Understanding Dementia

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.

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:

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 causes 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 pseudodementia, 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:

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 fifty 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 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.

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.

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 Disease - This disease causes symptoms similar to Alzheimer's disease. Individuals with Lewy Body Disease experience hallucinations and can become fearful.

What is mild cognitive impairment or early dementia?

Early dementia, also known as mild cognitive impairment, 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

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.

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.

• Related Articles
• Resources and references

Related Articles

Alzheimer’s Disease – The earlier you recognize the symptoms of Alzheimer’s disease and seek help, the better your chances of getting the care you need and maximizing your quality of life.

Vascular Dementia – Vascular dementia is one of the most common forms of dementia, ranking only second to Alzheimer’s disease.

Parkinson's Disease & Dementia – Learn about the relationship between Parkinson’s disease and dementia, and what you can do to manage symptoms.

Lewy Body Disease – Learn about Lewy Body Disease and what differentiates it from Alzheimer's, Parkinson's and the other dementias.

Pick’s Disease – Learn about Pick's Disease, its signs, symptoms, support and treatment methods.

Huntington’s Disease – Learn about the symptoms and treatment for Huntington's disease, and ways to live with the illness.

Creutzfeldt-Jakob Disease – Learn about Creutzfeldt-Jakob Disease, its different types, and how it is treated.

What’s Causing Your Memory Loss? – Learn how more than 50 conditions can mimic the symptoms of dementia and why it’s important to get an accurate diagnosis as early as possible. (Harvard Health)

Resources and References

Helpguide’s Yellow Pages
Resources for public assistance, social services, and other health and human services.

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)

You’re Wiser Now – Lead article in a special report on normal and abnormal brain aging that includes pieces on Alzheimer’s, conditions that mimic dementia, and strategies for maintaining a sharp mind. (AARP)

Authors: Melissa Wayne, M.A., Monika White, Ph.D., and Melinda Smith, M.A. Last updated: April 2013.