What You Should Know About Dementia
Last Updated: August 12, 2021
As you get older, it’s natural to worry about how aging will affect your memory. Dementia isn’t a normal part of the aging process, but it is more common in people over the age of 65, making it a major concern for seniors worldwide. Whether you’re worried about your own health or supporting a loved one as they age, it’s important to understand what dementia is and how many people it affects.
Dementia is a general term used to describe a decline in a person’s cognitive abilities. People use their cognitive abilities to solve problems, make plans, and remember things that happened in the past. The World Health Organization estimates that around 50 million people are living with dementia, with 10 million new cases diagnosed each year. WHO researchers also anticipate that the total number of people living with dementia will increase to 152 million by 2050.
A dementia diagnosis can be overwhelming, whether it affects you or someone you love. Not only do you have to think about the physical and psychological effects of dementia, but you also need to consider how you’ll pay for dementia care or share the responsibility with other family members. We created this guide to ensure you have the information you need to make good medical and financial decisions.
Types of Dementia
Many people use the terms “Alzheimer’s” and “dementia” interchangeably, but they don’t mean the same thing. Dementia refers to a set of symptoms associated with cognitive decline, while Alzheimer’s is a specific type of dementia. There are many other types of dementia that don’t fall under the Alzheimer’s classification. Below, we define each type of dementia and provide some background information on what you can expect.
Alzheimer’s disease is a progressive type of dementia caused by changes in the brain. These changes occur due to abnormal protein deposits that damage nerve cells, leading to a decline in your ability to think, reason, plan and remember. More than six million people in the United States are living with Alzheimer’s disease.
During the first stage, you may start to experience memory loss, changes in your personality, mood swings, and getting lost in familiar places. If you have an older relative with mild Alzheimer’s disease, you may notice that they ask the same question several times or take longer than usual to complete basic tasks.
The next stage, moderate Alzheimer’s disease, is characterized by worsening memory loss and confusion. You may find yourself having trouble recognizing close friends and family members. It may also become more difficult to perform activities of daily living, learn new things or cope with changing circumstances. If the disease progresses, the tissue in the brain shrinks, making it difficult to communicate.
Lewy Body Dementia
Lewy body dementia develops when alpha-synuclein, a protein, builds up in the brain. These protein deposits are known as Lewy bodies. It can be difficult to distinguish Lewy body dementia from Alzheimer’s disease because they cause some of the same symptoms. You may have trouble thinking or experience changes in your mood or behavior. Lewy body dementia can also cause abnormal movements. For example, if an older loved one has Lewy body dementia, you may notice that they move slowly or shuffle when they walk.
Lewy body dementia is one of the most common types of dementia, affecting approximately one million people in the United States alone. In addition to the cognitive changes that occur with this type of dementia, you may have visual hallucinations, balance problems, tremors, or difficulty swallowing. If you’re concerned about a loved one, watch for these signs of Lewy body dementia, along with repeated falls, changes in posture, and a loss of coordination.
Vascular dementia refers to cognitive decline associated with a stroke or some other type of vascular problem within the brain. These problems reduce the amount of blood flowing to the brain, depriving the brain tissue of the oxygen it needs to work properly. Like Alzheimer’s, vascular dementia can cause slower thinking, attention problems, and difficulty staying organized; however, memory loss isn’t as significant in vascular dementia as it is in Alzheimer’s disease. The severity of symptoms depends on the number of brain injuries you’ve had, how big they were, and where in the brain they occurred.
If you have high blood pressure, diabetes, or another chronic health condition, it’s important to follow the treatment plan prescribed by your doctor. These conditions can cause blood clots or narrowing of the blood vessels, increasing the risk of stroke and other vascular problems. If you care for an older family member, make sure they see a doctor regularly and take all medications as prescribed.
If you have two or more types of dementia, then you have mixed dementia. The symptoms of mixed dementia vary based on several factors, including what types of dementia you have and how far they’ve progressed. You may experience difficulty speaking, remembering things, completing daily activities, or taking care of your finances. Mixed dementia can also cause balance problems, delusions, hallucinations, or problems with movement.
