Dementia: Symptoms, stages, and types

Dementia is a common term used to describe multiple cognitive weakening symptoms such as forgetfulness. It is a symptom of multiple underlying diseases and brain disorders.

Dementia is not in itself a single disease but a generic term to describe symptoms of memory, speech, and thought loss.

While age increases the likelihood of developing dementia, it is not a normal part of ageing.

An overview of the most recent census shows that in 2010, 4.7 million people in the United States, aged 65 or older, were living with Alzheimer’s disease. Association for Alzheimer’s predicts that:

  • just over a tenth of people aged 65 years or more have Alzheimer’s disease
  • this proportion rises to about a third of people aged 85 and older
  • Alzheimer’s accounts for 60-80 percent of all cases of dementia

The article discusses possible causes of dementia, the different types and any treatments available.

Fast facts on dementia

  • there are an estimated 47.5 million dementia sufferers worldwide
  • one new case of dementia is diagnosed every 4 seconds
  • dementia mostly affects older people but is not a normal part of aging

Symptoms

Symptoms of dementia include memory loss, disorientation and changes in mood.
Symptoms of dementia include memory loss, disorientation and changes in mood.

A person with dementia can exhibit any of the following symptoms mainly due to memory loss.

Some signs may be detected by themselves, others may be identified only by caregivers or healthcare workers.

The indications used to compile this list are published in the journal American Family Physician by the American Academy of Family Physicians (AAFP) in the journal American Family Physician.

Potential dementia symptoms include:

  • Recent memory loss – a sign of this might be asking the same question repeatedly.
  • Difficulty completing familiar tasks – for example, making a drink or cooking a meal.
  • Problems communicating – difficulty with language; forgetting simple words or using the wrong ones.
  • Disorientation – getting lost on a previously familiar street, for example.
  • Problems with abstract thinking – for instance, dealing with money.
  • Misplacing things – forgetting the location of everyday items such as keys, or wallets, for example.
  • Mood changes – sudden and unexplained changes in outlook or disposition.
  • Personality changes – perhaps becoming irritable, suspicious or fearful.
  • Loss of initiative – showing less interest in starting something or going somewhere.

As the patient ages, late-stage dementia symptoms tend to worsen.

Dementia stages

Dementia is sometimes loosely divided into four stages:

mild cognitive impairment: marked by general oblivion. It affects many people as they age but for some it just leads to dementia.

Mild dementia: humans with moderate dementia may experience cognitive impairments that sometimes affect their daily lives. Symptoms include loss of memory, frustration, changes in personality, getting lost and difficulties in planning and performing tasks.

Moderate dementia: daily life becomes more challenging, and the individual may need more help. Symptoms are similar to mild dementia but increased. Individuals may need help getting dressed and combing their hair. They may also show significant changes in personality; for instance, becoming suspicious or agitated for no reason. There are also likely to be sleep disturbances.

Severe dementia: Symptoms have dramatically deteriorated at this point. There may be a lack of communication skills and the individual may need full-time treatment. Simple tasks become difficult, such as sitting and keeping one’s head up. Command of the bladder may well be lost.

Dementia types

There are several types of dementia, including:

  • Alzheimer’s disease is characterized by “plaques” between the dying cells in the brain and “tangles” within the cells (both are due to protein abnormalities). The brain tissue in a person with Alzheimer’s has progressively fewer nerve cells and connections, and the total brain size shrinks.
  • Dementia with Lewy bodies is a neurodegenerative condition linked to abnormal structures in the brain. The brain changes involve a protein called alpha-synuclein.
  • Mixed dementia refers to a diagnosis of two or three types occurring together. For instance, a person may show both Alzheimer’s disease and vascular dementia at the same time.
  • Parkinson’s disease is also marked by the presence of Lewy bodies. Although Parkinson’s is often considered a disorder of movement, it can also lead to dementia symptoms.
  • Huntington’s disease is characterized by specific types of uncontrolled movements but also includes dementia.

Other disorders leading to symptoms of dementia include:

  • Frontotemporal dementia also known as Pick’s disease.
  • Normal pressure hydrocephalus when excess cerebrospinal fluid accumulates in the brain.
  • Posterior cortical atrophy resembles changes seen in Alzheimer’s disease but in a different part of the brain.
  • Down syndrome increases the likelihood of young-onset Alzheimer’s.

Early signs

Early signs of dementia can include:

  • Changes in short-term memory.
  • Changes in mood.
  • Trouble finding the right words.
  • Apathy.
  • Confusion.
  • Being repetitive.
  • Finds it hard to follow a storyline.
  • Trouble completing everyday tasks.
  • Poor sense of direction.
  • Difficulty adapting to changes.

