What Is Dementia? Understanding Cognitive Decline

While normal aging may impact cognitive function even in healthy individuals, the diseases that cause major impairment often begin earlier in life and cause more severe cognitive decline as you age. Researchers recently characterized “major neurocognitive disorder” and “mild cognitive disorder” as new terms to associate with the blanket condition of dementia. Dementia may cause significant disruption, and palliative care may be required in the later stages of the disease's progression.

To understand dementia, it can be crucial to explore its signs and symptoms, underlying causes, and risk factors along with the basics of treatment. This can help to give caregivers some comfort when facing a common dementia diagnosis in a loved one. With a firm understanding of dementia, caregivers may learn to better navigate its complexities and patients may feel more prepared to manage different types of dementia throughout disease progression.

Overview: Dementia definition

Dementia is an umbrella term for the cognitive effects of degenerative neurological conditions affecting the brain and nervous system. It is characterized by serious memory problems and the loss of cognitive function that sometimes can mimic the symptoms of certain developmental disabilities after a point. 

While the normal aging process often involves some degree of cognitive deterioration, dementia causes a more rapid and drastic decline and often starts earlier in life. Dementia may affect memory, attention, language, and problem-solving. Over time, these neurodegenerative conditions may significantly impair a person's ability to function unassisted. Though there are common types of dementia and most types affect cognitive abilities and thinking skills, the disease can affect people differently.

Cognitive symptoms of dementia 

Dementia can affect the brain in unique ways. Symptoms that can signal dementia may be mild initially, worsening in frequency and severity over time, and, because the disease processes affect certain brain regions as it progresses, can include cognitive, psychological, behavioral, and physical changes. Below are some of the most common cognitive symptoms of dementia. 

Memory loss

Early dementia may make it difficult to use cognitive skills. People may struggle to remember new information or recall essential dates, while later stages of progressive dementias may interfere with the ability to remember important life events, people, language, and identity. In some cases, memory exercises may support slowing cognitive decline. However, because dementia is degenerative, this decline is often inevitable. 

Difficulty with complex tasks or abstract thinking

Dementia can impact one's ability to engage in high-level thinking, such as playing games or performing mental math. It may also eventually impact language skills and the ability to form understandable sentences. 

Disorientation

Individuals may become easily disoriented, forgetting where they are or how they got there. They may not recognize places, people, or familiar objects or could lose track of time, dates, and seasons. For example, a patient with a dementia diagnosis might have a familiar neighborhood trouble them because it feels suddenly unfamiliar.

Impaired judgment and reasoning

Dementia can interfere with decision-making and problem-solving capabilities. This interference may prompt irresponsible spending, susceptibility to scams or deceit, or inappropriate or unsafe choices.

Difficulty with language 

Individuals with dementia may become unable to express themselves effectively, remember words, or understand others. They may also use unusual words or say things that don’t make sense.

Psychological dementia symptoms

Dementia can change mood, as mood and personality are often controlled by the brain, like other bodily functions. Below are some possible psychological symptoms of the intellectual and developmental disabilities that come with dementia. 

Personality changes

Dementia may make individuals more or less agreeable. They may exhibit certain behaviors or tendencies that might have been uncharacteristic prior to the disease's onset. Some caregivers who were close to the individual before the onset of their condition may perceive that their entire personality has changed. 

Mood swings

People with dementia may be prone to fast, unexpected, or extreme changes in mood or affect, becoming angry or agitated more easily.

Paranoia

Those with dementia may have suspicious or paranoid thoughts about those around them, including family and caregivers. 

Anxiety

As cognitive impairment worsens, those with dementia may become less capable of making sense of the world around them, which may induce anxiety, insecurity, confusion, and fear. Over time, this can lead to other health conditions, such as high blood pressure.

Hallucinations

Parkinson's disease and Lewy body dementia may affect the brain's visual pathways, causing complex visual hallucinations. These hallucinations can be significantly distressing for patients and contribute to anxiety or paranoia. 