When a loved one develops mixed dementia, you may notice that they don’t seem to care as much as they used to about other people’s feelings. They may also ask you the same questions over and over or repeat the same stories every time you see them. Because multiple types of dementia influence each other, it’s important for your loved one to seek medical care as soon as the symptoms appear. Dementia isn’t curable, but there are some things you can do to improve their quality of life once it’s diagnosed.
Parkinson’s Disease Dementia
People with Parkinson’s disease may develop dementia as a result of structural and functional changes in the brain. Although many of the symptoms of Parkinson’s dementia are similar to those produced by other types of dementia, Parkinson’s tends to have more of an impact on daily life because it causes physical and cognitive changes. For example, you may experience tremors or have difficulty walking, making it difficult to work or participate in your hobbies.
In the early stages of Parkinson’s disease, the physical symptoms are the most prominent. You may have trouble making typical facial expressions or speaking without slurring your words. Slower movements, changes in your writing and muscle rigidity are some of the other physical symptoms of the disease. If you develop Parkinson’s dementia, you may eventually experience memory problems, difficulty concentrating, mood changes, confusion or hallucinations. Parkinson’s disease can’t be cured, but there are medications available to control some of the symptoms.
Frontotemporal dementia is caused by changes in the frontal and temporal lobes of the brain. What sets FTD apart from other forms of dementia is that symptoms usually start to appear between the ages of 40 and 65. In the frontal variant of FTD, the main symptoms of the condition relate to behavior and personality. FTD may also manifest as primary progressive aphasia, which makes it difficult to communicate with others. Semantic dementia interferes with your ability to understand language and use it effectively, while progressive nonfluent aphasia affects your ability to speak.
Scientists don’t know exactly what causes FTD, but some people with the condition have Pick bodies in their brain cells, which causes some of the brain tissue to shrink over time. While memory loss is often one of the earliest signs of Alzheimer’s disease, FTD typically causes early changes in personality and behavior. It’s difficult to recognize these changes when they’re happening to you. If a loved one develops FTD, they may have trouble holding a job, maintaining their hygiene or controlling their behavior.
Huntington’s disease is a genetic disorder that causes a loss of nerve cells in the brain, resulting in personality changes, forgetfulness, involuntary movements, and other symptoms. Like FTD, Huntington’s disease typically begins at a younger age, with many people experiencing symptoms between the ages of 30 and 50. More than 40,000 Americans have symptomatic Huntington’s disease, and another 200,000 are at risk of inheriting it. Huntington’s disease is genetic, which means you develop it if you inherit a defective copy of the huntingtin gene from one of your parents.
The cognitive changes that occur in Huntington’s disease are similar to those caused by other forms of dementia, although memory loss typically occurs later in the progression of the disease. If you develop Huntington’s disease, you may have a hard time getting and staying organized, multitasking or making calculations while you cook or balance your checkbook.
Creutzfeldt-Jakob disease is caused by a prion, a type of protein that causes other proteins in the brain to fold abnormally, causing them to accumulate in the brain tissues. Prion diseases can cause rapidly developing dementia as well as muscle stiffness, confusion, hallucinations, difficulty speaking and difficulty walking. Because the symptoms progress so rapidly, you may require help with daily activities. The good news is that Creutzfeldt-Jakob disease and other prion diseases are extremely rare — only 350 cases are diagnosed in the United States each year.
What distinguishes CJD dementia from other types of dementia is how quickly it progresses. As the abnormally folded proteins damage brain cells, it becomes more difficult to think and reason. Damage to the brain cells also causes mood swings, agitation, disorientation and apathy. Scientists haven’t found a cure for CJD yet, but your doctor may be able to prescribe medications and other treatments to ease some of your symptoms.
- Normal pressure hydrocephalus (NPH): NPH causes cerebrospinal fluid to build up in the brain, making it difficult to think clearly and use your reasoning abilities. It may also make it difficult to concentrate or cause changes in your personality.
- Metabolic dementia: Anything that changes your metabolism can cause reversible dementia, including liver cirrhosis, thyroid problems, low blood sugar (hypoglycemia) and Cushing’s disease.
- Brain tumors: The presence of certain benign (noncancerous) brain tumors can cause dementia. The risk of permanent damage to the brain cells declines if the tumor is removed in its early stages.
