs. dementia

The inevitable changes of aging can be both humbling and surprising. Skin wrinkles, hair fades, bodies chill, and muscle mass wanes. In addition, the brain shrinks, working memory goes on strike, and mental speed slows. But while many people do experience mild and gradual memory loss after age 40, severe and rapid memory loss is definitely not a part of normal aging. In fact, many people preserve their brainpower as they get older by staying mentally and physically active and making other healthy lifestyle choices.

The most common forms of mental decline associated with aging are:

  • Slower thinking and problem solving – The speed of learning slows down; short-term memory takes longer to function; reaction time increases.
  • Decreased attention and concentration – More distractedness. All of the interruptions make learning more difficult.
  • Slower recall – A greater need for hints to jog the memory.

Distinguishing between normal memory loss and symptoms of dementia is not an exact science but there are some clues to look for:

Normal Memory Changes or Dementia Symptoms?
Typical Aging: Symptoms of Dementia:

Complains about memory loss but able to provide detailed examples of forgetfulness

May complain of memory loss only if asked; unable to recall specific instances

Occasionally searches for words

Frequent word-finding pauses, substitutions

May have to pause to remember directions, but doesn't get lost in familiar places

Gets lost in familiar places and takes excessive time to return home

Remembers recent important events; conversations are not impaired

Notable decline in memory for recent events and ability to converse

Interpersonal social skills are at the same level as they've always been

Loss of interest in social activities; may behave in socially inappropriate ways

Adapted from: The American Medical Association

What causes dementia and its symptoms?

In a healthy brain, mass and speed may decline in adulthood, but this miraculous machine continues to form vital connections throughout life. However, when connections are lost through inflammation, disease, or injury, neurons eventually die and dementia may result. The prospect of literally losing one's self can be traumatic, but early intervention can dramatically alter the outcome. Understanding the causes of dementia is the first step.

In the past twenty years, scientists have greatly demystified the origins of dementia. Genetics may increase your risks, but scientists believe a combination of hereditary, environmental, and lifestyle factors are most likely at work.

Dementia can be caused by:

  • Medical conditions that progressively attack brain cells and connections, most commonly seen in Alzheimer's disease, Parkinson's disease, or Huntington's disease.
  • Medical conditions such as strokes that disrupt oxygen flow and rob the brain of vital nutrients. Additional strokes may be prevented by reducing high blood pressure, treating heart disease, and quitting smoking.
  • Poor nutrition, dehydration, and certain substances, including drugs and alcohol. Treating conditions such as insulin resistance, metabolic disorders, and vitamin deficiencies may reduce or eliminate symptoms of dementia.
  • Single trauma or repeated injuries to the brain. Depending on the location of the brain injury, cognitive skills and memory may be impaired.
  • Infection or illness that affects the central nervous system, including Creutzfeldt-Jakob disease and HIV. Some conditions are treatable, including liver or kidney disease, depression-induced pseudo dementia, and operable brain tumors.

Can dementia be prevented or delayed?

Recent research suggests that good health habits and mental stimulation may prevent dementia altogether or at least delay its onset. Just as physical exercise keeps you physically fit, exercising your mind and memory can help you stay mentally sharp, no matter how old you are.

Strategies to improve mental clarity and keep your brain functioning optimally:

  • Exercise consistently
  • Eat a brain-healthy diet
  • Challenge your mind
  • Get regular and restful sleep
  • Minimize stress
  • Avoid smoking and limit drinking

Types of dementia

All dementias involve cognitive decline that impacts daily living. However, it's important to pinpoint the specific type of dementia in order to optimize treatment. More than 50 conditions involve dementia, but the most common types of dementia are Alzheimer's disease and vascular dementia.

Alzheimer's disease

Alzheimer's disease is the most common form of dementia, accounting for up to two-thirds of all diagnosed cases. If your dementia symptoms are the result of Alzheimer's disease, medications can delay the onset of more debilitating symptoms. Early diagnosis can prolong independence and is the first step towards treatment, management, and living life fully.

