Dementia 101: Types, Symptoms, Stages, Early Signs & More
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Dementia 101: Types, Symptoms, Stages, Early Signs & More
According to the World Health Organization (WHO), 55 million people had dementia in 2021, with a yearly incidence rate of approximately 10 million new cases each year. At the moment, dementia is the seventh leading cause of death and one of the major causes of disability and dependence among older people in the world. Women are more affected, accounting for 65% of dementia cases worldwide.
In America, according to the 2024 National Health Statistics Report on Dementia Among Adults aged 65+, the estimated number of people with dementia is about 10% with a higher prevalence typically found in nursing homes and residential care communities. Dementia is a debilitating disease that can develop silently for years, causing significant damage to the brain long before noticeable symptoms appear or timely intervention is possible.
In this article, we will explore what dementia is, how it differs from normal aging, its types, symptoms, stages, causes, treatment options, and practical strategies to support patients and caregivers.
What Is Dementia and How Is It Different from Normal Aging?
A 2024 article by the Centers for Disease Control and Prevention (CDC) reports that dementia is not a specific disease but rather a group of diseases affecting cognitive abilities, interfering with one’s daily life.
Dementia often occurs as a result of damage to the brain from injury or a disease. Its symptoms involve a progressive decline in cognitive function, thinking, and behavior. This is often associated with a disturbed emotional state, difficulty with language, and decreased motivation to get things done. Sadly, it is a disease that worsens over time.
Although dementia is often associated with old age, it is not the same thing as normal, age-related memory decline. Biologically, as we age, we experience changes in our bodies, which are often accompanied by a decrease in both physical and mental abilities. However, the striking differences between dementia and a decline in memory as a result of age are based on the severity and progressive nature of cognitive impairment.
People with normal aging can sometimes make poor decisions, miss their steps, forget the day of the month or year it is, and remember later, or misplace items, but eventually retrace their steps to find them. In contrast, people with dementia often struggle to recognize these mistakes, cannot resolve them without help, and may become confused and distressed because they are unable to navigate their way out of the situation.
Common Types of Dementia and How They Differ
There are different types of dementia, with Alzheimer’s disease being the most common. While all dementias share core features such as progressive cognitive decline, they differ in their symptoms, underlying biomarkers, severity, and the specific brain regions affected. Some types of dementia include: Alzheimer’s disease, Frontotemporal disorder (FTD), Lewy body dementia, and vascular dementia.
Early Signs and Symptoms of Dementia to Watch For
Early signs of dementia may be hidden within the brain for years before noticeable changes appear. However, there are key warning signals that should not be ignored. They include:
- Difficulty remembering things
- Repeating questions
- Wandering and getting lost in a familiar environment
- Taking a longer time to accomplish normal daily tasks
- Losing interest in things
Other symptoms include difficulty understanding and expressing oneself, difficulty with speech, experiencing memory loss, poor judgment, confusion, emotional instability, etc. These signs and symptoms can vary from person to person, and also depending on the type of dementia.
How Dementia Progresses: Stages and What to Expect
All forms of dementia are progressive in nature. Progressive dementia often begins with mild, manageable symptoms but gradually worsens over time, eventually leaving individuals heavily dependent on others to carry out their daily activities. The dementia stages are broadly classified into early, middle, and late. They are described below.
Early-stage dementia
Early-stage dementia typically affects specific brain regions involved in memory and reasoning, which later expand as the disease progresses. Symptoms at this stage are usually fewer and milder, and one can still go about their daily life without much assistance.
Middle-stage dementia
More assistance is needed to carry out daily activities in this stage, and it is often the longest stage of dementia. Basically, all the symptoms in the early stage of dementia get worse at this stage, and some people may develop hallucinations or delusions depending on the type of dementia. These changes could explain why a person may find it difficult to manage their emotions. They might become upset, fearful, or get angry very easily, and also shift between these emotions very easily. This could stem from a loss of independence, misunderstanding their environment, or frustration over not being able to communicate their needs.
Late-stage dementia
Dependence becomes total in this stage of dementia. One will often need assistance in carrying out simple tasks such as tying their shoelaces, eating, washing, and dressing. This stage of dementia is usually the shortest, typically lasting between one and two years. At this stage, a person may lose the ability to recognize familiar places, objects, and even loved ones.
In some cases, they may not recognize themselves in the mirror. Speech becomes severely impaired, with difficulty forming sentences or even a complete loss of verbal ability, leading them to rely on non-verbal communication. Emotional changes such as depression and apathy are common, while behaviors like aggression and restlessness may also recur as the person often feels scared, threatened, or confused.
