What is dementia?


“Dementia” is the word used to describe loss of memory, logical thought, and social abilities to the point that it interferes with daily life.

Dementia is not a normal part of aging. (Many people in their nineties function very well.) But dementia does become more common with age. Consider:

  • 3 percent of adults age seventy to seventy-four have some form of dementia
  • 33 percent of those age ninety and older

Dementia is not a disease in and of itself. It is merely a collection of symptoms.

There are many, many causes of dementia. Alzheimer’s disease is the most common cause (about 80 percent). There is also vascular dementia, caused by not enough blood to the brain. People who have had a stroke or brain bleed may develop vascular dementia. Dementia can also result from a long history of heavy alcohol use, a tumor, or a brain disease such as Huntington’s disease. So far, these types of conditions are not curable.

Temporary dementia can occur because of depression, dehydration, medication side effects, or a fever or infection. A vitamin deficiency or a thyroid disorder can also result in dementia symptoms. These temporary conditions mean that the dementia may be curable if the underlying cause is treated.

If dementia is a concern for your family member, it is important to have your relative tested to identify which condition is at the root of the memory problem. If it can be cured, you want to do so right away. Even for conditions that can’t be cured, medications can slow the progression of the disease. But they must be started in the early stages.

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Dementia symptoms

Depending on the underlying condition, dementia symptoms can include any one or more of the following:

  • Loss of ability to remember new information or recent events. Your family member may ask the same question over and over. Or they may repeat the same story ten minutes after telling it the first time.
  • Confusion and loss of logical thinking. Trouble with memory also affects the reasoning part of the brain. This is where we track that “a” leads to “b,” which leads to “c.” For instance, dealing with numbers and calculations, such as adding and subtracting, often becomes challenging with dementia.
  • Bad judgment and loss of wisdom or common sense. Weighing the pros and cons of a situation takes mental energy. Your family member may have trouble zeroing in on a decision. For instance, ordering at a restaurant may become frustrating. Or you may find that your relative purchases unnecessary or unusual goods. Poor judgment may also make your family member vulnerable to scams and con artists.
  • Difficulty with multistep activities. Complex activities are especially hard when you can’t remember what you’ve just done. Early signs of dementia may include problems making a meal or balancing the checkbook.
  • Getting lost or disoriented. Your relative may get lost in familiar places. They may not be able to follow directions easily.
  • Reduced verbal skills. Difficulty finding words can be a sign of dementia. We all have trouble with this now and then. But persons with dementia frequently substitute odd or unrelated words when they can’t find the ones they want.
  • Loss of interest in usual activities/hobbies. This is also a sign of depression. Depression and memory loss frequently occur together. (It’s depressing to lose your mental abilities!)
  • Changes in personality. Your loved one may become paranoid. The brain changes of dementia can erase social inhibitions. Your relative might say or do rude or embarrassing things that are unusual for the person you have known. They may become agitated or combative and appear to not care about other people’s feelings.
  • Difficulties with movement. Stiff and inflexible muscles, tremors, or muscle weakness all point to a need to be tested.
  • Visual hallucinations. If your loved one is seeing things others do not see, this is definitely a sign that something is amiss.

If you or your loved one are worried, talk to the doctor. Describe the symptoms you’ve observed and ask for a full medical evaluation.

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Normal forgetfulness versus dementia

You and your loved one may be worried about the possibility of dementia. It’s quite common for people to forget a person’s name or have trouble finding a word, and immediately wonder if this is the beginning of Alzheimer’s. Most likely it’s what’s called the “normal forgetfulness of aging.”

As we age, our brains just slow down. We can’t multitask as well as we used to. We may get easily distracted or have trouble concentrating. But these natural changes are not the same thing as dementia.

To help people understand the difference, the Alzheimer’s Association created a 10 Warning Signs campaign that compares the normal forgetfulness of aging with signs of early dementia.

