The term dementia describes a group of common symptoms associated with illnesses caused by gradual and progressive death of the brain cells. Some examples of diseases presenting with dementia symptoms are Alzheimer’s disease, stroke, Pick’s disease, etc. Since there is no way these dead brain cells can be revived, dementia as it progresses can severely hamper the quality of life of the patients and make even routine activities unmanageable on their own.
It is, therefore, of utmost important to recognize dementia symptoms and get a diagnosis at the earliest possible. Though dementia by itself is incurable, medical support can help reduce the severity of dementia symptoms and enable the patient and his family members cope better. And the sooner you recognize dementia symptoms, the easier it is to manage them.
Identifying dementia symptoms
Dementia is mainly a disorder of the aged (above 60-65 years), unless it happens due to some injury to the brain or due to genetic factors. No doubt that memory loss and forgetfulness are a normal part of aging, but when their extent is such that they start interfering with routine daily-life tasks, something more than normal aging is at work. It is, therefore, important to go on alert mode and familiarize yourself with further signs and symptoms of dementia if you have an elderly person showing such traits. Alzheimer’s disease organizations have prepared a checklist for recognizing dementia symptoms.
These are: decline in short-term memory, even though long-term memory may still be intact. This means the person forgets what he said or did few hours back, but still remembers things from the past, difficulty remembering recently read or learned things, complete brain fog from time to time, e.g., not remembering at all whether medication has been taken or not just few minutes back, difficulty finding words to convey information, confusion regarding time and places, e.g., missing appointments and getting lost while driving, misplacing things at odd places and not finding them later, difficulty in problem solving, mood swings and changes in behaviour, loss of interest in activities previously enjoyed, slurred speech and general decline in other cognitive functions.
Q: Can we break them down and look at each type, beginning with the cognitive symptoms?
A: Certainly. The cognitive symptoms are among the most noticeable and are often among the earliest symptoms to appear. They may include impairment, slowing or loss of:
orientation (of time, place and people)
the ability to calculate
the ability to learn new things
the ability to use language
A person with dementia may also experience a shortened attention span and a decrease in his ability to concentrate.
These symptoms can be further complicated by perceptual problems, such as agnosiathe inability to associate an object with its useand apraxiathe inability to use an object. There may be other types of perceptual problems, as well.
Q: No wonder people with dementia often develop emotional symptoms! Are the emotional symptoms of dementia reactions to these intellectual losses?
A: In part. Just think about how you would react if, arriving at a store, you forgot what you came for. Or how would you feel if someone you didn’t recognize approached you and seemed to know a lot about you? In the first instance, you might feel irritated; in the second, anxious, suspicious or even paranoid. Now imagine how you might feel if those incidentsor similar onesoccurred with regularity. Reactions to intellectual lossesor to the results of those lossesdefinitely affect emotions. But the emotional symptoms of dementia are not solely reactions to these types of situations. They are also rooted in actual changes in the brain.
Q: In what way?
A: The brain not only controls our thinking and physical functioning, it also controls our emotions and, ultimately, our behaviors. So changes in or damage to the brain can alter our feelings and behavior, essentially changing our personalities. As you know, Alzheimer’sand many of the other diseases and disorders that cause dementia, for that matterdestroys brain cells and damages the brain. It also alters amounts of important brain chemicals.
Q: Let me get this straight. You’re saying that the emotional symptoms of dementia are caused in part by reactions to intellectual losses and in part by physical changes in the brain. Can you give me an example?
A: Certainly. Depression is, understandably, a common symptom of dementia. (Ironically, depression is occasionally mistaken for dementia, something we discuss further in other section. As you might assume, experiencing a decline in your cognitive abilities and being aware of that decline can generate emotional reactions akin to depression.
But many experts believe that the depression that occurs with dementia is also a reaction to other, physical changes that are occurring. For example, one 1995 study indicates that, at least in Alzheimer’s patients, depression symptoms, such as passivity, disinterest in activity, listlessness and apathy, may actually be a result of a decrease in dopamine, a brain chemicala decrease caused by Alzheimer’s (American Journal of Geriatric Psychiatry). Regardless of whether this theory is proved true or whether it applies to people with other dementing illnesses, it illustrates the complexity of our emotions.
Q: So what are the possible emotional symptoms of dementia?
A: People with dementia may be depressed, anxious, irritable, insecure, withdrawn, afraid, hostile, jealous and/or paranoid. They may be agitated, particularly in the late afternoon or evening (a trait often referred to as sundowning). They may be apathetic and not react to anything going on around them (a condition known as flatness of affect), or they may have extremely volatile emotions, spontaneously laughing or crying for no obvious reason (a condition known as emotional lability). They may become stubborn and/or lose their sense of humor.
While this may seem overwhelming, remember that not everyone with dementia experiences every symptom. In addition, not every symptom a person does experience will continue throughout the course of her illness.
Q: That’s good to know. Do these emotional changes have any effect on behavior?
A: Yes. The behavior of people with dementia, like that of all people, is influenced by both emotion and thought.
A person with dementia whose emotions are affected by changes in his brain may lose interest in things he once enjoyed, while a person whose dementia has affected his logical thought processes may have difficulty following through on tasks or projects. In both cases, the individual may discontinue activities that were previously normal for him, changing his typical behavior.
In addition to discontinuing normal patterns of behavior, there can also be exaggerations of existing behaviors. Behavior, as you know, is a very individual thing. That said, however, certain behaviors appear with some frequency in people with dementia.
Q: What are those behaviors?
A: Before we list them, bear in mind that not every person with dementia exhibits every behavior, and not every behavior a person does experience continues throughout the course of the illness that is causing dementia. We discuss the prevalence of these symptoms in more detail in Chapters 2 and 3 when we discuss the various diseases and disorders that cause dementia. For now, here are the basics.
People with dementia may experience:
lack of initiative
loss of interest in things they previously enjoyed
an inability to follow through on tasks and projects
restlessness (which can lead to wandering)
sleep disturbances or changes in sleep patterns
Q: Anything else?
A: As they gradually lose the socially appropriate behavior skills they learned as children, they may shed their inhibitions and begin to say or do things that would otherwise embarrass them. They may become insensitive to or inconsiderate of others or become demanding.
If their language skills are affected, their communication habits may change. They may have difficulty following a conversation, or substitute one word for another in their own speech.
If the part of the brain that controls coordination is affected, their physical coordination may decline and motor skills may suffer. They may have difficulty walking or feeding themselves; they may become incontinent.
In short, they gradually become more and more dependent on others.
Q: Some of these behaviors are frightening and dangerous. Is there any way to prevent them?
A: Many of the behavioral symptoms of dementia can be treated, regardless of the underlying cause of dementia. In fact, dealing with the behavioral symptoms of dementia is a major focus of the latter part of this book.
Q: That’s good. But what about dementia symptoms overall? Are they permanent?
A: That depends on what has caused them. As we’ve said, some of the diseases, disorders and conditions that cause dementia can be cured, treated or held in check; others cannot. Depending on the underlying cause and the extent of brain damage, treating the illness may bring an end to dementia symptoms or at least stop them from progressing. When dementia symptoms are caused by incurable illnesses, however, they cannot be reversed.
Fortunately, even for incurable diseases such as Alzheimer’s, there are measures that severity of dementia symptoms. We discuss these methods of coping with dementia in more detail later. But first, we need to take a closer look at the various diseases, conditions and disorders that cause dementia.
Marie Louise Caltabiano
Article first published online: 6 MAY 2005