The Ultimate Guide to Dementia

In the early stages of dementia, a person can still perform most of their daily tasks independently. However, prompt intervention yields the best outcomes for seniors as the disease progresses. Annual check-ups with a primary care physician become increasingly important with age. At these appointments, doctors do basic memory screenings that identify dementia in its early stages. If memory lapses are noted during this appointment, the doctor may recommend neuroimaging, such as CT scans and MRIs and cerebrospinal fluid (CSF) biomarker tests which helps diagnose dementia before the onset of life-alerting symptoms. This early detection allows seniors to gain information, plan healthcare strategies, and come to terms with their diagnosis before a significant cognitive decline occurs.

As of 2023, nearly 6.7 million Americans are affected by Alzheimer's disease, which represents 60-80% of all dementia cases. Symptoms vary from person to person during the early stages of Alzheimer's. Some older adults misplace household items, while others forget recent conversations and events. Those with Alzheimer's may become less flexible with change or demonstrate poor judgment in decision-making. While these symptoms can be alarming, early recognition improves outcomes and quality of life, according to a recent study. This study suggests that interventions such as therapy can significantly slow the disease's progression.

While there are many types of dementia, most exhibit similar symptoms. The most common symptoms affect memory and include short-term memory loss, increased confusion, and the inability to remember conversations. As dementia progresses, however, symptoms increase and affect most areas of life. Those with Alzheimer's may become confused or lose the ability to concentrate on a task. Many people experience personality changes. In general, psychologists note an increase in depression, anxiety, and apathy in patients with dementia. As the disease progresses further, some people may experience vivid hallucinations or exhibit inappropriate behavior.

There are four main types of dementia—Alzheimer's, Lewy Body dementia, Pick's Disease (Frontotemporal Dementia), and vascular dementia. As noted, most symptoms overlap between these conditions, but there are a few notable differences.

• Alzheimer's, the most commonly diagnosed and recognized form of dementia, exhibits the classic symptoms of memory decline and wandering.
• Pick's disease presents with more emotional, language, and behavioral symptoms rather than memory decline than other types,
• Lewy Body Dementia is associated with sleep problems, motor symptoms that mimic Parkinson's disease and cognitive disorganization. Vascular dementia, caused by blood clots or disrupted cranial blood flow, affects judgment, decision-making, and the ability to learn new information

Although the exact cause of Alzheimer's is unknown, several risk factors increase the likelihood that someone will develop the condition. The most significant risk factor for developing Alzheimer's disease is simply age. Most people receive an Alzheimer's diagnosis at 65 or older, and after age 65, the risk for the condition doubles every five years. Alzheimer's also tends to run in families, and a combination of genetics and environmental factors are believed to play important roles in the development of this condition. Perhaps surprisingly, scientists discovered a —research suggests a significant correlation between clinically diagnosed depression and later development of Alzheimer's. Other risk factors include significant head injuries, diabetes, high blood pressure, and heart disease.

While research concerning Alzheimer's disease is ongoing, most studies suggest that the condition is caused by a combination of factors. Age-related brain changes, genetics, environmental factors, and lifestyle habits contribute to the development of the disease. Scientists posit that age, alongside these other factors, contributes to the atrophy and inflammation of neurons and the loss of their connections.

Lewy Body dementia causes some symptoms distinct from other forms of dementia. While similar memory loss and confusion occur, this form of dementia is well-known for visual hallucinations, insomnia, and illogical ideas. Hallucinations appear early on during the condition and can lead to paranoia or other psychological disruptions. At first, memory difficulties may not be as noticeable as in Alzheimer's disease; however, as Lewy Body dementia progresses, these difficulties become more apparent and often disrupt daily life. The condition also causes significant changes in movement. Some noticeable movement difficulties may include rigidity, tremors, loss of coordination, and difficulty swallowing.

Doctors use several diagnostic techniques to differentiate between Alzheimer's and Lewy Body Dementia. However, the unique symptoms between the two conditions are often good indications for disease diagnosis. Those who present moderate memory concerns paired with visual hallucinations, sleep disorders, and movement difficulties receive a Lewy Body diagnosis. People who express trouble with memory, wandering, and facial recognition are more likely to receive an Alzheimer's confirmation. These symptom-based assessments yield helpful results, but the most accurate diagnoses come from neuroimaging or bloodwork.

Pick's disease results when tau proteins accumulate within neurons in the frontal or temporal lobes of the brain. While this condition can affect memory, most people note a significant behavioral or personality change within the diagnosed individual. Some people with Pick's disease have difficulty planning or carrying out a task, while others with the condition experience an inability to control impulsive behaviors. These behaviors may be violent or socially inappropriate, depending on disease progression. As the frontal lobes degenerate, the individual loses self-awareness and social dexterity, making their behaviors increasingly erratic and illogical. Excessive emotion or emotional flatness has also been observed in those diagnosed with Pick's disease.

