Dementia

Overview

How does the brain store information?

Information is stored in different parts of your memory. Information stored in recent memory may include what you ate for breakfast this morning. Information stored in the short-term memory may include the name of a person you met moments ago. Information stored in the remote or long-term memory includes things that you stored in your memory years ago, such as memories of childhood.

How does aging change the brain?

When you’re in your 20s, you begin to lose brain cells a few at a time. Your body also starts to make less of the chemicals your brain cells need to work. The older you are, the more these changes can affect your memory. Aging may affect memory by changing the way the brain stores information and by making it harder to recall stored information. Your short-term and remote memories aren’t usually affected by aging. But your recent memory may be affected. For example, you may forget names of people you’ve met today or where you set your keys. These are normal changes.

What is dementia?

Dementia is a brain disorder that makes it hard for people to remember, learn and communicate. These changes eventually make it hard for people who have dementia to care for themselves. Dementia may also cause changes in mood and personality. Early on, lapses in memory and clear thinking may bother the person who has dementia. Later, disruptive behavior and other problems can create a burden for caregivers and other family members. Dementia is caused by the damage of brain cells. A head injury, stroke, brain tumor or disease (such as Alzheimer’s disease) can damage brain cells and lead to dementia.

Symptoms

What are the symptoms of dementia?

The symptoms of dementia include:

  • Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you’ve already given them the answer. They won’t even remember that they already asked the question.

  • Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.

  • Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.

  • Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.

  • Poor judgment. Even a person who doesn’t have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.

  • Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.

  • Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can’t find these things later.

  • Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes.

  • Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.

  • Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people

What about when I know a word but can’t recall it?

This is usually just a glitch in your memory. You’ll almost always remember the word with time. This may become more common as you age. It can be very frustrating, but it’s not usually serious.

How can I tell if my memory problems are serious?

A memory problem is serious when it affects your daily living. If you sometimes forget names, you’re probably okay. But you may have a more serious problem if you have trouble remembering how to do things you’ve done many times before, get to a place you’ve been to often, or do things that require steps (such as following a recipe). Another difference between normal memory problems and dementia is that normal memory loss doesn’t get much worse over time. Dementia gets much worse over several months to several years. It may be hard to figure out on your own if you have a serious problem. Talk to your family doctor about any concerns you have. If your memory problems are caused by a certain medicine you’re taking, your doctor can prescribe another medicine that doesn’t have this side effect. If another condition is causing your memory loss (such as depression), your doctor can help you treat the condition.

Diagnosis & Tests

What should I do if I think I may have dementia?

Talk with your doctor. Your doctor can do tests to find out if your experiences are caused by dementia. The sooner you know, the sooner you can talk to your doctor about treatment options.

What should I do if a family member is showing signs of dementia?

If your family member is showing some of the signs of dementia, try to get him or her to go see a doctor. You may want to go along and talk with the doctor before your relative sees him or her. Then you can tell the doctor about the way your relative is acting without embarrassing your relative.

Treatment

How is dementia treated?

Some causes of dementia can be treated. However, once brain cells have been destroyed, they cannot be replaced. Treatment may slow or stop the loss of more brain cells. When the cause of dementia can’t be treated, the focus of care is on helping the person with his or her daily activities and reducing upsetting symptoms. Some medicines can help people who have dementia. Your family doctor will talk with you about treatment options.

Complications

Why do people who have dementia become agitated?

The agitation can have many causes. A sudden change in surroundings or frustrating situations can cause people who have dementia to become agitated. For example, getting dressed or giving the wrong answer to a question may cause frustration. Being challenged about the confusion or inability to do things caused by the dementia may also make the person agitated. As a result, the person may cry, become irritable, or try to hurt others in some way.

How can I deal with agitation?

One of the most important things you can do is avoid situations in which your loved one might become frustrated. Try to make your loved one’s tasks less difficult. For example, instead of expecting him or her to get dressed alone, you can just have your loved one put on one piece of the outfit (such as a jacket) on his or her own. You can also try to limit the number of difficult situations your loved one must face. For example, if taking a bath or shower causes problems, have him or her take one every other day instead of every day. Also, you can schedule difficult activities for a time of day when your loved one tends to be less agitated. It’s helpful to give frequent reassurance and avoid contradicting him or her.

What should I do if hallucinations are a problem?

If hallucinations are not making your loved one scared or anxious, you don’t need to do anything. It’s better not to confront people who have dementia about their hallucinations. Arguing may just upset your loved one. However, if hallucinations are scary or upsetting to your loved one, you can try to distract the person by involving him or her in a pleasant activity.

What if my loved one will not go to sleep at night?

Try one or more of the following if your loved one is having trouble sleeping:

  • Try to make the person more aware of what time of day it is. Place clocks where he or she can see them.

  • Keep curtains or blinds open so that he or she can tell when it is daytime and when it is nighttime.

  • Limit the amount of caffeine he or she consumes.

  • Try to help your loved one get some exercise every day.

  • Don’t let him or her take too many naps during the day.

  • Make your loved one’s bedroom peaceful. It is easier to sleep in a quiet room.

  • At night, provide a night light or leave a dim light on. Total darkness can add to confusion.

  • If your loved one has arthritis or another painful condition that interrupts his or her sleep, ask your doctor if it is okay to give your loved one medicine for pain right before bed.

What if wandering becomes a problem?

Sometimes very simple things can help with this problem. It is all right for your loved one to wander in a safe place, such as in a fenced yard. By providing a safe place, you may avoid confrontation. If this doesn’t work, remind your loved one not to go out a certain door by placing a stop sign on it or putting a piece of furniture in front of it. A ribbon tied across a door can serve as a similar reminder. Hiding the doorknob by placing a strip of cloth over it may also be helpful. An alarm system will alert you that your loved one is trying to leave a certain area. Your alarm system may just be a few empty cans tied to a string on the doorknob. You might have to place special locks on the doors, but be aware that such locks might be dangerous if a house fire occurs. Don’t use this method if your loved one will be left home alone. Make sure your loved one wears a medical bracelet with his or her name, address and medical conditions, in case he or she does wander away from home.

Other Organizations

Questions to Ask Your Doctor

  • Can dementia be prevented?

  • Are there any support groups for caregivers of people with dementia?

  • What types of medicines treat dementia? Are there side effects?

  • Does dementia run in families? Am I at risk?

  • What types of tests are used to diagnose dementia?

  • Do people with dementia ever get better?

Memory problems that aren’t part of normal aging

  • Forgetting things much more often than you used to

  • Forgetting how to do things you’ve done many times before

  • Trouble learning new things

  • Repeating phrases or stories in the same conversation

  • Trouble making choices or handling money

  • Not being able to keep track of what happens each day

Citations

  • Early Diagnosis of Dementia by KS Santacruz, M.D. and D Swagerty, M.D., M.P.H.( 02/15/01, http://www.aafp.org/afp/20010215/703.html)