How to Recognize Signs of Senile Dementia

Watching a loved one fall victim to the ravages of Alzheimer’s disease or other forms of dementia can be heartbreaking. Dementia is a term used to describe a set of symptoms that impair daily functioning and affect memory, thinking, and social abilities.[1] Nearly 11% of dementia is considered potentially reversible. Potentially reversible dementias are more likely to be seen in patients younger than 65 years old. Depression, hypothyroidism and B12 deficiency are some potentially reversible causes of dementia.[2] There’s no cure for dementia, but there are treatments that may help with its symptoms. Knowing the signs of dementia’s approach can be a blessing because when you know what the future holds, you can make plans to help a loved one deal with its effects.



Observing the Signs of Dementia

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    Check for memory loss. Everyone forgets things from time to time. However, dementia sufferers may have difficulty remembering recent events or familiar routes and names.[3]

    • Everyone’s memory is different, and occasional forgetfulness is common among the general population. Family members and close friends will be the best judges of changes in behavior from baseline.
    • If memory loss reaches a point where it interferes with day-to-day activities, take the individual to see his or her doctor for more evaluation.
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    Look for trouble doing tasks they used to do easily.[4] Dementia sufferers may forget to serve the meal they just cooked or forget they cooked it in the first place. People with dementia may have difficulty with other daily tasks such as putting on clothing. Generally, look for obvious declines in daily hygiene and dressing habits. If you notice the individual is having increasing difficulty with these common daily tasks, consider seeing your doctor for further evaluation.
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    Take note of problems in using language.[5] It’s normal for people to fumble for the right word. But, dementia sufferers often get flustered when they can’t find the right word. This may cause them to blow up at the person they’re talking to, which can be frustrating to both parties.

    • Changes in language usually begin with difficulty remembering words, sayings, and expressions.
    • It will progress to a decline in ability to understand other people’s language.
    • Eventually, the person may be unable to communicate verbally at all. At this stage, people communicate only by facial expression or gesture.
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    Note signs of confusion.[6] People with dementia often suffer from confusion about spatial, time, and temporal contexts. This is more than simple memory loss or “senior moments” — spatial, time, and temporal confusion show an inability to understand where the person is in the moment.

    • Spatial confusion may cause dementia sufferers to forget directions, thinking north is south and east is west. They may wander off, then forget how they got to a place and how to return to where they belong.
    • Time disorientation is marked by the performance of behaviors at inappropriate times. This might be subtle — like slight changes in eating or sleeping schedules — but it can also be more significant. An individual might eat breakfast in the middle of the night and then get ready for bed in the middle of the day.
    • Place disorientation may cause confusion about where sufferers are, causing them behave inappropriately. They may find it hard to perform common tasks outside of their home due to spatial disorientation. This can be very dangerous, as the individual can’t navigate environments beyond the home.[7]
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    Do not ignore misplaced items. Sufferers of dementia often place objects in locations that don’t make sense. For example, they may put a purse in the freezer or a thermos lid down in the basement.
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    Observe problems with abstract thinking and reasoning. While a normal person may make occasional mistakes in keeping a checkbook, someone suffering from dementia may forget the concept of numbers. They may also fail to recognize that a whistling teakettle means that water is boiling on the stove and let the water evaporate away.
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    Watch for changes in mood or personality.[8] While people may get moody from time to time, dementia sufferers may have sharp, rapid mood swings. They can go from giddily happy to blazing mad in minutes, or they may become generally irritable or paranoid. Dementia sufferers are often quite aware that they’re having problems with common tasks, and this can be frustrating. This sometimes results in outbursts of irritability, paranoia, or the like.

    • It is important not to upset the individual even further by getting mad, as this is counterproductive to both people.
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    Check for signs of passivity. The person may no longer want to go to places they used to go, take part in activities they used to enjoy, or see the people they used to see. As day-to-day activities become more difficult, many individuals may become more and more introverted. Instead, they may settle into a quiet lifestyle, unmotivated to do anything inside or outside of the home.