Behavioral symptoms

Below are potential behavioral symptoms people with dementia may experience due to their changing brains. 

Withdrawal

Dementia may cause individuals to retreat from social situations and lose interest in spending time with others or engaging in formerly enjoyable activities. 

Agitation

The confusion, anxiety, and distress caused by dementia may cause individuals to become agitated, restless, or irritable, causing them to pace, fidget, hit, push, or kick. Over time, this can cause symptoms similar to anxiety such as elevated blood pressure.

Repetitive behaviors

Memory issues may cause dementia patients to repeat themselves or forget they have already said or done something. They may also form fixations or obsessions about specific tasks or routines. When these obsessions are interrupted, they may become upset or distressed. 

Wandering

Individuals with dementia may be prone to episodes of wandering, which may pose a safety risk. They may walk away from their homes or care facilities, often believing they have somewhere to be. People may benefit from more frequent or residential care when they start wandering. 

Inappropriate behavior

Dementia can affect the brain's ability to filter thoughts, leading to inappropriate behavior, such as swearing, making unwelcome comments, or engaging in inappropriate sexual behaviors.

Physical symptoms

Below are some of the most common physical symptoms of dementia. 

Coordination challenges

Some types of dementia affect areas of the brain involved in balance and motor coordination, so individuals may progressively need more intensive assistance. At the end of the disease's progression, individuals may struggle to sit up, walk, eat, drink, or breathe. 

Muscle rigidity

Muscle rigidity is frequently seen in Lewy body dementia and Parkinson's, resulting in muscle stiffness and tightness. It may also cause shakiness and difficulty walking. 

Sleep disturbances

Adults living with dementia often experience sleep challenges, such as insomnia or waking up in the middle of the night. At some points in the disease's progression, they may sleep more often. 

Appetite and weight changes

Dementia may cause changes in appetite, food preference, and eating habits. These changes may contribute to weight loss or gain. 

Causes of dementia

There are several types of dementia, each caused by a different neurodegenerative disease. These diseases cause structural changes to the brain's neurons, impacting cognitive function. 

Alzheimer's disease

Alzheimer's disease is caused by a buildup of plaques and abnormal tangles of proteins called neurofibrillary tangles. This specific disease is the most common form of dementia. It often starts after age 40 but can begin earlier in early-onset Alzheimer's. As the most common dementia diagnosis, Alzheimer’s disease makes up 60-80% of dementia cases.

Frontotemporal disorders (FTD)

FTD disorders are a group of neurodegenerative disorders that affect the brain's frontal and temporal lobes. Characterized by personality and behavior changes, these conditions are caused by a loss of neurons and a buildup of proteins in the brain thanks to the underlying disease processes.

Vascular dementia

Vascular dementia is caused by brain damage from vascular conditions like strokes, brain hemorrhage, and narrow or damaged blood vessels. 

Lewy body dementia 

Lewy body dementia is caused by abnormal deposits of alpha-synuclein, a protein in the brain. Lewy body dementia may sometimes accompany Parkinson's disease. 

Other causes of dementia

Other conditions that cause dementia include Creutzfeldt-Jakob disease, Huntington’s disease, and HIV-associated dementia. 

Parkinson’s disease

Parkinson's is a progressive neurological disorder characterized by problems with motor control. In later stages, it may cause dementia. 

Risk factors for developing dementia

Several factors may elevate the risk of dementia. Some risk factors can be mitigated through lifestyle interventions, while others cannot. 

Age

Age is the strongest known risk factor associated with dementia. The probability of developing dementia increases substantially with age. Though many begin exhibiting symptoms in middle age, the risk rises significantly after 65. However, it may be possible to slow the aging process through exercise, nutrition, adequate sleep, and stress management. Despite these efforts, all forms of dementia are degenerative. 

