Stages & Symptons of Dementia

Globally, there are about 47.5 million who suffer from dementia, and every four seconds, there is a new patient that gets diagnosed with dementia. While it is mainly associated with older people, it’s not a normal part of ageing.

But what exactly is dementia? Dementia can’t be described as any specific disease. It is an overall term that is used to describe different symptoms that are linked with a cognitive decline or decline in memory such as forgetfulness.

An analysis that was done after the most recent census in 2010 in the United States estimates that there are about 4.7 million people that are aged 65 years and above that have the Alzheimer’s disease. In fact, it is estimated that Alzheimer’s accounts for about 60 to 80 percent of all dementia cases by the Alzheimer’s Association. The association also goes ahead to say that more than a tenth of people who are 65 years or more have the Alzheimer’s disease with the proportion increasing to almost a third of people who are aged 85 years and over. There is a great range books on this subject and we have reviewed some of the best here.

In
this article, we will discuss the possible causes of dementia, the different
types of dementia, any treatments that are available and whether dementia
symptoms get affected by the seasons of the year.

Symptoms of Dementia

There
are certain symptoms that can help doctors or physicians diagnose a patient
with dementia. While some patients may notice some of the symptoms themselves,
there are cases where the healthcare worker or caregiver may be the one that
notices the symptoms. A person suffering from dementia may exhibit any of the
symptoms below. This is usually as a result of memory loss. The symptoms listed
below have been compiled by the American Academy of Family Physicians in their
journal known as American Family Physician. 

  • Loss of recent memory which means that you might ask the same question repeatedly
  • Difficulty in completing a task that is familiar and easy such as preparing a meal or making a drink
  • Problems when communicating – they find their language difficulties and may forget simple words or end up using the wrong ones
  • Disorientation which may result in them getting lost even when walking in a street that was previously familiar
  • Difficulty with abstract thinking such as dealing with money
  • Loss of initiative where a person becomes less interested in going somewhere or starting something
  • Sudden mood changes that lead to unexplained changes in one’s disposition or outlook
  • Easily misplacing things and forgetting where they place their everyday items such as wallets or keys or any other item that they use on a daily basis
  • You may witness personality changes where a person becomes easily irritable, fearful or suspicious of people around them even if they are family

Studies have shown that as the patients continue to age, the symptoms of late-stage dementia tend to get worse.

Stages of Dementia

The
stages of dementia can roughly be split into four different stages namely mild
cognitive impairment, mild dementia, moderate dementia, and severe dementia.
Below is a description of each stage:

  • Mild Cognitive Impairment

This
stage of dementia is usually characterized by overall forgetfulness. While it
affects a lot of people as they age, it only ends up progressing to dementia
only for some people.

  • Mild Dementia

From
the name, people who get diagnosed and live with mild dementia tend to
experience cognitive impairments that sometimes impacts their day to day life.
Patients with mild dementia may exhibit symptoms such as memory loss,
personality changes, confusion, and difficulty in planning, getting lost and
difficulty in carrying out tasks.

  • Moderate Dementia

People
living with moderate dementia may find their daily life more challenging, and
patients may need a little more help. While the symptoms are similar to those
of mild dementia, the only difference in moderate dementia is that they are
increased. Patients may need help getting simple tasks such as combing the hair
or dressing done. They may experience sleep disturbances and show a lot of
changes in their personality by becoming easily agitated and suspicious.

  • Severe Dementia

By
the time one gets diagnosed with severe dementia, it means that the symptoms
have worsened. Those suffering from severe dementia may not only lose their
ability to communicate, but they will also need round the clock care. Simple
tasks like holding their head up or sitting end up being impossible and they
may also lose their bladder control.


Type of Dementia

There
are various type of dementia such as:

  • Alzheimer’s Disease

In
the case of the Alzheimer’s disease, a person’s brain usually has fewer nerve
connections and cells which results in the shrinking of the total brain size.
It is normally associated with protein abnormalities in the brain.

