When mom keeps losing her keys (that are still in her purse), we brush it off and joke about getting older. When dad is always asking the same question (that you already answered), we pat him on the back and call it “old-timers”. The truth is, memory loss is NOT a normal part of aging and yet the magnitude of this problem is growing across the country.
Ten percent of 65-year olds, 25 percent of 75-year olds, and 50 percent of 85-year olds will get Alzheimer’s disease. That means if you live past 85, you’ve got a 50/50 chance of getting Alzheimer’s making it the seventh leading cause of death. Even worse, the number of people diagnosed is predicted to triple in the next few decades.
What is Dementia?
Dementia is not a specific disease. It is a group of symptoms. Dementia is referred to as a decline in memory or other thinking skills that is severe enough to impact everyday activities. It is sometimes referred to as “senility” or “senile dementia” and was once thought to be a normal part of the aging process. Today we know this is not the case, while the likelihood of having dementia increases with age, it is not inevitable.
Symptoms of Dementia
It is rare for the individual to notice symptoms first. Usually it is caregivers or family members that notice a change. Oftentimes healthcare workers may be the first notice the first signs of dementia while treating a patient.
There are different symptoms based on the type of dementia: cognitive and psychological. Cognitive symptoms include the following:
- Memory loss that starts small and is usually noticed by a spouse or someone else first.
- Communication and language difficulties, problems finding the right words at the right time.
- Ability to focus and pay attention is diminished, sometimes resulting in getting lost while driving or losing track in the middle of a complex task.
- Reasoning and judgment are impaired so problem-solving becomes slow and planning or organizing is difficult.
- Visual perception may be compromised in a way that interferes with major motor functions and makes it difficult to drive or complete other spatial activities.
Psychological symptoms also present themselves, but are often more difficult to notice unless they are more severe. These types of symptoms include:
- Personality changes
- Inappropriate behavior
In order for the patient to be diagnosed with dementia, at least two areas of either cognitive or psychological impairment must be affected.
There is no one test to determine if someone has dementia. Instead, a doctor will test memory performance and cognitive health using standard questions and tasks. This gives the doctor a look at how the person is functioning and what might be going on inside the brain. The first part of the test involves asking a set of ten questions. The questions are basic information and the patient will be given a score based on their answers. Some of these questions include:
- What is your age?
- What is the time, to the nearest hour?
- What is the year?
- What is your date of birth?
The second part of the test involves asking the family member or caregiver close to the patient about their recent actions. Some of the questions they are asked may include:
- Has the patient been less able to remember recent events or conversations?
- Has the patient been struggling to find the right words or using inappropriate ones?
- Has the patient found difficulty managing money or medications?
- Has the patient needed more help with transport without injury?
If these basic questions seem conclusive, the physical may follow-up with more detailed questions, blood tests, and even CT scans to focus on what type of dementia is present and if it can be reversed.
What Causes Dementia?
The cause of dementia is a bit of a chicken and the egg scenario. It is unclear if dementia causes brain cell death, or brain cell death causes dementia. Either way, the symptoms are caused by damage to, or complete loss of nerve cells and their connections in the brain. This is similar to what happens to patients with a head injury, stroke, or a brain tumor.
Dementia can also be caused by other factors including:
- Prion diseases – for instance, CJD (Creutzfeldt-Jakob disease).
- Frontotemporal dementia also known as Pick’s disease.
- HIV infection – how the virus damages brain cells is not certain, but it is known to occur.
- Normal pressure hydrocephalus
- Posterior cortical atrophy
- Down syndrome, which increases the likelihood of young-onset Alzheimer’s.
- Certain reversible factors including medication interactions, depression, vitamin deficiencies, and thyroid abnormalities.
Different Types of Dementia
There are several types of dementia. Most know of Alzheimer’s but the other types of dementia are less well-known. The type of dementia is important to understand how the patient’s brain is reacting and how to care for them.
The five main types of dementia include:
- Alzheimer’s Disease: This is characterized by “plaques” between the dying cells in the brain and “tangles” within the cells (both are due to protein abnormalities). When you see an Alzheimer’s brain, it has noticeably less nerve cells and connections and is considerably shrunken in size overall.
- Vascular Dementia: This second most common type of dementia. It is caused by damage to the vessels that supply blood to the brain. This type affects problem-solving, focus and organization before any noticeable memory loss.
- Dementia with Lewy bodies: This neurodegenerative condition is linked to abnormal structures in the brain involving a specific protein called alpha-synuclein.
- Parkinson’s Disease: While it is generally considered a disorder of movement, Parkinson’s is a disease in the dementia family. It is marked by the presence of Lewy bodies causing dementia symptoms.
- Frontotemporal Dementia: This is characterized by the breakdown of nerve cells and their connections area of the brain that manages personality, behavior and language. In this case, the memory of the individual may remain intact while their personality, thinking, judgment, and language may change completely.
Some individuals may be diagnosed with mixed dementia. This occurs when there are two or three types occurring together. For instance, a person may show both Alzheimer’s disease and vascular dementia at the same time.
When you notice that mom got lost at the same grocery store she’s used for 45 years, or dad suddenly forgets to pay the bills, these are the earliest signs of dementia. Once dementia progresses, there are three main stages for most patients:
- Early-stage: This is when family members will notice a moderate decline in cognitive abilities. At this stage a doctor can usually detect clear problems during a basic interview and exam.
- Mid-stage: This is when dementia starts to impair daily living and patients need help with activities like bathing, dressing, and preparing meals.
