Dementia refers to a decline in mental function (loss of memory, language, problem-solving and other thinking abilities) severe enough to interfere with a person’s ability to complete daily tasks. The condition presents itself in a variety of forms, with Alzheimer’s disease being the most common.
The worldwide statistics associated with dementia are extraordinary:
- Approximately 45 million people — mostly over 65 years old — have dementia
- About 2.5 million people younger than 65 suffer from some type of dementia
- Someone is diagnosed with dementia every four seconds
- A woman over the age of 65 is two-and-a-half times more likely to develop dementia than a man of the same age
In the United States alone, 5.8 million people have dementia. Dementia care can become quite difficult, often requiring 24-hour supervision to provide assistance and ensure safety. This is why many people choose to utilize memory care communities, with staff members who specialize in the behaviors and needs associated with dementia.
What is Dementia?
Dementia is an umbrella term that refers to a group of symptoms that affect memory, communication skills and reasoning. Symptoms can become serious enough to interfere with the ability to perform simple daily activities, such as eating, dressing and bathing.
There are many different types of dementia. Alzheimer’s disease is the number one cause, accounting for 60-80% of all dementia cases, according to the Alzheimer’s Association. Other types of dementia include vascular dementia, Lewy body dementia and frontotemporal dementia.
Though most causes for dementia are progressive and incurable, some types of dementia are reversible if addressed early enough. Once the underlying deficiencies or illnesses are addressed, dementia may disappear unless irreparable damage to the brain has occurred. That’s why, if you have any concerns, it’s best to see your doctor to get a diagnosis as soon as possible. Most dementias cannot be cured; however, medications can be used to manage the symptoms associated with the disease process.
Although memory loss is associated with dementia, not everyone who has memory loss has dementia. Normal age-related changes in memory and thinking occur as a person ages; however, memory loss and confusion that interfere with basic daily activities are not normal to the aging process.
What Are the Symptoms of Dementia?
Dementia symptoms can be divided into cognitive and sensory changes and psychological changes. Cognitive and sensory changes include:
- Memory loss
- Communication difficulties, especially trouble finding the right words
- Difficulties with complex tasks
- Disorientation and confusion
- Difficulty with motor functions and coordination
- Difficulties with organization, planning, reasoning and solving problems
- Disorientation and confusion
- Reduced visual perception
- Loss of ability to identify objects
- Decreased sense of smell and a metallic taste in the mouth
Psychological changes include:
- Mood swings
- Changes in behavior and personality
Dementia signs include:
- Inability to complete tasks independently
- Problems naming close family members or the names of familiar items
- Repetition of questions
- Frequent misplacement of items and/or forgetting their function
- Inability to retrace steps and becoming lost
- Needing more time than usual to finish activities
What Causes Dementia?
The primary cause of dementia is damage to brain cells. This damage could be caused by:
- Family history and genetic disorders
- Mental and neurological disorders
- Increasing age
- Clumps of protein accumulations in the brain
- Metabolic disorders, including diabetes and thyroid problems
- Vitamin deficiencies
- Alcohol and drug abuse
- Repetitive brain injury (as seen in boxers) and traumatic brain injury
- Infections that cause high fever
- Damage to blood vessels in the brain
- Heavy metal or pesticide poisoning
- Certain medications can cause dementia
- Brain tumors
As people age, they have a greater chance of developing dementia. In fact, age is one of the contributing factors of dementia.
Stages/Progression of Dementia
Dementia is a progressive disease, and it passes through seven distinct stages. Becoming familiar with these stages will help families and friends know what to expect. Treatment can help slow the progression of the disease.
The Pre-Dementia Stages: Stages 1 to 3
During the first three stages of early stage dementia, little if any cognitive impairment is present. The individual who is in early stage dementia is typically able to live independently. They are likely to experience memory lapses, often referred to as “senior moments.”
Stage 1: Normal Functioning
During stage 1, there is no cognitive decline. Someone with this stage of dementia development generally doesn’t exhibit any major signs of memory loss or cognitive impairment.
Stage 2: Very Mild Cognitive Decline
During this stage of dementia development, a person will have occasional memory lapses. These lapses generally entail forgetting names or forgetting where an object has been placed. This memory decline may be easily mistaken for normal age-related cognitive decline, often referred to as “senior moments.” Even with clinical testing, dementia is virtually undetectable at this stage. If there is a concern for early-onset dementia, especially where there is a family history of early-onset dementia, other symptoms should be present to help confirm.