10 Warning Signs of Alzheimer’s Disease

1. Memory loss sufficient to disrupt daily life – such as forgetting recently learned information, important dates or events, asking for the same information over and over, relying more and more on memory aides or family members.

2. Problem-solving difficulties – An inability to follow plans, work with numbers, follow recipes, or keep track of bills.

3. Trouble completing familiar daily tasks – Driving to a familiar location, remembering rules to a game, completing assignments at work.

4. Confusion over time or place – Losing track of dates and seasons, or forgetting where you are or how you got there.

5. Difficulty understanding visual images – Trouble reading, judging distances, colors, or contrast, or recognizing your own reflection.

6. Problems with spoken or written words – Difficulties following a conversation, finding the right word, or calling things by the wrong name.

7. Misplacing things – Putting things in unusual places, unable to retrace steps, accusing others of stealing.

8. Poor judgment – Decline in decision making, giving away large sums of money, paying less attention to personal grooming.

9. Withdrawal from work or social activities – Trouble remembering how to complete a work project or favorite hobby, avoiding sports or social events.

10. Changes in mood – Becoming confused, depressed, suspicious, fearful, or anxious. Easily upset when out of comfort zone.

Source: Alzheimer's Association

Vascular dementia

Vascular dementia results from a series of small strokes or changes in the brain's blood supply. Sudden onset of symptoms may be a sign of this dementia. Vascular dementia severely impacts memory and cognitive functioning. However, there are ways to prevent and reduce its severity.

Mixed dementia

Mixed dementia is a condition in which Alzheimer's disease and vascular dementia occur simultaneously. The combination of the two types of dementia most commonly occurs in people of an advanced age, often indicated by cardiovascular disease and dementia symptoms that get worse slowly over time.

Less common forms of dementia

  • Pick's Disease – Pick's disease affects personality, orientation and behavior. It may be more common in women and occurs at an early age.
  • Creutzfeldt-Jakob Disease – The disease progresses rapidly along with mental deterioration and involuntary movements.
  • Huntington's Disease – Huntington's is an inherited, degenerative disease. The disease causes involuntary movement and usually begins during mid-life.
  • Parkinson's Dementia – Parkinson's is a progressive disorder of the central nervous system. In later stages of Parkinson's disease, some patients develop dementia.
  • Lewy Body Dementia – This disease causes symptoms similar to Alzheimer's disease. Individuals with Lewy Body dementia experience hallucinations and can become fearful.

What is mild cognitive impairment (MCI) or early dementia?

Early dementia, also known as mild cognitive impairment (MCI), involves problems with memory, language, or other cognitive functions. But unlike those with full-blown dementia, people with mild cognitive impairment are still able to function in their daily lives without relying on others.

Many people with mild cognitive impairment eventually develop Alzheimer's disease or another type of dementia. However, others plateau at a relatively mild stage of decline and are able to live independently. Some people with mild cognitive impairment even return to normal. It is not yet fully understood why mild cognitive impairment progresses to Alzheimer's disease in some, while remaining stable in others. The course is difficult to predict, but in general, the greater the degree of memory impairment, the greater the risk of developing Alzheimer's down the line.

According to The Mayo Clinic's Dr. Ronald Peterson, roughly fifteen percent of the population between ages 70 and 90 experience minimal cognitive impairment.

Symptoms of early dementia or mild cognitive impairment include:

  • Frequently losing or misplacing things
  • Frequently forgetting conversations, appointments, or events
  • Difficulty remembering the names of new acquaintances
  • Difficulty following the flow of a conversation

What to do if you have symptoms of dementia

Why not just wait and see?

When symptoms of dementia appear suddenly, it is critical to seek medical attention. Conditions such as stroke, drug interactions, tumors, and seizures should be treated immediately. Timely intervention may also control or eliminate symptoms from other physical and psychological factors.