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Cognitive, Emotional, and Behavioral Changes in Dementia
The changes in emotion, cognition, and behavior aren’t surprising in dementia because, as dementia progresses, the brain shrinks and centers of the brain that directly influence these aspects of our life are directly affected. For example, the cerebral cortex, which is responsible for cognitive functions in our brain, is affected in dementia. Common examples of cognitive, emotional, and behavioral changes affected by dementia include:
Cognitive changes in dementia
- Harder to focus or pay attention.
- Loss of memory.
- Loss of previously learnt information and skills.
- Poor decision-making and choices.
- Difficulty in managing daily routines and planning.
- Poor risk assessment.
- Misinterpreting sounds, sights, or environments.
- Difficulty understanding spoken or written language.
- Word-finding problems, reduced vocabulary, or inability to form coherent sentences.
- Trouble judging distances, recognizing faces or objects, or navigating familiar places.
Emotional changes in dementia
- Increased irritability and anger;
- Depression or low mood;
- Mood swings;
- Loss of emotional control;
- Apathy or emotional flatness;
- Paranoia;
- Heightened anxiety and fear;
Behavioral changes in dementia
- Social withdrawal;
- Erratic sleep cycle;
- Aggressiveness;
- Losing inhibition;
- Repetitive behavior;
- Sundowning;
- Hiding, hoarding, and losing things.
These cognitive, emotional, or behavioral changes often overlap and vary with the type and stage of dementia. Understanding them not only helps explain the challenges people face but also guides families and caregivers in providing better support.
What Causes Dementia? Key Biological and Environmental Factors
The cause of dementia is multifactorial. It is the result of an interplay of various factors such as age, genetics, lifestyle, and other medical conditions. However, our focus in this article is on the biological and environmental factors that can cause dementia.
The biological causes of dementia are diverse and complex. Neurodegeneration plays a major role, often linked to abnormal protein buildup such as tau, amyloid, and Lewy bodies. Neurodegenerative diseases like Huntington’s and Parkinson’s disease can also contribute to its development. Vascular damage is another significant factor, as seen in vascular dementia, where reduced blood flow from stroke, atherosclerosis, or chronic hypertension leads to cognitive decline. Infection and immune-related damage are equally important.
Some of them, like HIV, syphilis, Lyme disease, or prion disease, are capable of damaging brain tissues and triggering dementia-like symptoms. Genetic factors further influence risk, as some forms of dementia are associated with genetic alterations, and mutations in certain genes can directly lead to dementia.
Environmental factors can also play a role in the development of dementia. Prolonged exposure to toxins, such as heavy metals like lead and mercury, has been associated with brain damage that may increase dementia risk. Chronic alcohol use is another well-known contributor, as it can impair brain function and eventually cause alcohol-related dementia. In addition, traumatic brain injuries, whether from accidents or repeated impacts in contact sports, can damage brain tissues over time, raising the likelihood of developing dementia later in life.
Risk Factors That Increase the Likelihood of Developing Dementia
Age is the strongest risk factor for dementia, and it is expected to drive a major rise in cases over the coming decades. However, other factors increase your risk of dementia, while some of them are modifiable, others are not. Apart from age, other risk factors include hypertension, stroke, excessive alcohol use, atherosclerosis, diabetes, Down syndrome, genetics, head injuries, Parkinson’s disease, and smoking.
How Dementia Is Diagnosed and Monitored Over Time
Since dementia isn’t the only condition that causes cognitive decline, doctors often begin with a differential diagnosis by assessing other diseases that might cause cognitive difficulties and possibly treat them. They can then proceed by checking the vital signs of the patient and possibly call for laboratory tests to check for various chemicals, vitamins, and hormones, which can help uncover or rule out possible causes of symptoms.
Dementia evaluation often includes a thorough medical and family history, which can provide important insights about a person’s risk of developing the condition. Additionally, tests such as cognitive and neurological assessments, brain imaging, psychiatric evaluation, and blood work may be used to help confirm the diagnosis, rule out other causes, and, when repeated over time, monitor disease progression and guide intervention at each stage.
Can Dementia Be Prevented or Delayed?
Dementia cannot be completely prevented because some causes are beyond one’s control. However, dementia prevention is possible to some extent by adopting healthier lifestyle habits. These include not smoking, limiting alcohol intake, eating a balanced diet rich in brain-friendly nutrients such as omega-3 fatty acids, antioxidants, controlling blood pressure, minimizing exposure to environmental toxins, staying physically active, and maintaining strong social connections.
Evidence-Based Lifestyle Strategies to Support Brain Health
It is widely accepted that people with stronger mental well-being often experience better brain health. But what lifestyle choices set them apart and contribute to this advantage? Let’s explore some of them.
- Social connectedness: It has been proven that those with a better social network have better mental and brain health than those who don’t.
- Exercise: Regular exercise can increase blood flow to the brain and is associated with growth of new neuronal connections and improved hippocampal function;, a part of the brain responsible for memory and learning.