- Poisoning: Heavy metals, recreational drugs and other substances can damage brain cells, causing dementia-like symptoms. It may be possible to reverse the damage with immediate treatment.
- Oxygen deprivation: A lack of oxygen can damage the cells in your brain. Chronic exposure to smoke, choking, severe asthma and spending time at high altitudes can deprive your brain cells of the oxygen they need, resulting in dementia-like symptoms. The damage may be reversible if the flow of oxygen is quickly restored.
- Wernicke-Korsakoff syndrome: Wernicke-Korsakoff syndrome develops as a result of severe vitamin B-1 deficiency associated with alcohol use disorder. If you get treated quickly, it may be possible to reverse the dementia symptoms.
- Subdural hematoma: If you sustain a head injury that causes bleeding within the skull, you may develop dementia-like symptoms. Quick treatment gives you the best chance of reversing the symptoms after such an injury.
Signs of Dementia
It can be difficult to determine if memory loss and other dementia symptoms are caused by dementia or just a normal part of aging. Below, we explain the eight most common signs of dementia. While noticing the signs of dementia can be helpful, remember that only a doctor can diagnose this condition. If you suspect you or a loved one may be experiencing early symptoms of the condition, speak to a medical professional.
Forgetting things once in a while is completely normal. Even younger people forget where they put their keys or miss dental appointments because they forgot about them. Forgetfulness becomes a cause for concern when you start forgetting the names of loved ones, when you find yourself repeating the same stories all the time, and when your memory lapses become frequent.
Memory loss is often one of the first symptoms of Alzheimer’s disease, so it’s important to pay attention if older loved ones start to be more forgetful than usual. Many people with early Alzheimer’s remember things that happened decades ago, but they may have trouble remembering what they ate for breakfast or the name of a person they met a few days ago.
Difficulty Performing Familiar Tasks
Dementia can make it difficult to perform familiar tasks that you’ve done hundreds or even thousands of times. One example is cooking a meal from scratch. Even if you previously knew the recipe by heart, you may find it difficult to remember what ingredients you need or what steps to follow when preparing the meal. A loved one with dementia may abandon hobbies they’ve always enjoyed or fail to complete projects they were once excited to begin.
The damage to the brain that occurs in some types of dementia can interfere with your language skills, including your ability to speak clearly. You may have trouble choosing words or forget the names of common items in your home. An older loved one with dementia may get frustrated when you’re talking to them because they can’t remember the words they wanted to use.
As dementia progresses, you may not be as oriented to people, place, and time as you used to be. You may find yourself losing track of time, wondering how you got somewhere or getting lost in neighborhoods or buildings that should be familiar to you. If you have an older loved one with dementia, you may notice that they become disoriented when visiting relatives, attending social events, and going to medical appointments.
Impaired Abstract Thinking
Abstract thinking relates to your ability to understand what things mean. If you have dementia, you may have trouble with activities that require abstract thinking, such as balancing your checkbook, engaging in complex discussions, or following instructions for a task. Abstract thinking is especially difficult when you’re trying to follow a sequence or understand cause-and-effect relationships.
Since you became an adult, you’ve been using your judgment on a daily basis. Decisions about what to eat, when to go to the doctor and how to interact with others eventually become second nature. If you have dementia, however, you may not be able to make good decisions like you always have. Dementia makes it difficult to plan things in advance, manage your finances responsibly and make good choices related to your safety.
Behavior or Mood Changes
Many medical conditions cause changes in mood and behavior, but dementia is one of the most common. As dementia progresses, you may develop symptoms of depression, experience more anxiety than usual or be afraid of things that never bothered you before. Older family members with dementia may also withdraw from their loved ones due to embarrassment over their memory loss and difficulty communicating. You may even notice that your loved one is more or less inhibited than they used to be.
Is It Alzheimer’s or Dementia?