- Late-stage: In this phase there is a severe decline in cognitive function. Generally, the patient has no ability to speak, walk, or eat on their own.
These general stages are broken down further into 7 small stages known as the Global Deterioration Scale (GDS). This scale helps both medical professionals as well as family members and caregivers to understand the progression of dementia and Alzheimers.
Stage 1: No cognitive decline
- No dementia diagnosis
- Includes anyone who has no mental impairment and functions normally.
Stage 2: Very Mild Cognitive Decline
- No dementia diagnosis
- This is the part of forgetfulness that is normal to all aging adults. It’s simply losing names of old associates or forgetting where you left your wallet. No other symptoms are present and there’s no other clear indicators of decline.
Stage 3: Mild Cognitive Decline
- Diagnosed as Mild Cognitive Decline
- At this stage there is still no official diagnosis, but the forgetfulness begins to increase and the individual finds it harder to concentrate or continue working as they used to. This is when they may get lost in a familiar area or have difficulty finding the right words to use. This is usually when loved ones start to notice a few signs here and there.
- Some patients may stay at this phase for between 2 to 7 years before progressing into the next stage of decline.
Stage 4: Moderate Cognitive Decline
- Diagnosed as Moderate Cognitive Dementia
- This includes increased difficulty concentrating, decreased memory of recent events, difficulty managing money of completing complex task. This is usually when patients are still in complete denial of their symptoms and start to withdraw because they may realize things are becoming more difficult.
- Generally, this stage is about two years before the disease progresses.
Stage 5: Moderately Severe Cognitive Decline
- Diagnosed with Moderately Severe Cognitive Dementia
- Memory loss becomes more prominent and they may forget major relevant aspects of their current life, like their address or phone number. Some will maintain memories of their early life, but only small snippets. In this stage, speech may severely decline and personality changes are clearly evident.
- This is a relatively short phase, usually 18 months or less before moving into stage 6.
Stage 6: Severe Cognitive Decline, Mid-stage Dementia
- Diagnosed with Severe Cognitive Decline
- In this stage, patients require daily care for basic activities. They are now forgetting names of close family members and short term memory is basically eliminated completely. In this stage the patient becomes more childlike and may have a problem with basic skills like counting to 10 and incontinence may set in. The ability to speak begins to decline while delusions, emotional changes, compulsions, anxiety, and agitation may be more present.
- At this point, patients are usually in a long-term care facility and may continue to live there for a few years before Stage 7 sets in.
Stage 7: Very Severe Cognitive Decline, Late-stage Dementia
- Diagnosed as Very Severe Cognitive Decline or Late Dementia
- In this final stage of dementia, patients require round the clock care. They are unable to complete any basic task on their own and often lose the ability to use the toilet, eat, or walk on their own. They generally have no ability to speak or communicate at all.
- Once in stage 7, patients usually live no more than 2 years.
How To Prevent Dementia
There is no effective known treatment for dementia. However, we know more about the brain than ever before. Today we know what affects brain function and brain aging and how our nutrition, inflammation, toxins, stress, exercise, hormones and genetics play into that process. With the information we have today, we have a better understanding of steps we can take to reduce our chances of experiencing dementia symptoms. These include:
- Balance your blood sugar with whole foods and a low glycemic diet.
- Exercise daily — even a 30-minute walk can help.
- Deeply relax daily with yoga, meditation, biofeedback, or just deep breathing.
- Take a multivitamin and mineral supplement.
- Take an omega-3 fat supplement.
- Take extra vitamin B6, B12, and folate.
- Take vitamin D.
- Treat thyroid or low sex hormones.
- Get rid of mercury through a medical detoxification program.
- Stop smoking.
Difference Between Dementia and Alzheimer’s
Dementia and Alzheimer’s are not the same thing. Dementia is an overall term used to describe symptoms that impact memory, daily activities, and communication. Alzheimer’s is a progressive and diagnosable disease and is the most common type of dementia in adults. Alzheimer’s disease gets worse with time and affects memory, language, and thought. Between 60 and 80 percent of dementia patients develop Alzheimer’s disease.
How To Deal With People With Dementia
People who have dementia lose some ability to reason and communicate. As the disease progresses it affects their personality, reasoning, and social skills. This can make it challenging to talk to your aging loved one or ask them to do something.
For example, you ask your loved one to take a shower and they won’t, the best thing you can do is not to argue with them. They don’t have the ability to reason or argue, so getting upset and yelling will only make the situation worse. Instead, try asking them in a different way and if they still refuse, then it’s best to leave it alone and try again later.
Communication and bonding with someone who has dementia can be challenging or awkward if you don’t know how to engage with them. To better communicate, try these tips:
- If you don’t know what the person is asking for, ask them to point or show you what they want.
- Use short, simple words and sentences when communicating.
- Don’t use negatives; instead of saying “Don’t go there” say “Let’s go over here”
- Try these activities to spend quality time with your loved one.
- Go through old photos or memorabilia
- Watch an older movie with them
- Take them to low stress activities like a zoo, aquarium, museum
Take It One Day At A Time
Treatment of dementia depends on its cause and most often the outlook is not optimistic. It’s a long road for both the patient and the caregiver. The most important thing to realize is that you and your loved one are not alone with Dementia. There are resources and help available to assist during this process.
As a Certified Dementia Care Practitioner, Patti Naiser is able to provide advice on how to communicate and handle someone with Dementia. If you need help finding a Memory Care community, Patti can help you with that too. You don’t have to go at this alone. Give Patti a call today.