- Cognitive stimulating activities: mind-teaser games, educational activities, intellectual inquisition, and mental challenges have been shown to maintain the volume of certain brain regions even at old age, thereby strengthening cognitive reserves.
- Good sleep: To maintain healthy brain health, scientists suggest that adults need between 7 and 8 hours of sleep every night.
- Healthy food: Scientists have suggested the adoption of the Mediterranean diet, DASH diet, Okinawan diet, and Nordic diet. These diet types emphasize plant-based foods, encourage healthy fats, minimal processed foods, lean proteins, and reduce sodium intake.
In summary, adopting simple but evidence-based lifestyle habits – staying socially connected, exercising regularly, keeping your mind engaged, sleeping well, and eating a balanced diet can go a long way in protecting your brain health. Promoting dementia awareness alongside these habits is key, as it empowers people to take steps that may lower their risk of cognitive decline.
Treatment Options for Managing Dementia Symptoms
Dementia treatment aims to manage symptoms, maintain quality of life, and, where possible, slow down disease progression since there is currently no cure.
To improve cognitive function, FDA-approved Alzheimer’s medications include donepezil, galantamine, and rivastigmine. These medications, collectively known as cholinesterase inhibitors, work by slowing down the metabolism of acetylcholine, a neurotransmitter essential for memory and learning. They are primarily used in the treatment and management of mild to moderate Alzheimer’s disease..
Memantine is another FDA-approved drug used for managing moderate to severe Alzheimer’s. . It works by modulating the activities of glutamate, an important neurotransmitter for learning and memory.
It is well established that the symptoms of dementia go beyond memory. Antipsychotics such as haloperidol and risperidone, may be prescribed for behavioral symptoms but carry significant safety risk and only for shorter-term due to increased strong and death risk in older adults. However, less risky, antidepressants can be prescribed and often supportive as well.
Additionally, non-drug approaches can be incorporated into the overall management plan. These include: supportive care, memory training, physical exercise programs, mental and social stimulation, etc. While current treatments help manage symptoms, ongoing clinical trials on dementia research are exploring new therapies that may offer greater hope to dementia patients.
Support Resources for Caregivers and Families Affected by Dementia
Caring for someone with dementia can be overwhelming, often to the point where caregivers neglect their own needs. If you find yourself in this situation, you can tune in to various forms of dementia care, dementia support, and trusted dementia resources. These avenues of dementia can ease your stress and guide the way. Some of the resources include:
- Home care services
- Adult care services
- Respite services, which provide short-term service for people dementia
- Assisted living facilities provide help for people who need help with their daily care
Other resources include palliative and hospice care, nursing homes with memory care units, and federal and state government support for people living with such conditions. Outsourcing some of these duties as a caregiver or a family member to someone with dementia would help you create time to rest and plan for other aspects of your life.
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Frequently Asked Questions
What are the early signs of dementia, and how can I differentiate them from normal age-related changes?
Early signs of dementia often include persistent memory loss, confusion, difficulty with language, or changes in mood and daily functioning, whereas normal aging usually involves mild forgetfulness that doesn’t disrupt everyday life.
How can I effectively communicate with a loved one diagnosed with dementia, especially when they struggle to understand or respond?
Speak slowly, use short sentences, maintain eye contact, and be patient. Use touch and reassuring tones when they struggle to understand or respond.
What practical steps can I take to create a safe and supportive environment for someone with dementia at home?
You can create a safe and supportive home by removing tripping hazards, labeling rooms or items for easier navigation, and keeping a consistent daily routine. In addition, ensure good lighting, lock away harmful substances and objects, but provide familiar objects that offer comfort and orientation.
How can I manage my own emotional and physical well-being while caring for someone with dementia, especially if I feel overwhelmed or stressed?
When caring for someone with dementia, it is important to take regular breaks, ask for professional respite, and maintain your own healthy routines (sleep, exercise, nutrition).
How do I approach difficult conversations about end-of-life care and advance directives with someone who has dementia?
Though not an easy conversation, it’s usually best to include a trusted family member or healthcare professional to guide the conversation.
REFERENCES
Diagnosed dementia in adults aged 65 and above, United States 2022
The difference between normal aging and dementia
Memory Problems, Forgetfulness, and Aging
Brain anatomy and how the brain works
What Is Dementia? Symptoms, Types, and Diagnosis
The progression, signs, and stages of dementia
Dementia symptoms and areas of the brain
Hippocampus and its involvement in Alzheimer’s disease: a review
The emotional impact of a dementia diagnosis
How does dementia change a person’s behavior
Major neurocognitive disorders
What Is Dementia? Symptoms, Types, and Diagnosis
Effects of Omega-3 Polyunsaturated Fatty Acids on Brain Functions: A Systematic Review
Lifestyle choices and brain health
On the relationship between the social brain, social connectedness, and well being
Working out boosts brain health
What are the treatments for dementia
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