Because Alzheimer’s and dementia are often used interchangeably, it can be difficult to determine which form of dementia you have. Alzheimer’s is certainly the most common, accounting for 60% to 70% of all dementia cases, but it’s possible your symptoms are caused by FTD, Lewy body dementia, vascular dementia, or some other type of dementia. If it’s Alzheimer’s, you may experience some of the following symptoms:
- Difficulty remembering where you were going or how to get there
- Changes in your writing or speaking abilities
- Trouble performing calculations
- Difficulty performing multi-step tasks, such as preparing a meal
- Inability to remember the names of your friends and family members
- Increased anxiety
- Sudden mood changes
- Changes in your sleep patterns
- Personality changes
- Loss of interest in activities you once enjoyed
Scientists still have much to learn about Alzheimer’s and other forms of dementia. As a result, there’s currently no cure for Alzheimer’s disease, and there’s no way to stop the disease from progressing. Despite the fact that no cure exists, you shouldn’t lose hope. There are treatments available to help control your symptoms and maintain the highest quality of life possible.
In the United States, the Food & Drug Administration has approved cholinesterase inhibitors for people with Alzheimer’s disease. These medications slow down the metabolism of a chemical called acetylcholine, improving communication between nerve cells and easing some of the symptoms of Alzheimer’s disease. The FDA has also approved a drug called memantine to slow down the decline in cognitive function caused by Alzheimer’s. Anti-anxiety medications, antidepressants, and antipsychotics may also be used to treat Alzheimer’s symptoms. Not all treatments work for all people, however; it’s important to work with your loved one’s doctor to determine which medications are making a difference and which ones are not.
Only a licensed medical professional can diagnose dementia. If you’re experiencing concerning symptoms, or if you think a loved one has dementia, schedule a medical assessment immediately. The sooner a diagnosis is made, the sooner everyone can work together to develop a treatment plan.
Mental Status Tests
Physicians often use mental status tests to determine if someone meets the criteria for a dementia diagnosis. One such test is the Mini-Cog, which has three steps: identify three objects, draw the face of a clock and then recall the three objects identified earlier. The test is non-invasive and takes just a few minutes, but it can help your doctor find out if you have any concerning dementia symptoms.
The Mini-Mental State Evaluation is also used to diagnose dementia. The test is a little more involved than the Mini-Cog, as it tests several different cognitive skills. The person administering the test will ask you where you are, what date it is, and what time it is. These questions help determine if you’re oriented to place and time. You’ll also be asked to perform tasks related to comprehension, math, language, and counting. Some physicians use an updated version of the MMSE, the Saint Louis University Mental Status exam. In this modernized version, your score is adjusted based on your education level.
Because dementia can develop due to structural changes in the brain, imaging tests are an important diagnostic tool. Computed tomography (CT) scans and magnetic resonance imaging are used to view the structures of the brain and look for abnormalities. Positron emission (PET) scanning can also be used to assess the function of your brain, giving your doctor more insight into what might be causing your symptoms. You may need to have multiple imaging tests to give your physician as much information as possible, as some tests provide more detail than others.
The Clinical Dementia Rating Scale
The Clinical Dementia Rating Scale is also used to assess people with symptoms of dementia. For each category, the examiner assigns a rating of 0, 0.5, 1, 2, or 3, with 0 indicating no impairment and 3 indicating severe impairment. The categories include memory, judgment, and problem solving, orientation, home and hobbies, community affairs, and personal care. Category scores are added together to determine a total score; a score of 3.0 to 4.0 indicates very mild dementia, while a score of 16.0 to 18.0 indicates the presence of severe dementia.
Care Options for Seniors with Dementia
As dementia progresses, it becomes more difficult to perform day-to-day activities. Fortunately, many care options exist for people who have this medical condition. If you have a trusted relative, you may rely on them to care for you. Residential care is also an option, especially if you have long-term care insurance or private insurance that offers a high level of benefits. No matter how compassionate your loved ones are, the time will come when you need professional care. Below, we explain the two most common types of care for seniors with dementia to help you understand your available options.
In-Home Care for Seniors with Dementia
In-home care is just what it sounds like: professional care provided in your home or the home of a loved one. One of the main benefits of in-home care is that you can continue living in your neighborhood and maintain your relationships with friends and family members. If you care for someone with dementia, an in-home caregiver can also give you a break if you’re sick or need to run errands.
Several types of in-home care are available, including skilled care, personal companion services, homemaker services and personal care services. Companion services are less specialized than other types of in-home care, but they’re a good option if you just want someone to visit with you and help you engage in recreational activities. Skilled care is typically provided by a nurse or some other licensed professional. This type of care is ideal if you have medical needs that you can’t manage on your own.
