As we age, it’s normal for our memory to undergo subtle changes. However, if forgetfulness is affecting you or your loved one and getting in the way of daily life, it’s a good idea to talk to your doctor about the early signs of Alzheimer’s and dementia.
Dementia affects not just memory, but also behavior, communication, emotions, and cognition. It is not a normal part of aging. Alzheimer’s disease is the most common cause of dementia. It accounts for 60-80% of cases.
Alzheimer’s and dementia affect more than 50 million people worldwide. Here’s what you need to know.
What is dementia?
Dementia is the deterioration of cognitive functioning; that is, thinking, remembering, and reasoning, and behavioral abilities. This happens in an extent that interferes with the person’s daily life.
It is not a specific disease, but a term used to refer to a group of symptoms caused by other conditions.
It affects memory, language skills, orientation, calculation, comprehension, visual perception, learning capacity, problem-solving, judgment, focus, emotional regulation, social behavior, and self-management. Some people living with dementia might also experience a change in their personality.
Dementia progresses differently for each person, and can range in severity. At its mildest stage, it might begin to impair day-to-day functioning. At its most severe, a person living with dementia might have to depend on others to perform basic activities. It is one of the major reasons for disability and dependency among seniors.
While it is commonly believed that dementia affects older individuals, as many as half a million Americans under the age of 65 are living with early onset dementia.
Dementia can have an overwhelming physical, mental, and economic impact not just on the people who have it, but also on their caregivers and family members.
The difference between Alzheimer’s and dementia
Alzheimer’s is a specific disease, while dementia is a general term for a group of symptoms that result from a variety of diseases. Alzheimer’s is the most common form of dementia, accounting for 60-80% of cases.
Signs of Dementia
While people may normally experience a decline in cognitive function as they age, this is more pronounced with dementia. This happens in a way that affects daily functioning. Here are common dementia symptoms.
Memory loss
Forgetting things like names or appointments and then remembering them later is normal.
A person living with dementia, however, might forget things more often. These can include the names of close friends and family members, or recent events such as news they just saw on television, or the activities they took part in earlier in the day.
Difficulty with tasks
With normal aging, physical impairment may lead to difficulty with tasks. Daily tasks may be difficult for a person living with dementia as they progressively lose their cognitive abilities.
Disorientation
It’s normal to enter a room and forget for a brief time why you went there. A person living with dementia might get lost in familiar places, or not remember how they got there at all.
Language
Normal aging might make someone occasionally have difficulty finding the right word. Someone living with dementia might experience this more frequently.
It’s normal for someone to have the need to concentrate more in conversations or to get distracted when there are many speaking at the same time.
A person living with dementia, however, will often have trouble participating in a conversation. They may regularly get distracted while someone is speaking.
Abstract thinking
Someone living with dementia might have more difficulty connecting past experiences to the present. They might also have trouble doing basic math, reading between the lines, or understanding jokes or sarcasm.
Judgment
It’s normal to lose the ability to react quickly and to make mistakes with decision-making or finances as you grow older.
Someone living with dementia, however, might have difficulty assessing risks. They might also be unable to keep track of their finances or lose their ability to plan and think decisions through.
Visual perception or spatial skills
Decreased visual acuity is a normal part of aging. Someone living with dementia, however, might have difficulty interpreting visual information. They might be unable to judge distance while driving or taking the stairs or become unable to recognize shadows or their own reflection.
Misplacing things
It’s normal for someone to lose their keys or wallet but then be able to retrace where they might have left them. A person living with dementia, however, may leave their things in unusual spaces and not be able to find them.
Moodiness
All people become tired or sad from time to time. However, a person living with dementia might experience rapid mood swings. They could be easily frightened, and may be irritated even when surrounded with loved ones or friends.
Stages of Alzheimer’s
Alzheimer’s symptoms are more specific than dementia symptoms. These symptoms manifest in the person as the disease progresses. These symptoms and their severity are used to define seven distinct stages of Alzheimer’s.
It is important for caregivers and family members to be familiar with these stages. Knowing what to expect could help decrease stress in the long run. It also assures that the person living with Alzheimer’s is getting the right level of care and support for their current stage.
The 7 Stages of Alzheimer’s disease
Stage 1: Normal behavior
Changes in the brain related to Alzheimer’s disease can begin as much as 10 years before symptoms become noticeable.
At this stage, the disease is undetectable. If your loved one begins to show signs of mild cognitive decline such as forgetfulness, they might be entering stage two of the disease.
Stage 2: Very mild decline
At this stage, the person will begin to show the forgetfulness associated with normal aging. They might forget their keys or their wallet, but they are able to carry on with day-to-day tasks. People at this stage should be generally able to maintain a high level of independence.
Stage 3: Mild decline
Once Alzheimer’s disease has progressed to this stage, the person’s daily life might be disrupted. They might begin to perform poorly at work, or have difficulty performing household tasks. They might also struggle to find the right words when communicating with others.