Stage 3: Mild Cognitive Impairment
Mild cognitive impairment, also referred to as MCI, is typical in stage three. During this stage of dementia development, cognitive difficulties become evident, although many people with MCI can continue to live independently. Dementia presents itself in stage 3 commonly when a person:
- Easily becomes lost
- Work performance declines
- Misplaces and/or loses important items
- Has difficulty recalling information that was previously read
- Has challenges with concentration
As these dementia signs worsen and begin to interfere with daily activities, individuals with MCI often begin to experience anxiety and depression. Anyone who experiences any of these early stage dementia signs should visit a clinician to receive a proper diagnosis.
The Mid-Dementia Stages: Stages 4 and 5
The middle stage of dementia usually lasts the longest. In fact, it can last for many years. During this time, dementia symptoms worsen and increasing levels of care will be needed. Damage that has occurred in the brain can make it difficult to perform everyday tasks and to express oneself. In this stage, words may get mixed up. The result can be understandable frustration and anger, which may lead a person with dementia to act out in unpredictable ways, such as refusing to bathe.
Stage 4: Mild Dementia
At this stage of dementia, the symptoms cause people to withdraw socially. To hide their symptoms and to reduce anxiety, people in this stage may avoid activities and situations that they consider to be challenging. Changes in mood and personality become evident as well. People with dementia may deny the existence of their symptoms as a defense mechanism.
At this stage, a person with dementia may:
- Have increased memory difficulties, experiencing trouble remembering details of their past
- Experience difficulty recognizing familiar faces
- Become lost when traveling to familiar locations
- Become easily disoriented
- Have a diminished capacity to handle finances, arrange travel plans, etc.
- Have diminished recall of recent and current events
Stage 5: Moderate Dementia
As dementia progresses into stage 5, people require assistance with some daily activities. The most common dementia symptoms associated with this stage include:
- Major memory problems, like becoming unable to recall names of family members and forgetting basic information about themselves, such as their address or telephone number
- Difficulties making decisions
- Disorientation of time and place
Although this stage interferes with basic abilities, individuals in stage 5 don’t require assistance to complete basic tasks such as eating and toileting. During stage 5, individuals can still remember their own names. They are generally able to recall the names of their spouses and children.
The Final Stage of Dementia: Stages 6 and 7
During the final stage of dementia, the remaining memory and cognitive skills begin to deteriorate rapidly. The dementia patient will progressively lose the ability to have a conversation, engage with the world around them or even control their muscles. If they talk, their words may not make sense; therefore, expressing their thoughts becomes difficult. Their personality may undergo significant changes or may fade away altogether.
Stage 6: Moderately Severe Dementia
At the point when the dementia patient begins to forget the names of their spouse and children, they are entering stage 6. In this stage, they are typically unaware of their surroundings. They are unable to recall recent events and have incorrect memories of their past. During this stage, they will require 24/7 care. Dementia symptoms that occur during stage 6 include:
- Behavior that is delusional
- Agitation, aggression and anxiety
- Obsessive behavior
- Loss of willpower
It is during stage 6 that dementia patients often begin to wander. They may have hallucinations and find it difficult to sleep.
Stage 7: Severe Dementia
During the final stage of dementia, the brain appears to have a disconnect from the body. Frequently, dementia patients progressively lose all verbal and speech capabilities, as well as motor skills. They require assistance to do basic activities such as eating, walking and toileting.
Causes and Risk Factors of Dementia
There are several factors that increase your risk of dementia. As we look at causes and risk factors, it’s important to understand that a risk factor is not the same as a cause. For example, one risk factor for Alzheimer’s disease and vascular dementia is diabetes; however, that doesn’t mean that diabetes causes either of them. Not everyone who has diabetes develops dementia. Additionally, you have control over some of these risk factors, such as smoking, but not others, such as age.
There are medical risk factors and genetic/lifestyle risk factors. Medical risk factors associated with dementia include:
- Atherosclerosis, which can lead to the death of brain cell connections, the brain cells themselves and vascular dementia
- Mild cognitive impairment increases the risk for dementia and Alzheimer’s disease, but they do not always lead to either
- High levels of LDL cholesterol increase the risk of vascular dementia
- High levels of homocysteine are a risk factor for Alzheimer’s disease, vascular dementia, stroke (which can cause dementia) and cognitive impairment
- Diabetes leads to an increased risk of Alzheimer’s disease and vascular dementia
- Experiential and psychological factors — such as isolation and not regularly engaging in cognitively stimulating activities — lead to an increased risk for Alzheimer’s disease
- Most people with Down Syndrome develop the plaques and tangles associated with Alzheimer’s disease, and many develop dementia
Genetic/lifestyle risk factors associated with dementia include:
- Age: the risk of developing Alzheimer’s disease, vascular dementia and several other memory problems increases with age, usually beginning at age 65
- Genetics: if a close family member has dementia, your risk is increased
- Smoking may significantly increase your risk of dementia
- Excessive drinking increases the risk of Korsakoff syndrome, a type of dementia
If you have any of these risk factors, make an appointment to see your doctor and talk to them about what you can do to reduce your risk.