While behavioral and personality changes are hallmarks of Pick's disease, the condition also causes other symptoms. Pick's disease may contribute to primary progressive aphasia, a language disorder where people lose the ability to speak and understand language. In some cases, general intellectual functioning remains preserved, even when language difficulties arise. Additional symptoms of the condition include shaky hands, difficulty walking, and balance problems.

Sundown Syndrome, sometimes called sundowning, occurs in the late afternoon or early evening. Common among people with dementia, sundowing presents as an increase in neuropsychiatric symptoms and includes behaviors like agitation, aggression, and confusion. Scientists have yet to discover exactly why this phenomenon occurs, but some suggest it may be related to circadian rhythmicity and environmental factors.

Managing Sundown Syndrome in dementia populations can be challenging, but researchers have found a few strategies that aid in lessening these behaviors. Bright light therapies and melatonin aid in mild cases of sundowing. However, people with more extreme symptoms may benefit from acetylcholinesterase inhibitors or antipsychotics, which must be prescribed by a medical doctor.

Vascular dementia, the leading nondegenerative cause of dementia, results from blood clots in or reduced blood flow to the brain. While these vascular events (strokes and hemorrhages) commonly occur in elderly adults, vascular dementia is known to affect people of all ages. Cardiovascular risk factors such as hypertension, diabetes, and smoking may increase the risk of developing vascular dementia.

Symptoms of vascular dementia vary depending on where the brain bleed or blood clot occurs. The most common cognitive symptoms of vascular dementia include forgetfulness, trouble following instructions or learning new information, and poor judgment. Occasionally, people may develop tremors or weakness in their extremities. Research suggests that many adults experience concurrent diagnoses of both vascular dementia and Alzheimer's, which makes isolating distinct symptoms for each condition difficult for care providers.

Caring for a loved one with dementia presents a host of unique challenges. Typically, people with mild forms of dementia can still live independently but need regular check-ins and outside medication management. Those with more advanced stages of the disease require live-in support, and many families find that memory care centers offer the best resources for their loved ones. As the condition progresses, people with Alzheimer's will require assistance with personal hygiene and daily tasks, and most need to be supervised to prevent wandering. Research suggests consistent care assignments, predictable daily schedules, and purposeful tasks provide the best outcomes for seniors with dementia.

While there's no fool-proof way to prevent dementia, lifestyle changes may protect against the disease. Some are obvious—staying physically active, eating a healthy diet, controlling hypertension, and maintaining a healthy weight. However, recent research unearthed some less obvious preventative measures. Studies suggest one of the best ways to stave off dementia is through social connection with friends and family through regular gatherings and communicative interactions. Another tip? Get hearing aids. Many seniors lose meaningful connections with loved ones because of an inability to hear. Studies suggest that working hearing aids may reduce cognitive decline for aging adults.

Holistic approaches offer effective, natural solutions to dementia. Easy ways to mitigate dementia risk through holistic methods include dietary changes and increased exercise. However, holistic methods don't end with prevention. Aromatherapy and massage may help reduce agitation and anxiety in seniors with dementia, although more research is required. Light therapy offers hope to those struggling with sundown syndrome, and studies suggest it may help stabilize the disrupted circadian rhythm in people with dementia. While holistic treatment methods provide temporary symptom relief, working with a licensed doctor is important to ensure all care needs are met.

Each stage of dementia presents unique challenges. The earliest stages of dementia may be asymptomatic, but neuroimaging reveals subtle changes that indicate early disease. Mild dementia, characterized by subtle behavior changes, forgetfulness, and difficulty coming up with the right words, can often be managed at home with scaffolding from loved ones. The next stage, moderate dementia, requires more care. People in this stage forget important details about their daily lives, wander, and may develop psychological symptoms such as paranoia. When this happens, people with moderate dementia often require assistance with all personal hygiene tasks and need daily supervision. Late-stage dementia needs around-the-clock care, as people with advanced disease progression lose awareness of their surroundings and experience a significant decline in their physical abilities.

While many use the terms dementia and Alzheimer's disease interchangeably, it is important to remember that dementia refers to a broad range of cognitive diseases and declines. Alzheimer's accounts for 60-80% of all dementia cases in the United States, and the symptoms of forgetfulness and memory loss are easily recognized in the broader culture. While less common, Lewy body dementia, vascular dementia, and Pick's disease all fall into the broader dementia umbrella. These diseases bear their own unique symptoms, and it's important to work with a medical professional when diagnosing cognitive conditions.