Because dementia and its symptoms can be caused by any number of conditions, obtaining an accurate diagnosis is critical for management and treatment. The sooner you address the problem, the better, so make an appointment with your doctor right away.

Your doctor can assess your personal risk factors, evaluate your symptoms, offer tips on healthy lifestyle adjustments, and help you obtain appropriate care.

If you suspect dementia:

  • Report your symptoms to your doctor as soon as possible and schedule regular follow up visits.
  • Keep a list of your symptoms and concerns and ask family members for their observations. Write down specific information about the frequency, nature, and setting of your memory, cognitive, or behavior concerns.
  • Take charge by learning as much about dementia as you can. Knowing what to expect will help you plan, adjust, and live life as fully as possible.

MCI / Alzheimer’s Questionnaire

The sooner you diagnose symptoms of MCI or Alzheimer’s, the sooner you can take steps to address the problem. The following 21-question test is designed to measure mild cognitive impairment and your risk of developing Alzheimer’s disease.

The questions are intended to be answered by a spouse, close friend, or other loved one.

While the Alzheimer’s Questionnaire is considered quite accurate, it should not be used as a definitive guide to diagnosing mild cognitive impairment or Alzheimer's disease, but as a tool to test whether your loved one needs further assessment.

Click here to see the MCI / Alzheimer's Questionnaire

Use this questionnaire to test whether a person's memory loss needs further assessment.

Memory

1. Does your loved one have memory loss?

2. If yes, is his or her memory worse than a few years ago?

3. Does your loved one repeat questions, statements, or stories in the same day? (2 points)

4. Have you had to take over tracking events or appointments, or does your loved one forget appointments?

5. Does your loved one misplace items more than once per month, or so that he or she can't find them?

6. Does your loved one suspect others of hiding or stealing items when he or she cannot find them?

Orientation

7. Does your loved one frequently have trouble knowing the day, date, month, year, or time, or check the date more than once a day? (2 points)

8. Does your loved one become disoriented in unfamiliar places?

9. Does your loved one become more confused outside the home or when traveling?

Functional Ability (exlcuding physical limitations)

10. Does your loved one have trouble handling money (tips, calculating change)?

11. Does your loved one have trouble paying bills or doing finances? (2 points)

12. Does your loved one have trouble remembering to take medicines or tracking medications taken?

13. Does your loved one have difficulty driving or are you concerned about him or her driving?

14. Is your loved one having trouble using applicances (e.g. microwave, oven, stove, remote control, telephone, alarm clock)?

15. Does your loved one have difficulty completing home repair or other home-related tasks, such as housekeeping?

16. Has your loved one given up or significantly cut back on hobbies such as golf, dancing, exercise, or crafts?

Visuospatial Ability

17. Does your loved one get lost in familiar surroundings, such as their own neighborhood? (2 points)

18. Does he or she have a decreased sense of direction?

Language

19. Does your loved one have trouble finding words other than names?

20. Does your loved one confuse names of family members or friends? (2 points)

21. Does your loved one have trouble recognizing familiar people? (2 points)

Please answer all the questions

Score:

Interpreting the score:

  • 0 to 4: No cause for concern
  • 5 to 14: Memory loss may be MCI, an early warning of Alzheimer's
  • 15 and above: Alzheimer's may have already developed

This questionnaire is not intended to replace professional diagnosis.

Source: BMC Geriatrics

How to limit the impact of MCI

Mild cognitive impairment (MCI) affects different areas of cognition for different people. But you can limit MCI's daily impact with simple steps.

Memory

Good habits can help you compensate for a bad memory. If you're having trouble remembering, develop a routine to reinforce consistent habits. Keep your keys on a hook by the door, park in the same area so you can find your car with less effort, and link medication regimens with other activities, such as eating a meal. Memory aids, such as notebooks or smartphones, are also helpful for tracking to-do lists, appointments, and important dates.

