Questions & Answers About Dementia

We will take a look at some of the common types of dementia and the ways in which they are diagnosed and treated. A diagnosis of dementia is usually triggered by a noticeable decline in memory and thinking abilities that interfere with one’s performance of daily life activities. At times these changes can be subtle, but over time there is a noticeable change in how you think and behave. The first and most obvious symptoms of dementia include mood changes, frequent forgetfulness, difficulty concentrating or navigating in space and time. These changes can often be dramatic and they can include behavioural issues like agitation, aggression, paranoia or withdrawal from activities. It also includes changes to your language abilities, such as being unable to string a sentence together or being able to no longer understand words that you used to use easily.

What are the signs and symptoms of dementia? 

The symptoms of dementia can include:

  • Memory problems
  • Cognitive problems
  • Personality changes
  • Language problems
  • Difficulty with complex thinking

The objective and observable warning signs of dementia may include memory loss that disrupts daily life functioning, such as misplacing things and losing the ability to retrace steps: forgetting what you have just read or where you have put your keys. Other signs include confusion of time or place, trouble understanding visual images and spatial relationships, poor judgement mood and personality changes (e.g., anxiety, apathy, suspiciousness, agitation, depression, and aggressiveness). Some other noticeable signs of dementia include: 

  • Problems with naming, attention and speech
  • Frequent repeating of questions or phrases
  • Decreased ability to carry out daily tasks, such as cooking, reading, writing etc
  • Inability to complete mental tasks
  • Difficulty in following instructions
  • Lack of coordination and loss of balance
  • Decreased ability  to speak clearly and understand complex instructions
  • Extreme fatigue/lethargy

What are the most common types of dementia?

The most common type of dementia is Alzheimer's Disease, which accounts for about 60% to 70% of all dementia cases(WHO). This form of dementia is specifically characterised by memory loss, changes in personality and language. Other types of dementia include vascular dementia, caused by a lack of blood flow to the brain that damages brain tissue. Lewy body dementia is a category of dementia which includes Parkinson's Disease Dementia (PDD) and Dementia with Lewy Bodies (DLB). Neither of them is characterised by mood changes. One is characterised by extrapyramidal symptoms occurring before cognitive decline. Another is characterised by initial cognitive decline specifically in visuospatial, attention and executive function modalities.1 Lastly, frontotemporal dementia is characterised by changes in behaviour and language. Mixed dementia with clinical features of more than one type of dementia is also possible.

What is the difference between dementia and Alzheimers?

Dementia is a syndrome and a general term that refers to "loss of the ability to function" or decline in mental ability severe enough to interfere with daily life. Alzheimer’s is the most common cause of dementia and is a specific disease. Dementia is not.

Is there a link between dementia and memory loss?

Dementia is a chronic, progressive brain syndrome that generally impacts an individual's cognitive abilities. Although by definition, memory loss is one of the most common symptoms of dementia, there is more to dementia than just memory loss. Dementia is a general term for a group of brain disorders that not only cause problems with memory but general thinking and behaviour as well. While the main symptom may be memory loss, people with dementia may also have difficulty completing familiar tasks, communicating or understanding written or spoken words. As such, the term applies to a wide range of illnesses that affect your brain, including alzheimer's disease.

Is dementia part of normal ageing?

It is not part of normal ageing. Dementia is a complex, serious illness. However, dementia is not an inevitable consequence of ageing. In fact, dementia can also affect younger people. And although about 5% of people over 65 have dementia and this percentage increases as you get older, dementia is not inevitable. Why? Because in rarer types of dementia a strong genetic link has been evidenced, the majority of dementia is not hereditary and there are steps you can take to reduce your risk of developing dementia.

What are the risk factors for dementia?

Inherited dementia is rare and as such, it is important to know what factors increase the risk of dementia and what conditions can protect your brain's health. Many of the attributed factors associated with an increased risk of dementia are specifically linked with lifestyle. Lack of sleep,  smoking, unmoderated alcohol intake, high cholesterol and blood pressure, are all factors that may contribute to the risk of dementia. To the same extent, anything that contributes to protecting your brain's health will also reduce your risk of developing the condition.

Factors such as a healthy diet, eating a balanced diet and being physically active will protect your brain health in the long term. By following an active lifestyle on a regular basis you will not only keep your brain healthy, but also your heart. Being active, exercising regularly, maintaining a healthy weight, eating a healthy balanced diet, maintaining good heart health and having a regular sleep schedule are known factors to reduce the risk of dementia.

