Living with Dementia
Coping Tips & Strategies for Both You and Your Family
When you don’t seem to be remembering things as well as you did in the past, it can be extremely upsetting, even frightening. Facing up to the possibility of memory loss or dementia inevitably shifts your perceptions, relationships, and priorities. But experiencing symptoms of dementia doesn’t have to mean the end of your normal life. Certain types of dementia can be slowed or even reversed if caught in time. The first step is to understand what distinguishes normal memory loss from dementia symptoms, and how to identify the different types of dementia. The more you understand about dementia, the more you can do to improve the outcome and preserve your sense of control.
What are the signs and symptoms of dementia?
As we age, many of us experience lapses in memory. It can be worrying and confusing to realize that something you once took for granted isn’t working as well as it used to. But learning to differentiate the signs and symptoms of dementia from normal aging can help to either set your mind at rest or encourage you to begin taking steps to slow or reverse the condition.
What is dementia?
Dementia is a collection of symptoms including memory loss, personality change, and impaired intellectual functions that result 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. Whatever the diagnosis, there can be plenty of things you can do to help slow or prevent symptoms of dementia and continue to enjoy a full and rewarding life.
Common dementia signs and symptoms
- Memory loss
- Impaired judgement
- 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
Someone with dementia symptoms may
- repeatedly ask the same questions
- become lost or disoriented in familiar places
- be unable to follow directions
- be disoriented about the date or time of day
- not recognize or be confused about familiar people
- have difficulty with routine tasks such as paying the bills
- neglect personal safety, hygiene, and nutrition
Normal memory changes vs. dementia symptoms
It’s something we all have to face but the inevitable changes of aging can still be both humbling and surprising. But while experiencing wrinkling skin, fading hair color, and mild, short-term memory loss is common as we age, severe and rapid memory loss is definitely NOT a part of normal aging. In fact, many people are able to preserve their brainpower as they get older by staying mentally and physically active and making other healthy lifestyle choices.
Normal memory changes associated with aging may include:
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 dementia symptoms is not an exact science but there are some clues to look for:
|Are memory changes typical aging or symptoms of dementia?|
|Typical aging:||Symptoms of dementia:|
You or a loved one complain about memory loss but are able to provide detailed examples of forgetfulness
Complain of memory loss only if asked; unable to recall specific instances
Occasionally search for words
Frequent word-finding pauses, substitutions
May have to pause to remember directions, but don’t get lost in familiar places
Get lost in familiar places and takes excessive time to return home
Remember 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?
In a healthy brain, mass and speed may decline in adulthood, but this miraculous organ continues to form vital connections throughout life. However, when connections are lost through inflammation, disease, or injury, neurons eventually die and dementia can develop. While the prospect of literally losing one's self can be extremely traumatic, early intervention can dramatically alter the outcome.
In the past 20 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 also 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.
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, with the most common types being Alzheimer's disease and vascular dementia.
This 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 continuing to enjoy a full life.
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 daily tasks - Such as 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 right name.
7. Misplacing things - Putting things in unusual places, unable to retrace steps, accusing others of stealing.
8. Poor judgement - 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 results from a series of small strokes or changes in the brain's blood supply. A sudden onset of symptoms can indicate vascular dementia, and while it severely impacts memory and cognitive functioning, there are ways to prevent and reduce its severity.
This 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 advanced senior years, often indicated by cardiovascular disease and dementia symptoms that get worse slowly over time.
Less common forms of dementia
Pick's Disease affects personality, orientation and behavior. It may be more common in women and occurs at an early age.
Creutzfeldt-Jakob Disease progresses rapidly along with mental deterioration and involuntary movements.
Huntington's Disease is an inherited, degenerative disease. The disease causes involuntary movement and usually begins during mid-life.
Parkinson's Dementia can develop in the later stages of Parkinson's disease, a progressive disorder of the central nervous system.
Lewy Body Dementia causes symptoms similar to Alzheimer's disease. People 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 MCI are still able to function in their daily lives without relying on others.
Many people with MCI 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 MCI 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 MCI 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
MCI / Alzheimer’s Questionnaire
The following 21-question test is designed to measure MCI 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 questionnaire is considered quite accurate, it should not be used as a definitive guide to diagnosing MCI or Alzheimer's disease, but as a tool to test whether your loved one needs further assessment.
Use this questionnaire to test whether a person's memory loss needs further assessment.
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
What to do if you have symptoms of dementia
Because dementia 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 dementia 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.
Why early intervention is so important
When dementia symptoms 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.
Preventing or delaying dementia
Recent research suggests that healthy lifestyle 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. These strategies can help reduce your risk of dementia.
The 6 pillars of dementia prevention:
1. Regular exercise. Starting a regular exercise routine, including cardio and strength training, may reduce your risk of developing dementia by up to 50 percent.
2. Social engagement. The more you connect face-to-face with others, the stronger your memory and cognition is likely to be.
3. Healthy diet. Brain-healthy eating habits can help reduce inflammation, protect neurons, and promote better communication between brain cells.
4. Mental stimulation. By continuing to learn new things and challenge your brain, you can strengthen your cognitive skills and stay mentally sharp.
5. Quality sleep. Getting quality sleep can flush out brain toxins and avoid the build-up of damaging plaques.
6. Stress management. Unchecked stress takes a heavy toll on the brain, shrinking a key memory area, hampering nerve cell growth, and worsening dementia symptoms.
Dementia treatment, planning, 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 fear, disbelief, and dismay many people experience after a dementia diagnosis. While dealing with dementia is a major life challenge, the above pillars of dementia prevention can be used to help slow the onset of more debilitating dementia symptoms. You can also use the following guidelines to help ease your journey and preserve your way of life:
Emotional connection can make a positive difference. As you deal with dementia symptoms, 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. Discuss and document treatment and end-of-life preferences with your doctors and family members 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 can also be empowering.
Watch for treatable changes. Depression, sleep disturbances, and medication interactions can make dementia symptoms 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. 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 your changing needs.
Savor positive experiences. Even when dementia is at an advanced stage and you sense your mind may be half-gone, try to see it as half-present. With appropriate support and understanding, people with dementia are still capable of experiencing and providing enjoyment and connection—even through the final stages of the disease.
Resources and references
Dementia: Hope Through Research – Provides information on identification, treatment, types, and prognosis for dementia. (National Institute of Neurological Disorders and Stroke)
What is Dementia? – Lists the types, causes, risk factors, and warning signs of dementia. (Alzheimer's Association)
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)
Mild Cognitive Impairment (MCI) – Comprehensive information about MCI symptoms, normal aging, treatment, and recommendations. (University of California at San Francisco)