    • Notice if the person spends hours sitting in a chair and staring into space or watching television.
    • Look for declining activity, poor hygiene, and problems with common day-to-day activities.
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    Compare the current behavior to what you know of the person. Dementia requires a “constellation” of erratic and noticeably declining behaviors. No one indicator is enough for a diagnosis. Just forgetting things doesn’t necessarily mean someone has dementia. Look for a combination of all the symptoms listed above. The better you know the individual, the easier it will be to notice changes in their usual behavior.



Confirming the Signs

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    Familiarize yourself with some types of dementia. Dementia is a widely varying condition, and it will look different from patient to patient. In large part, you will be able to predict how the patient will progress by taking the cause of the dementia into consideration.

    • Alzheimer’s disease – dementia progresses gradually, usually over the course of years. The exact cause is unknown, but plaques and structures called neurofibrillary tangles have been found in the brains of Alzheimer’s patients.[9]
    • Lewy body dementia: protein deposits, called Lewy bodies, develop in nerve cells the brain and cause a decline in thinking, memory, and motor control abilities. Hallucinations may also occur, and lead unusual behavior like talking to someone who isn’t there. [10]
    • Multi-infarct dementia: dementia occurs when a patient suffers many strokes that block a brain artery.[11] People suffering from this type of dementia may have symptoms that stay the same for awhile and then get worse as they have additional strokes. [12]
    • Frontotemporal dementia: portions of the frontal and temporal lobes of the brain shrink causing personality changes or the ability to use language. This type of dementia tends to occur between the ages of 40 and 75.[13]
    • Normal Pressure hydrocephalus: a buildup of fluid puts pressure on the brain, causing dementia that comes gradually or abruptly, depending on how fast the pressure increases.[14]A CT or MRI will show evidence of this type of dementia.
    • Creutzfeldt-Jakob disease: this is a rare and fatal brain disorder believed to be caused by an unusual organism called a “prion.” Though it may be present for a long time before symptoms emerge, the condition comes on very suddenly. A biopsy of the brain will reveal prion proteins believed to be cause of the condition.[15]
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    Take the person to a doctor. If you think you see a “constellation” of behavioral changes and symptoms, you need expert evaluation. In some cases, a primary care physician will be able to diagnose dementia. More often, the patient needs to be referred to a specialist, such as a neurologist or gerontologist.
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    Provide the patient’s medical history. This should include a detailed record of how and when symptoms developed. Based on this review, a doctor may order tests like a blood count or tests for levels of blood glucose or thyroid hormone. These tests will be specific to the type of dementia that your doctor is testing for.
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    Inform the doctor about all medications being taken.[16] Certain combinations of drugs may mimic or add to the symptoms of dementia. Sometimes, the mixing of unrelated drugs used to treat different diseases causes dementia-like symptoms. This type of drug mixing is common with older people, so make sure you have an accurate medication listing.

    • Some classes of common medications that can cause issues are: benzodiazepines, beta-blockers, selective serotonin re-uptake inhibitors, neuroleptics, and diphenhydramine (among others).
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    Be prepared for a full physical examination. A physical exam might identify a disorder that overlap with or contributes to dementia. Examples of related conditions include heart disease, stroke, nutritional deficiency, or kidney failure. Variations in each of these factors may give a clue to the type of dementia that needs to be treated.[17]

    • The doctor may also conduct a psychiatric evaluation to rule out depression as an underlying cause of a patient’s symptoms.[18]
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    Allow the doctor to evaluate cognitive abilities. This might include tests for memory, math, and language skills, including the ability to write, draw, name objects, and follow directions. These tests assess both cognition and motor skills.
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    Submit to a neurological evaluation.[19] This evaluation will cover balance, reflexes, sensory and other functions in the patient. This is done to rule out other disorders and identify treatable symptoms. The doctor may also order a brain scan to identify underlying causes like strokes or tumors. The main forms of imaging used are MRIs and CT scans.[20]
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    Understand whether or not the dementia is reversible.[21] The dementia that arises from certain causes can sometimes be treated and reversed with medical care. Others, however, are progressive and irreversible. It’s important to know which category the patient falls into, so you can plan for the future.

    • Potentially reversible causes of dementia include hypothyroidism; neurosyphilis; Vitamin B12/folate deficiency/thiamine deficiency; depression; and subdural hematoma.
    • Irreversible causes of dementia include Alzheimer’s disease,multi-infarct dementia, and HIV dementia.

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