What is the main cause of dementia?

Ageing is associated with cognitive decline. As the brain ages, glial cells (supporting cells) become less resilient and decline over time, leading the cognitive decline. The main cause of dementia in Alzheimer’s Disease is associated with the abnormal accumulation of proteins that end up damaging brain cells and which over time impair brain cell function. However, the fact that not all people developed dementia due to these abnormal accumulations is an indication that other factors contribute to the onset of the condition, most specifically lifestyle.

In vascular dementia, the cause of dementia is associated with the increased narrowing of blood vessels leading to brain cell damage and death. In frontotemporal dementia, the above-referred protein accumulation specifically forms in the front and side parts of the brain leading to brain cell damage in that area and affecting the important cognitive abilities of such brain areas.

What tests are used to diagnose dementia?

Dementia is a group of symptoms, meaning it can't be diagnosed in a conventional way of thinking about diagnosis. On the other hand, AD can be diagnosed because it is a specific disorder.

Seeking a diagnosis is often scary or overwhelming. However, it is important to understand that the earlier you are diagnosed, the better care you can receive. To this extent, a number of psychological tests have been designed to help doctors determine if a person has dementia. These tests include things such as memory and concentration assessments and physical and neurological specific exams with neuroimaging equipment such as Magnetic Resonance Imaging (MRI) that help make the diagnosis by provide evidence of damage to your brain structure and allow doctors to provide a more accurate and objective diagnostic.

A dementia assessment is an opportunity to understand how well your cognition has developed in the past and try to predict how well it might develop at any given point in time allowing you to take preventive measures against further declines if any.

What to do if a loved one is suspicious of having dementia?

The best type of support a family member or friend can offer to someone diagnosed with dementia is to be there for them. As the person with dementia is no longer able to fully take care of himself, more specifically for things that were for so many years taken for granted, it is critical to be there for them when they need it, especially to avoid amounting frustrations for the person with dementia. Another key factor that may help people preserve some of their sense of independence – particularly in terms of mental ability - is providing them with appropriate tools: schedules, reminders, memo techniques to help them with day-to-day life. For example, a person with dementia may not remember to take their medication on time or to eat certain vitamins that are important for maintaining as much as possible their brain health. To protect their safety, it is important to set up ground rules, for instance by removing trip hazards and preventing them from exerting themselves while having a shower or bathing.

Support for a loved one with dementia can be difficult to deal with. As such, it is also important to set aside time every day to spend with your loved one in order to limit their frustration and avoid social isolation as much as possible. Being patient and having a good understanding of the stages of dementia may help you adapt. 

What are the stages of dementia?

Different forms of dementia progress through relatively mild symptoms that get worse with time, usually over several years. The stages of dementia may vary widely from person to person, with some people showing symptoms only very late in the disease process and others showing symptoms early. The majority of patients, however, will progress in stages. The following is how the stages of dementia may be broken down:

Early stage

During the early stage of dementia, people have some symptoms that interfere with their daily lives. They may have a hard time remembering things or making decisions. Their judgement skills may not be as good as usual and they may have trouble finding the right words. They may become easily confused and forgetful or have trouble finding familiar places. Their mood or personality might change a little bit, but they can still function at home, at work and in relationships.

Middle stage

During the middle stage of dementia, people need more help with everyday tasks. Someone in the middle stage needs reminders about things they used to do easily and might need extra help at home. Friends and family members can step in to provide that help.

Late-stage

Someone with late-stage dementia needs full-time care and support for example, for paying bills or making sure medications are taken but as well as with daily tasks associated with personal care, such as eating, washing and dressing.

Dementia risk calculator

Because alzheimer’s disease is a degenerative brain disorder, it is important that you are aware of your risk level and take appropriate health precautions that you should maintain throughout your lifetime.

References

  1. Gomperts SN. Lewy Body Dementias: Dementia With Lewy Bodies and Parkinson Disease Dementia. Continuum (Minneap Minn). 2016; 22(2 Dementia):435–63.
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Rodrigo Montenegro

Master of Science - MSc. Neuroscience, Universidad Isabel I, Spain

Rodrigo Montenegro is a Neuroscientist with Sleep Medicine specialization from Oxford University. Rodrigo has worked as a lead Neuroscientist developing a clinical grade sleep-headband and as a consultant in applied medical neuromodulation technologies.

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