  • Dementia with Lewy Bodies

This
is a neurodegenerative condition that is associated with abnormal structures
found in the brain. The changes by the brain involve the alpha-synuclein
protein.

  • Mixed Dementia

This
refers to the diagnosis of two or three types of dementia that occur together.
For example, a patient may show both vascular dementia and Alzheimer’s disease
at the same time.

  • Parkinson’s Disease

While
it is identified by the presence of Lewy bodies, it is also largely considered
as a movement disorder that can eventually lead to symptoms of dementia.

  • Huntington’s Disease

It
includes dementia, but distinct types of uncontrolled movements also
characterize it.

There
are also other disorders that are known to lead to dementia symptoms such as:

  • Frontotemporal dementia also referred to as Pick’s disease
  • Normal pressure hydrocephalus which occurs when there is an excess accumulation of cerebrospinal fluid in the brain
  • Posterior cortical atrophy which is similar to changes exhibited in Alzheimer’s disease only that they are if a different part of the brain
  • Down syndrome which increases the possibility of young-onset Alzheimer’s

Early Signs of Dementia

Some
of the early signs of dementia include:

  • Mood changes
  • Difficulty finding the right words to use
  • Short-term memory changes
  • Confusion
  • Being repetitive
  • Apathy
  • Difficulty in following a storyline and in completing everyday tasks
  • Difficulty getting used to changes
  • Poor sense of direction

Causes of Dementia

The
main cause of dementia is death of the brain cell. Besides that,
neurodegenerative disease that leads to the death of the brain cells overtime
is also linked with most cases of dementia. However, doctors have not yet been
able to establish whether dementia itself leads to brain cell death of whether
brain cell death leads to dementia. Apart from brain cell death, other causes
of dementia include stroke, brain tumor or a head injury among other causes.

Vascular
dementia also known as multi-infarct dementia prevents the normal flow of blood
which deprives the brain cells of oxygen leading to brain cell death. It is
caused by conditions like cerebrovascular disease, for instance, stroke.

Injuries
can also cause post-traumatic dementia which is directly linked to brain cell
death as a result of an injury. There are certain types of traumatic brain
injury especially the repetitive ones that most sport players get, are known to
cause dementia later in life. There is little to no evidence however that a
single brain injury increases the likelihood of one having a degenerative
dementia like Alzheimer’s disease.

Other
known cause of dementia includes Prion diseases like CJD, HIV infection where
the virus destroys the brain cells (although the exact way it does this isn’t
known) and reversible factors such as treating dementia by reversing the
effects of the underlying causes.

Diagnosing Dementia

In
most cases, doctors will usually start by asking the patient standard questions
and tasks which will help in testing cognitive health and memory performance.
According to researchers, it’s not possible to fully diagnose dementia without
using the below standard tests, fully completing them and recording all the
answers. However, there are other factors that need to be considered when
diagnosing for dementia.

  • Cognitive Dementia Tests

Today,
the cognitive dementia tests are used widely and have been recognized as a
reliable method of determining dementia. Of course, they have changed a bit
since they were first established in early 1970s. The abbreviated mental test
score has about ten questions such as what is your age? What is the year? What
is the time, to the nearest hour? What is your date of birth? Each question
that is answered correctly scores a point. If the patient scores six or less
points, it suggests cognitive impairment.

  • General Practitioner Assessment of Cognition (GPCOG) Test

This
test usually has another element where the observations of caregivers and
relatives is recorded. The test is mainly designed for doctors and happens to
be the first formal assessment of a patient’s mental ability. The second part
of the test usually probes someone who is close to the patient and has six
questions used to determine whether the patient has:

  • Become less able to recall recent conversations or event
  • Started using inappropriate words or struggles to find the right ones
  • Struggling to manage medications or money
  • Needs more help with transport (reason shouldn’t be injury related)

If the results suggest memory loss, the doctor will recommend a standard investigation which will include a routine blood test as well as a brain CT scan. Clinical tests will be used to identify or rule out the treatable causes of memory loss and aid in narrowing down potential causes like Alzheimer’s disease.

