Dementia Overview (cont.)

Dementia Symptoms

Symptoms of dementia vary considerably by the individual and the underlying cause of the dementia. Most people affected by dementia have some (but not all) of these symptoms. The symptoms may be very obvious, or they may be very subtle and go unrecognized for some time. The first sign of dementia is usually loss of short-term memory. The person repeats what he just said or forgets where she put an object just a few minutes ago. Other symptoms and signs are as follows:

Early dementia

• Word-finding difficulty - May be able to compensate by using synonyms or defining the word
  
  
• Forgetting names, appointments, or whether or not the person has done something; losing things
  
  
• Difficulty performing familiar tasks - Driving, cooking a meal, household chores, managing personal finances
  
  
• Personality changes (for example, sociable person becomes withdrawn or a quiet person is coarse and silly)
  
  
• Uncharacteristic behavior
  
  
• Mood swings, often with brief periods of anger or rage
  
  
• Poor judgment
  
  
• Behavior disorders - Paranoia and suspiciousness
  
  
• Decline in level of functioning but able to follow established routines at home
  
  
• Confusion, disorientation in unfamiliar surroundings - May wander, trying to return to familiar surroundings

Intermediate dementia

• Worsening of symptoms seen in early dementia, with less ability to compensate 
  
  
• Unable to carry out activities of daily living (eg, bathing, dressing, grooming, feeding, using the toilet) without help 
  
  
• Disrupted sleep (often napping in the daytime, up at night) 
  
  
• Unable to learn new information  
  
  
• Increasing disorientation and confusion even in familiar surroundings  
  
  
• Greater risk of falls and accidents due to poor judgment and confusion  
  
  
• Behavior disorders - Paranoid delusions, aggressiveness, agitation, inappropriate sexual behavior 
  
  
• Hallucinations 
  
  
• Confabulation (believing the person has done or experienced things that never happened) 
  
  
• Inattention, poor concentration, loss of interest in the outside world  
  
  
• Abnormal moods (anxiety, depression)

Severe dementia

• Worsening of symptoms seen in early and intermediate dementia 
  
  
• Complete dependence on others for activities of daily living  
  
  
• May be unable to walk or move from place to place unassisted  
  
  
• Impairment of other movements such as swallowing - Increases risk of malnutrition, choking, and aspiration (inhaling foods and beverages, saliva, or mucus into lungs)  
  
  
• Complete loss of short- and long-term memory - May be unable to recognize even close relatives and friends  
  
  
• Complications - Dehydration, malnutrition, problems with bladder control, infections, aspiration, seizures, pressure sores, injuries from accidents or falls

The person may not be aware of these problems, especially the behavior problems. This is especially true in the later stages of dementia.

Depression in elderly people can cause dementialike symptoms. As many as 40% of people with dementia are also depressed. Common symptoms of depression include depressed mood, loss of interest in activities once enjoyed, withdrawal from others, sleep disturbances, weight gain or loss, suicidal thoughts, feelings of worthlessness, and loss of ability to think clearly or concentrate.

People with irreversible or untreated dementia present a slow, gradual decline in mental functions and movements over several years. Total dependence and death, often from infection, are the last stages.

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