Types of Dementia
There are many types of dementia. Let’s look at some of the most common.
Alzheimer’s disease is the leading cause of dementia, accounting for 60-80% of all cases of dementia. Alzheimer’s disease is a progressive brain disorder that affects memory and thinking skills. More than five million Americans have been diagnosed with Alzheimer’s disease.
As the name implies, Frontotemporal Dementia affects the frontal temporal area of the brain. Frontotemporal Dementia affects speech and causes behavioral and personality changes. People with Frontotemporal Dementia, sometimes referred to as Pick’s disease, have difficulty using spoken and written language.
Dementia with Lewy Bodies
Dementia with Lewy Bodies, also known as Lewy Body Dementia, occurs when abnormal microscopic deposits of protein called Lewy bodies form on the cortex of the brain. The main symptoms associated with this include visual hallucinations and a shuffling gait.
Vascular dementia is generally caused by one or more “silent” strokes or one major stroke. Silent strokes often occur without the patient realizing they’ve had a stroke. Symptoms of vascular dementia vary, depending on which part of the brain received damage during the stroke. Unlike dementia, vascular dementia usually begins with difficulties in making decisions, organizing, planning and poor judgment.
Creutzfeldt-Jakob Disease, also called subacute spongiform encephalopathy, is a brain disorder caused when normal proteins in the brain begin to fold into abnormal shapes. Creutzfeldt-Jakob Disease typically causes memory loss, impaired thinking and blurred vision/blindness. Unlike many other forms of dementia, this type progresses quickly.
Mixed dementia is a combination of two types of dementia. The most common combination is vascular dementia and Alzheimer’s disease. Some studies indicate that mixed dementia may be even more prevalent than Alzheimer’s disease.
Mild Cognitive Impairment
Mild Cognitive Impairment is a subtle and slight decline in memory or the ability to think clearly. This is the stage between the expected age-related decline in cognitive abilities and the more serious cognitive decline associated with dementia. It can cause problems with memory, thinking skills, language skills and judgement.
Diagnosis, Treatment and Care
Diagnosis of Dementia
Diagnosis of dementia is based on tests performed or ordered by a doctor. A definitive dementia diagnosis can only be made after death during an autopsy examination of the brain.
Doctors order laboratory and imaging tests to rule out other causes of dementia symptoms. The diagnostic work-up may include the following tests:
- Neurological and physical exam
- Blood tests
- Neuropsychological and mental status testing
- Brain imaging, which may include magnetic resonance imaging (MRI), computerized tomography (CT), Amyloid PET (positron emission tomography) imaging, fluorodeoxyglucose (FDG) PET scan and Tau PET imaging scans
- Spinal tap to measure beta-amyloid or tau levels in the cerebrospinal fluid
- Genetic testing may be used for dementias that are genetic in nature
Treatment of Dementia
Unless the dementia is reversible, such as that caused by vitamin deficiencies or illness, there is no cure. Some medications can help with the symptoms associated with dementia, such as memory loss and other cognitive changes. Two types of drugs are currently used to manage cognitive symptoms and attempt to slow the decline:
- Cholinesterase inhibitors, such as rivastigmine (Exelon), galantamine (Razadyne) and donepezil (Aricept)
- Memantine (Namenda)
Other medications may be used to manage related symptoms, such as antianxiety drugs and antidepressants. Medications such as Risperdal may be used to control aggression.
Care for Dementia Patients
Caring for someone with dementia means doing what is necessary to provide a safe and supportive environment. It’s important to establish routines and minimize memory-demanding tasks. As functioning abilities are lost, changes will need to be made to ensure that the person’s needs continue to be met. What works one day may not work the next; therefore, care providers will need an extensive toolbox to care for the person with dementia.
As they move into the middle stages of dementia, people require more and more care and attention, often around the clock. This is when many families turn to memory care communities such as Avalina’s Valeo memory care neighborhood to provide the care that is needed and to address the resident’s physical, social, intellectual and spiritual well-being.