Forgetfulness Dementia
Memory Not remembering at the time but recalling the issue later. Not recalling recent events. Inability to learn new tasks.
Misplacing items Forgetting why you went into a room and retracing steps to remember. Putting belongings in odd places. Blaming others for stealing them. Inability to retrace steps.
Communication Occasional inability to find a word, then recalling it later. Unable to hold a prolonged discussion. Repeating questions or stories.
Poor judgment Periodically forgetting to pay a bill or making an unwise purchase. Impulsive spending, falling for scams. Dressing inappropriately.
Familiar tasks or places Needing help with something recently learned. Unable to recognize a familiar place or remember how to do a familiar activity.
Reasoning Occasional errors in checkbook. Problems balancing checkbook and paying bills. Difficulty making plans or problem solving.
Spatial perception Needing glasses to read. Trouble judging distance. Difficulty with balance.
Perception of time Can’t remember the day of the week. Can’t remember the month, or season, or year.
Withdrawal Deciding to do something different from your usual activities. Not socializing much, especially as it becomes harder to carry on a conversation.
Irritability Getting grumpy when you have to do something you don’t want to do. Big personality changes. Depression, agitation, fear, paranoia.
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Getting tested for dementia

There are many benefits to getting tested for dementia, and doing it early.

  • It helps to have an explanation for changes. It can ease hurt feelings in the family to understand it’s the disease, not the person, that is prompting odd behaviors or hurtful words.
  • If the cause is a curable condition, you decrease the time everyone is dealing with the frustrations and interference of dementia.
  • Even if the cause is not curable, there may be treatments that can decrease the symptoms. This improves quality of life sooner. Many medications work best when they are started early in the progression.
  • You can make sure the medications prescribed match the condition. Many people just assume memory issues are Alzheimer’s disease. But there are other causes. You don’t want to be taking a medication that won’t help or be missing out on one that could. Medications are sometimes given for one condition that may make a different condition worse. (Many dementias are misdiagnosed as Alzheimer’s, for instance. If it feels like there is a mismatch, ask for a second opinion.)
  • Early diagnosis allows for planning while your relative can still communicate their preferences. Topics to cover include how to handle issues that arise later in the disease. Consider independence, finances, care options, and driving. Early diagnosis also allows for planning about what’s important now. Perhaps your relative will want to quit working sooner. Or go on that dream trip from their bucket list.
  • With a diagnosis, your loved one can then participate in clinical trials. They can receive advanced treatments for little to no cost. Understand that the treatments are experimental. But since there is no known cure for many causes of dementia, it might be worth the chance.
  • Getting support from appropriate programs. Once you know the condition, you can look for support groups and respite programs to help. They are designed to assist not only the patient, but also family members who typically shoulder the bulk of the caregiving.
Has your loved one been given a formal diagnosis? What are the obstacles, if any, to getting a full assessment?

What’s involved in a test?
A full assessment is best ordered by a neurologist. It will involve many different tests because there are so many possible causes. Your loved one will likely need to go to several offices to get all the assessments done. Evaluations to expect include the following:

  • A physical examination. The doctor can look at blood pressure and other risk factors that tend to go along with Alzheimer’s disease. They can also order bloodwork and urinalysis to better understand the health of internal organ systems.
  • Blood tests. These tests will give a glimpse into issues such as infections, vitamin deficiencies, and thyroid, kidney, or liver problems. A new test measures the blood levels of beta amyloid, a protein that is typically high in people with Alzheimer’s. But this test has not received full FDA endorsement or acceptance in all states. It is also not yet considered an accurate enough test on its own.
  • Brain scans. Your relative may be asked to have an MRI, a CT scan, or a PET scan (positron emission tomography). These brain scans provide a visual picture of any abnormalities. They are not invasive, meaning nothing on the body gets punctured. They would normally be performed at an imaging center where one goes for x-rays and mammograms.
  • Cognitive and neurologic tests. These tests measure memory, language, math skills, problem solving, balance, and reflexes. They usually involve questions and answers. Sometimes drawing or working with blocks. Perhaps getting up out of a chair and walking down a hall. These tests establish a baseline of current abilities. Later retests show if there has been a decline. Family members may be encouraged to attend. They can contribute important information about behaviors and changes that the patient may not be aware of or may not remember are a problem.
  • Psychiatric assessment. Symptoms of dementia often appear in the context of depression, so it’s wise to evaluate whether depression or another mental health condition is contributing to mood or personality changes. Psychiatric assessments involve talking with a psychiatrist and answering questions.
  • Genetic testing. Chromosomal oddities have been shown to predispose one to Alzheimer’s. Other causes of dementia, such as Huntington’s disease, can be identified through DNA testing. Genetic testing is usually conducted on a blood sample.

It may take a month or more to see all the various specialists. Once the results are assembled, the neurologist or primary care doctor will go over the findings. You will want to attend this meeting as the goal will be to help you and your relative determine the best course of treatment.

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