The disease is commonly diagnosed at this stage, as symptoms of cognitive decline are more obvious for the person’s loved ones. However, since decline is gradual and many people don’t want to accept that a problem exists, it’s common for families to miss or ignore symptoms and wait to seek a diagnosis. Unfortunately, this can prevent the person from getting the level of help and support they need.
Stage 4: Moderate decline
At this stage of Alzheimer’s disease, the person is considered to have early-stage dementia. This period is marked by increased forgetfulness, trouble with concentration, and difficulty with problem-solving.
They might also have problems with managing their finances, or easily get lost in unfamiliar areas. They will also begin to withdraw from loved ones as socialization will become a challenge.
During this time, your loved one might also have difficulties with memory. They might remember things that happened in the distant past. However, they might easily forget details from recent events, such as the news or a conversation.
Fortunately, there are many options for helping the person living with dementia maintain a good quality of life during this stage. It’s critical for close family and caregivers to be well-educated about these options and to have a care plan in place to leverage them.
Stage 5: Moderately severe decline
This stage marks the beginning of middle-stage dementia.
People with moderately severe cognitive decline will likely need help with day-to-day tasks, such as preparing meals or getting dressed.
Memory loss will also be more severe, and they might forget important details such as their home address, and phone number. However, they are still likely to remember the names of their family members. Also, they will still be able to do many tasks independently, such as going to the toilet.
At this stage, it is critical for caregivers to have a clear care plan in place that assures the person living with dementia is still having an enjoyable and highly dignified life. Primary at-home caregivers also can begin to feel overwhelmed at this stage, so it’s crucial that they take care of themselves and leverage outside resources and support as needed.
Stage 6: Severe decline
During this stage, the person will gradually require greater assistance with their day-to-day activities. They are also likely to start to experience loss of bladder control and bowel movements.
People at this stage will also have increased difficulty with communicating. They might still be able to use words, but they will have difficulty expressing their feelings. They might also be unable to communicate they are in pain.
This period is also marked by major behavioral changes. Because they can no longer function independently, the person might become more frustrated. They might also experience increased anxiety, paranoia, and delusions.
At this stage, medical professionals, behavioral health professionals, and care professionals typically work together to provide the best combination of medication and daily care to maintain the best possible levels of physical and mental health for the person.
Stage 7: Very severe decline
People in this stage experience severe physical and mental impairment. People at this stage will require full-time care, and might be unable to walk, sit, stand, or even swallow their food by themselves. They are also likely to lose their ability to communicate.
In this stage it is important to keep treating the person with a high level of dignity, love, and deep respect.
What causes Alzheimer’s?
The exact cause of Alzheimer’s is yet to be known. Scientists believe it is influenced by various genetic, lifestyle-related, and environmental factors. It is characterized by the abnormal build-up of proteins in between neurons, which can begin years before symptoms appear.
This process damages the neurotransmitters that connect and send signals between brain cells. Gradually, different parts of the brain shrink, with the region that controls memory typically the first one to be affected.
Risk-increasing factors
There are several factors known to increase a person’s risk of contracting Alzheimer’s disease.
Age
Most people living with Alzheimer’s disease are aged 65 and older. While age is a risk factor, it is not a direct cause of the disease. However, after the age of 65, the risk of developing Alzheimer’s increases every five years. By the age of 85, the risk increases to one-third.
Alzheimer’s does not only affect older people. About 5% of people living with the disease are below the age of 65, and are in their 40s or 50s. Such cases are referred to as younger-onset or early-onset Alzheimer’s disease.
Family history and genetics
Those with a parent or sibling with Alzheimer’s disease are more likely to develop the disease. The APOE ɛ4 gene is also known to increase the risk of Alzheimer’s, but not everyone who has it will develop it.
Head injuries
Some studies have shown a link between traumatic head injuries and Alzheimer’s disease.
Down’s syndrome
Alzheimer’s disease symptoms tend to appear about 10 to 20 years earlier in people living with down’s syndrome. This risk factor is believed to be caused by having three copies of chromosome 21, which contains the amyloid precursor protein (APP) producing gene. Too much of this protein will cause a buildup of beta-amyloid plaques, which increases the risk of developing Alzheimer’s disease.
Cardiovascular disease
Research shows that the same risk factors associated with cardiovascular disease are associated with an increased risk of developing Alzheimer’s disease.
- Poor diet
- Lack of exercise
- Smoking
- High cholesterol
- High blood pressure
- Diabetes
These risks can be avoided with healthy lifestyle adjustments, such as eating a balanced diet.
Physical inactivity
Studies have shown that people with high levels of physical activity are less likely to develop Alzheimer’s disease than people who are physically inactive.
What causes dementia?
Dementia happens when parts of the brain that are responsible for memory, decision-making, learning, and language are damaged, or afflicted by disease. As such, there are various factors that cause dementia.
Although Alzheimer’s is the most well-known type of dementia, there are a number of other common types. Understanding the type of dementia can be an important factor in planning and executing the proper care for each person.
