WHAT IS DEMENTIA ?

DEMENTIA, simply put, is a group of symptoms associated with a progressive loss of brain functioning. The word “dementia” comes from “de” (without) and “mentia” (mind). 

          

DEMENTIA occurs because of diseases that affect the patient’s brain. Because the brain controls every function of our body, dementia patients have problems doing various tasks of daily life.

Patients may face memory loss, which increases as their dementia progresses. They may find it difficult to balance their bank statements or plan for visitors at home. Sometimes, they forget where they are (which house, which city) or the date and time. They may struggle to find the right words to explain what they want. They may show major personality changes, apathy, and socially inappropriate behaviour. Over time, they become unable to do the normal activities we all take for granted, and could have problems walking, talking, and swallowing food. In the final stage, they become fully dependent and are prone to serious complications such as pneumonia, infection, bedsores, multi-organ failure, and so on.

To people around them–their family, friends, colleagues, neighbours - Dementia Patients look confused and forgetful and/or start behaving strangely, such as withdrawing or getting aggressive or showing disinhibition. Many of these symptoms are often assumed to be part of normal ageing; but dementia is not normal ageing. Sometimes, especially when the patients are young and show behaviour changes (but don’t have memory loss), the symptoms may be mistaken as a psychiatric problem or even ignored as “stubbornness” or “bad character”.

On this page are:

• Examples of dementia symptoms
• The memory loss in dementia is different from normal memory problems we all face
• Dementia is not the same as normal old age
• While older people are more likely to get dementia, people in their 30s, 40s, and 50s can also get dementia
• Memory loss may not be an initial symptom in a person with dementia

Examples of Dementia Symptoms:

Patients may show some or most of the following symptoms (the number and intensity of the symptoms increases as dementia progresses):

• Forgetting important things, especially recent things
• Finding it difficult to plan events or solve problems                                                                 
• Normal, daily activities seem more difficult to do                                                       
• Wearing wrong / inappropriate clothes, or becoming untidy
• Getting confused about which day, month or year it is, or where the person is
• Having problems with pictures
• Having problems with numbers
• Using wrong words while speaking or writing
• Putting things at very unsuitable places (like putting a file in the fridge)
• Starting something, and then being unable to remember what they wanted to do, even after trying a lot
• Taking strange decisions about investments
• No longer understanding the value of money
• Behaving in socially inappropriate ways, taking off clothes, using abusive language
• Withdrawing socially
• Getting agitated for minor things or for no apparent reason at all
• Getting violent
• Becoming apathetic about what others feel
• Seeming suspicious about people

A useful reference to understand dementia symptoms is  10 Sign's of Alzheimer's from Alzheimer’s Association. This document describes each symptom and also explains how to distinguish between ‘normal ageing’ and dementia.

It is also useful to check the description of symptoms of fronto-temporal dementias, a group of dementias that involve the frontal and temporal lobes of the brain , and account for 5-10% of the cases (with a larger proportion being young onset cases). Check the Mayo Clinic pages and the AFTD site.

The memory loss in dementia is different from normal memory problems we all face.

A lot of people associate the word dementia with “memory loss”.  They also get worried every time they forget something, scared that they have dementia. But not every misplaced key or forgotten date indicates dementia. Many of us forget things occasionally, but this is different from the “memory loss” associated with dementia.  

In the early stages, patients often manage to cover up or compensate for memory loss. And even if they seem confused, people around them assume that this was a “normal” loss. To realize something is wrong, the family needs to be more alert.

As dementia progresses, however, the problem becomes more obvious. 

Understanding Memory Loss , a document at ADEAR, explains memory loss, and which types of memory loss are part of dementia. It also gives tips on how to handle memory loss. The document, while reassuring us that some memory loss is normal as we age, also reiterates: If you’re worried about your forgetfulness, see your doctor (Geriatrician).

In early stages, patients hide their confusion. 

DEMENTIA IS NOT THE SAME AS NORMAL AGE

Often, patients and their families ignore early symptoms of dementia, because they mistake these for old age. This confusion is worsened by language, where old age and senility are assumed as linked.  To top it all, the term “senile dementia” and “pre-senile dementia” are still used by some of the older doctors, linking “senile” with “dementia”.

But dementia is not just a faster case of ageing. It is usually caused by distinct changes in the brain, such as damage to brain cells. The symptoms are not just an exaggerated case of old age, and dementia may also occur in younger persons (see below).

Another confusion is that people think dementia is inevitable with age. It is not. Not everyone who grows old gets dementia. While the probability of getting dementia increases as one ages (more old people get dementia as compared to younger people), dementia is not a part of normal ageing, and it is NOT inevitable.

While older people are more likely to get dementia, people in their 30s, 40s, and 50s can also get dementia.

Most people think that only elderly persons get dementia. But while the probability of getting dementia increases with age, people can get dementia at younger ages, too. When someone who gets dementia is less than 65 years old, it is called younger onset dementia (also called young onset dementia or early onset dementia). Because of the general notion that dementia is an old age disease, when younger persons experience the symptoms, they do not seek support. Doctors, too, may ignore the symptoms or ignore dementia diseases as a possible cause; they may misdiagnose the problems as psychiatric disorders or other problems instead.

The WHO Report, Dementia, a Public Health Priority, states that (YOD stands for Younger Onset Dementia) “While it was estimated that YOD accounts for only 2.2% of all people with dementia in the United Kingdom, the true proportion may be closer to 6–9%.” This is a fairly significant proportion of the dementia population.

MEMORY LOSS may not be an initial symptom in a person with dementia.

There are many symptoms of dementia. Also, dementia may be caused by several diseases. Though memory loss is a prominent feature in the initial stages of some forms of dementia, it is not an initial symptom in some other forms of dementia. For example, in fronto-temporal dementias, the typical initial symptoms are personality changes like disinhibition and loss of restraint, inability to use appropriate words and having a halting speech, problems in walking and balance, etc. Persons suffering from this type of dementia may exhibit no memory loss.

(Source:  Dementia Care Notes)