 The Mini-Mental State Examination (MMSE)

This
is a cognitive test that is used to measure:

  • Word
    recall
  • Attention
    and calculation
  • Orientation
    to place and time
  • Language
    abilities
  • Visuospatial
    skills

The MMSE is usually used in diagnosing dementia that’s caused by Alzheimer’s disease as well as rate how severe it is and whether there is a need for drug treatment.

Treating Dementia

Unfortunately,
there is no possible way to reverse brain cell death. That means that there is
no known cure for treating degenerative dementia. Disorders such as Alzheimer’s
disease can be managed by treating the symptoms and providing care rather than
trying to treat the underlying cause. In the event that a reversible,
non-degenerative cause causes symptoms of dementia, treatment may be possible.
In this case, the treatment will be used to halt or prevent further brain
tissue damage. Examples include medication effects, vitamin deficiency, and
injury.

There
are some medications that can be used to reduce the symptoms of Alzheimer’s
disease. In the United States, there are four drugs known as cholinesterase
inhibitors that have been approved for use. These include drugs are known as
donepezil (brand name Aricept), galantamine (Reminyl), rivastigmine (Exelon)
and tacrine (Cognex). Memantine (Namenda) is an NMDA receptor antagonist that
can also be used by itself or with a combination of cholinesterase inhibitor.

Cholinesterase inhibitors can also come in handy in the behavioural elements of Parkinson’s disease. Besides treatment using drugs, there are other quality of life care that can be used such as “brain training” which may help boost cognitive functioning as well as aid with forgetfulness in the early stages of Alzheimer’s disease. It may involve using mnemonics and other memory aids like computerized recall devices.

Dementia Prevention

Although
certain risk factors are linked with dementia, age is tone of the biggest
predictor. Other known risk factors include:

  • Alcohol use and smoking
  • Atherosclerosis which is a cardiovascular disease that causes the arteries to become narrow
  • High levels of “bad” cholesterol
  • Above average homocysteine blood levels
  • Diabetes
  • Mild cognitive impairment which can sometimes lead to dementia

In Which Season does Symptoms of
Dementia Worsen?

A
recent study showed that seasons have a significant impact on cognition when it
comes to older adults. The study revealed that there is usually a significant
drop in mental ability during winter. It is already known that the four seasons
hold some sort of power over our brains in the form of what is famously known
as seasonal affective disorder. It is a type of depression that happens during
the winter months.

As
such, there have been studies that have shown that the winter is the season
when there is an onset of schizophrenia while other studies have shown seasonal
variation in attention and memory performance. A recent research study by
researchers from the University of Toronto and Sunnybrook Health Sciences
Centre in Canada tried establishing whether the Alzheimer’s disease has a
seasonal component to it. Establishing whether symptoms fluctuate within the
year could be vital for both the diagnosis and management of the disease.

The
scientists used data from 3,353 elderly people in the Canada, France and the
United States. While there are participants who had already been diagnosed,
others had not been diagnosed. All the participants underwent
neuropsychological testing which involved 19 cognitive tests while there was a
subgroup of participants that was tested for protein levels associated with
Alzheimer’s. An analysis of the data showed that the average cognitive
functioning was much better during summer and fall than in spring and winter.
In fact, the difference calculated was the equal to 4.8 years of normal
cognitive decline.

What
this meant was that during winter and spring, it was more likely for the
participants to meet the given criteria for cognitive impairment or dementia
that it was during summer or winter. There was a 31 percent chance during cold
months that the participants would fall into the diagnosis bracket. While the
researchers also considered a range of factors such as depressive symptoms,
level of physical activity, thyroid health and sleep quality that might
influence the results, the effects remained statistically significant.

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