Types of dementia
Alzheimer’s disease is the most common type of dementia, but there are many kinds and causes.
- Frontotemporal dementia pertains to uncommon brain disorders that primarily affect the frontal and temporal lobes of the brain that are associated with personality, behavior and language.
- Vascular dementia from the death of brain cells caused by stroke or other cerebrovascular diseases. In cases like these, the brain is deprived of oxygen as normal blood flow is restricted.
- Lewy body dementia is the second most common type of progressive dementia, after Alzheimer’s disease. It is associated with abnormal deposits of alpha-synuclein proteins in the brain, which leads to a decline in cognitive and independent functioning.
- Creutzfeld-Jakob disease is a rare, degenerative, and fatal disease that leads to brain damage and dementia. It is caused by the abnormal folding of prion proteins in the body.
- Huntington’s disease is caused by a genetic mutation that leads to the deterioration of neurons in the brain and spinal cord. This causes a severe decline in cognitive skills.
Dementia risk factors
Certain lifestyle-related and physical factors can increase the risk of developing dementia later in life. These include:
- Age
- Family history
- Illnesses such as heart disease and diabetes
- Depression
- Heavy alcohol use
- Smoking
- Lack of exercise and poor diet
Dementia Care
The majority of people living with Alzheimer’s and dementia receive care from their family members. In fact, 80% of people living with dementia receive care at home.
However, assuming the role of a caregiver can be physically and emotionally taxing. Every year, more than 16 million people in America provide 17 billion unpaid hours of care for people living with Alzheimer’s and dementia.
The stages of dementia care
The needs of your loved one will change as the disease progresses. Knowing what to expect as a caregiver at each stage will help you plan, and reduce anxiety and stress.
Early-stage care
During the early stages of dementia, your loved one will still be able to function independently.
Your role as a care partner at this time will be to support them, and make plans for the future. Finding ways how you can offer help with tasks while maximizing their independence will increase their confidence, and yours.
This stage can also be marked by strong emotions, such as denial and fear, for both the care partner and the person living with the disease. Making space to communicate and do activities that are meaningful for both of you will help you work past difficult feelings.
Middle-stage care
The middle stage of dementia can last for many years. People living with dementia will need more care at this time. Consider providing them with dementia-friendly activities to help maintain their daily happiness and well-being.
They might have difficulties with day-to-day tasks and routines. Expressing their thoughts will also be a challenge. The loss of independence will lead to them becoming frustrated. Providing therapeutic activities for people with dementia is an important part of the care process.
Caregivers at this time will have to take on more responsibilities. When the demands of care begin to increase, it’s critical for caregivers to ensure that they still take care of themselves. It’s important to take breaks, and reach out to family, friends, or other resources for help.
Some of these resources, such as adult day-care centers and home health agencies, can provide critical help and respite for primary at-home caregivers. It’s usually best not to wait until a caregiver is exhausted to start using outside resources. People living with dementia will also adjust more easily to these resources if they are introduced earlier in their progression.
Late-stage care
During the late stage of dementia, the primary concern for caregivers will be about preserving dignity and quality of life.
Connecting with your loved one in later stages is still possible. While people at this stage of the disease will lose most of their ability to communicate, studies show that the person at their core still remains.
At this point, people living with dementia will require extensive care and attention. They will have difficulty eating, swallowing, and walking, and will be vulnerable to infections.
This can be a difficult time for families, as some will have to decide whether moving them into a professional care facility will be needed.
Self-care for caregivers
The demands of caregiving can be exhausting and overwhelming. It is important to take steps to ensure your own well-being. Here are a few basic tips on self-care for caregivers.
Watch your health
If you are experiencing severe stress, exhaustion, or loss of appetite, it is best to inform your doctor right away. Make a point to visit your physician at least once a year. Leaving symptoms unchecked could lead to the decline of your physical and mental health.
Exercise regularly
While finding time as a caregiver might be a challenge, putting in as little as 10 minutes each day, or 30 minutes every other day to get moving can go a long way.
You can also ask family members or friends to take over for this short time, or roll out an exercise mat while your loved one takes a nap.
Eat a balanced diet
Ensure that your meals have a balance of fruits, vegetables, grains, and lean protein. Cut down on processed food, as well as items that are high in saturated fat, cholesterol, and sodium. Also, ensure that you are staying sufficiently hydrated.
Keep up your life outside of caregiving
Caregiving can become overwhelming, especially as the person you are caring for goes into progressive stages of Alzheimer’s Disease / dementia. It can be easy to let caregiving become your full-time identity. But it’s important to remember that your life and long-term happiness matter deeply, and at some point your role as a caregiver for your loved one will end. While it can be tricky to navigate, maintaining a vibrant and independent life throughout your caregiving journey is crucial.
In conclusion
Navigating the realities of Alzheimer’s and dementia can be overwhelming for the person living with dementia, the caregiver, and family members. Knowing the facts, as well as the support and care that are available will allow you to go through the journey with confidence and compassion.