Residential Memory Care
For some people, residential memory care is a safer option than in-home care. You may want to consider residential memory care if your dementia is getting worse or if your current caregiver is unable to continue helping you. Memory care facilities typically have extra features to make them safer and more comfortable for people with dementia. For example, some facilities have keypads on the door to make sure that residents can’t wander away and put themselves in danger. If you’re interested in residential care, use the Caring.com directory to find a memory care facility in your area.
“Alzheimer’s disease signs and symptoms”. UCSF Health, n.d., https://www.ucsfhealth.org/conditions/alzheimers-disease/symptoms. Accessed 13 July 2021.
“Creutzfeldt-Jakob disease fact sheet”. National Institute of Neurological Disorders and Stroke, 13 March 2020, https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Creutzfeldt-Jakob-Disease-Fact-Sheet. Accessed 13 July 2021.
“Dementia”. Mayo Clinic, 18 October 2017, https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013. Accessed 12 July 2021.
“Dementia”. World Health Organization, 21 September 2020, https://www.who.int/news-room/fact-sheets/detail/dementia. Accessed 12 July 2021.
“Frontotemporal dementia”. Johns Hopkins Medicine, n.d., https://www.hopkinsmedicine.org/health/conditions-and-diseases/dementia/frontotemporal-dementia. Accessed 13 July 2021.
“In-home care”. Alzheimer’s Association, n.d., https://www.alz.org/help-support/caregiving/care-options/in-home-care. Accessed 13 July 2021.
“Memory, forgetfulness, and aging: What’s normal and what’s not?”. National Institute on Aging, 21 October 2020, https://www.nia.nih.gov/health/memory-forgetfulness-and-aging-whats-normal-and-whats-not. Accessed 13 July 2021.
“Mini-Mental State Exam”. NCBI, n.d., https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/GetPdf.cgi?id=phd001525.1. Accessed 13 July 2021.
O’Bryant, S.E., et al. “Staging dementia using Clinical Dementia Rating Scale sum of boxes scores”. NCBI, 1 August 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409562/. Accessed 13 July 2021.
“Overview of Huntington’s disease”. Huntington’s Disease Society of America, n.d., https://hdsa.org/what-is-hd/overview-of-huntingtons-disease/. Accessed 13 July 2021.
“Parkinson’s dementia”. National Parkinson Foundation, n.d., https://www.parkinson.org/sites/default/files/PD%20Dementia.pdf. Accessed 13 July 2021.
“Parkinson’s disease”. Mayo Clinic, n.d., https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055. Accessed 13 July 2021.
“Pick’s disease”. Penn Medicine, 4 February 2020, https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/picks-disease. Accessed 13 July 2021.
“Prion diseases”. Johns Hopkins Medicine, n.d., https://www.hopkinsmedicine.org/health/conditions-and-diseases/prion-diseases. Accessed 13 July 2021.
Singh, Ravneet, & Sadiq, Nazia M. “Cholinesterase inhibitors”. NCBI Bookshelf, 10 May 2021, https://www.ncbi.nlm.nih.gov/books/NBK544336/. Accessed 13 July 2021.
“The appropriate use of neuroimaging in the diagnostic work-up of dementia”. NCBI, 1 February 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937983/. Accessed 13 July 2021.
“The language of dementia”. Dana Foundation, n.d., https://dana.org/article/the-language-of-dementia/. Accessed 13 July 2021.
“Using the Mini-Cog”. Mini-Cog, n.d., https://mini-cog.com/about/using-the-mini-cog/. Accessed 13 July 2021.
“Vascular contributions to cognitive impairment and dementia”. National Institute on Aging, 31 December 2017, https://www.nia.nih.gov/health/vascular-contributions-cognitive-impairment-and-dementia. Accessed 13 July 2021.
“What is dementia? Symptoms, types, and diagnosis”. National Institute on Aging, 2 July 2021, https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis. Accessed 13 July 2021.
“What is Lewy body dementia?”. National Institute on Aging, 27 June 2018, https://www.nia.nih.gov/health/what-lewy-body-dementia. Accessed 13 July 2021.