Executive function

Your executive function controls decision-making, planning, and organization. To combat potential confusion, simplify your choices and get rid of clutter. Clear out your closet to limit your clothing choices, pare down the number of cooking utensils and pots and pans in your kitchen. Label doors, cabinets, and boxes if you can't remember what's inside.

Visuospatial cognition

MCI often impairs your ability to interact with your visual world, which may include finding your way home and judging distances when you're driving. For early MCI, you can use GPS in your car and avoid driving during high-traffic times and in unfavorable weather conditions. For more advanced MCI, an on-the-road driving evaluation with a driver rehabilitation specialist can help determine if you have the skills to continue driving.

Language

Your ability to recall words and use them properly may become impaired. But continuing to chat with family and friends is the best way to keep language skills fresh. When you can't think of a word figure out another way to get the meaning across—or just say that you're having trouble finding the precise word. Getting anxious will only inhibit recall, so pause to allow for the possibility that the word may or may not come back to you, then move on in your conversation.

Social cognition

More effort may be required to recall someone's name, remember shared experiences, or hold up your end of a conversation. However, it's vital to regularly stay in touch with friends and family, beyond the telephone. Maintaining social interaction is beneficial for preserving cognition, and many of the most pleasurable experiences are those you share with others. Regularly schedule any activity you enjoy—dancing, a visit to the theater, a walk in the park—that involves interaction with other people.

Adapted with permission from Harvard Health Letter: November 2013, a newsletter published by Harvard Health Publications.

Dementia treatment and care

"I thought my life was over. I knew about dementia but I never thought it could happen to me." This sentiment reflects the denial, disbelief, and dismay common after a dementia diagnosis.

While dealing with dementia is a challenge, the following strategies can ease your journey:

  • Take care of yourself emotionally. As you deal with the symptoms of dementia, make sure you get the emotional support you need. Turn to close family members and friends, join a dementia support group, or talk to a therapist, counselor, or clergyman.
  • Make important decisions early. Avoid future medical, financial, and legal confusion by communicating your wishes and creating a plan. Designate a Power of Attorney for money and legal matters. Discuss and document treatment and end-of-life preferences with your doctors and family members. Create a Living Will and appoint someone you trust to make decisions for you in case you can no longer make them for yourself. Although these conversations may be difficult, making your wishes known is empowering.
  • Watch for treatable changes. Depression, sleep disturbances, and medication interactions can make the symptoms of dementia worse and limit independence. Treating them may require some experimentation with lifestyle changes and medication, but can be well worth the effort.
  • Create a dementia-friendly environment. Think happiness, independence, safety, and accessibility. Preserve your health and autonomy for as long as possible by taking simple actions: encourage memories with pictures and familiar objects; remove tripping hazards; increase lighting; and organize a caregiving network. Planning and flexibility can keep you one step ahead of changing needs.
  • Emphasize joy. When you sense the mind is half-gone, try to see it as half-present. With appropriate support and understanding, people with dementia are capable of experiencing and providing enjoyment and connection—even through the final stages of the disease.

More help for dementia

Resources and references

General information on dementia

Dementia: Hope Through Research – Provides information on identification, treatment, types, and prognosis for dementia. (National Institute of Neurological Disorders and Stroke)

Dementia: What Are Common Signs? – Lists causes and common signs of dementia. (FamilyDoctor.org)

Identifying Mild Cognitive Impairment – Short film providing information on MCI and various forms of dementia. (The Mayo Clinic, HBO Alzheimer’s Project)

Mild Cognitive Impairment (MCI) – Comprehensive information about MCI symptoms, normal aging, treatment, and recommendations. (University of California at San Francisco)

The Dartmouth Memory Handbook – Digital copy of the 4th Edition edited by Robert B. Santulli, M.D. Includes chapters on diagnosis and treatment of different types of dementia. (Caldwell Law)

Authors: Melissa Wayne, M.A., Monika White, Ph.D., and Melinda Smith, M.A. Last updated: November 2014.