Causes

Dementia can be caused by brain cell death, and most dementias are associated with neurodegenerative disease-a progressive brain cell death that occurs over time.

However it is not clear whether the dementia causes the death of the brain cell, or the death of the brain cell causes the dementia.

However, as well as progressive brain cell death, such as that seen in Alzheimer’s disease, dementia may be caused, among other causes, by a head injury, stroke, or brain tumor.

  • Vascular dementia (also called multi-infarct dementia) – resulting from brain cell death caused by conditions such as cerebrovascular disease, for example, stroke. This prevents normal blood flow, depriving brain cells of oxygen.
  • Injury – post-traumatic dementia is directly related to brain cell death caused by injury.

Some types of traumatic brain injury-especially if repetitive, such as those received by sports players-have been linked to certain later-life dementias. However, evidence is weak that a single brain injury increases the likelihood of developing degenerative dementia such as Alzheimer’s disease.

Could also cause dementia by:

  • Prion diseases – for instance, CJD (Creutzfeldt-Jakob disease).
  • HIV infection – how the virus damages brain cells is not certain, but it is known to occur.
  • Reversible factors – some dementias can be treated by reversing the effects of underlying causes, including medication interactions, depression, vitamin deficiencies, and thyroid abnormalities.

Diagnosing dementia

Standard questions and exercises include the first step in assessing memory performance and cognitive health.

Research has shown that dementia can’t be diagnosed accurately without using the standard tests below, completing them thoroughly and documenting all the answers; however, diagnosis also takes other factors into account.

Cognitive dementia tests

Cognitive dementia measures of today are commonly used and were checked as a reliable way to indicate dementia. Since its establishment in the early 1970s, they have changed little. There are ten questions to the abbreviated mental test score which include:

  • What is your age?
  • What is the time, to the nearest hour?
  • What is the year?
  • What is your date of birth?

correct answer gets one point; the cognitive impairment indicates scoring six points or less.

The General Practitioner Cognition Assessment (GPCOG) evaluation provides an additional element to record parent and caregiver observations.

This kind of examination, developed for physicians, may be the first standardized assessment of the mental ability of a person.

The second part of the test samples someone similar to the patient and consists of six questions to find out if the patient has:

  • become less able to remember recent events or conversations
  • begun struggling to find the right words or using inappropriate ones
  • found difficulty managing money or medications
  • needed more help with transport (without the reason being, for example, injury)

If the examination does indicate memory loss, then regular examinations, including routine blood tests and a CT brain scan, are recommended.

Clinical tests can recognize, or rule out, memory loss treatable causes and help to narrow down potential causes, such as Alzheimer’s.

Mini-mental State Assessment (MMSE) is a cognitive test that measures:

  • orientation to time and place
  • word recall
  • language abilities
  • attention and calculation
  • visuospatial skills

MMSE is used to help diagnose dementia caused by Alzheimer’s disease, and also to assess its extent and whether drug therapy is appropriate.

Treatments

Death of brain cells can not be reversed, therefore there is no known cure for degenerative dementia.

Additionally, condition treatment such as Alzheimer’s disease focuses on providing care and treating symptoms, rather than their underlying cause.

However, if dementia symptoms are due to a reversible, non-degenerative cause, more damage to the brain tissue may be avoided or reversed by care.

Examples include accidents, effects of treatment and lack of vitamin.

Many medications can reduce the symptoms of Alzheimer’s disease. There are four medications licensed for use in the U.S., called cholinesterase inhibitors:

  • donepezil (brand name Aricept)
  • galantamine (Reminyl)
  • rivastigmine (Exelon)
  • tacrine (Cognex)

Another form of drug, memantine (Namenda), an antagonist to the NMDA receptor, may also be used, alone or in conjunction with a cholinesterase inhibitor.

Cholinesterase inhibitors can also help with Parkinson’s disease’s behavioral components.

Other quality-of-life care

Brain training “can help improve cognitive functioning and help deal with forgetfulness in the early stages of Alzheimer’s. This could include the use of mnemonics and other memory aids, such as computerized retrieval tools.

Prevention of dementia

It is known to connect certain risk factors with dementia. Age is the largest factor, however. Some risk factors are as follows:

  • Smoking and alcohol use.
  • Atherosclerosis (cardiovascular disease causing the arteries to narrow).
  • High levels of “bad” cholesterol (low-density lipoprotein).
  • Above-average blood levels of homocysteine (a type of amino acid).
  • Diabetes.
  • Mild cognitive impairment can sometimes, but not always, lead to dementia.

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