Lifestyle factors

While a healthy lifestyle can slow the aging process and lower the risk of dementia, unhealthy lifestyle habits are an important risk factor. Smoking, drinking too much alcohol, using substances, maintaining a poor diet, and inactivity can substantially increase your risk of developing dementia. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

Metabolic disorders

Metabolic disorders like diabetes are known to be a risk factor for several types of dementia, including Alzheimer's and vascular dementia. Poor diet can interfere with the healthy functioning of the metabolism, which controls blood sugar levels. Elevated blood sugar causes inflammation, damaging the heart and brain. Over time, this damage may lead to dementia.

Genetics

Genetics may play a role in the development of dementia. In some cases, your genetic makeup, such as the presence of rare genetic variants,  may increase your risk of developing dementia, while in others, it may be inevitable. A family history of dementia can often indicate a higher risk of dementia. Genetic tests can help to identify these risks and make early diagnosis possible.

Traumatic brain injuries

Traumatic brain injury may be a risk factor for developing Alzheimer's, particularly in severe or repetitive brain injury cases. Brain injuries can lead to an abnormal buildup of proteins, elevating the risk of certain types of dementia including chronic traumatic encephalopathy (CTE). 

Trauma and post-traumatic stress disorder (PTSD)

According to studies, people with a history of complex traumatic events or a diagnosis of PTSD are almost two times as likely as others to develop forms of dementia in older adulthood. 

How do I get dementia diagnosed?

Visiting a primary care doctor is typically the first step in the diagnostic process. During that initial visit, your care provider may perform a physical exam and ask you questions about your health history and recent symptoms. Your provider may also order blood tests and other laboratory tests to check levels of various chemicals, hormones, and vitamins in the body. Doctors may also perform cognitive and neurological tests to assess functioning or brain scans to identify strokes, tumors, or changes to the brain’s structure and function. It is incredibly important to get a proper diagnosis of dementia as early as possible to slow progression.

Treating and managing dementia

Dementia may require significant involvement from an individual's medical providers and support system. In addition to pharmaceuticals aimed at slowing the disease's progression and managing its symptoms, individuals with dementia require consistent support to ensure health, safety, and quality of life.

In its early stages, it may be possible for individuals to manage dementia independently. Research into the efficacy of "brain training" activities is limited. However, evidence suggests these cognitive exercises may improve symptoms or slow mental decline. 

However, as the disease progresses, individuals may require palliative care from family, friends, or care professionals. This care may involve tending to patients' needs, ensuring they stay active and engaged, and keeping them safe. In its later stages, caregivers may need to ensure basic needs are met, such as bathing, dressing, and eating. 

Caregiver support

Dementia may place significant strain on caregivers. The constant demands of caring for a person with dementia may place significant stress on caregivers, who may have to take on the significant responsibility associated with round-the-clock care and support. Additionally, family caregivers may experience complex emotions and grief as the disease progresses.

In addition to education about how to care for a person with dementia effectively, caregivers may find value in seeking support for their own mental and emotional health. Caregiver support groups, online forums, and mental health treatment may provide relief, understanding, and wisdom as individuals adjust to their role as caregivers and encounter challenges and obstacles. 

Therapy for caregivers

Both individual and group therapy may be a vital source of mental health support for caregivers. Therapy can be a place to vent, work through complex thoughts, and learn to manage the emotional and mental toll of caring for a loved one. Cognitive-behavioral therapy, for example, has been proven effective in helping clients cope with the emotional effects of being a caregiver. 

In some cases, caregivers may face barriers to quality in-person treatment. When these barriers occur, online therapy through a platform like BetterHelp may be of value. Through an online platform, you can choose an appointment time that fits your schedule, including outside of standard business hours. In addition, you may be able to send messages to your therapist throughout the week, with responses when they are available. 

Studies also back up the effectiveness of online therapy. Online CBT has been proven as effective as in-person therapy. Some studies have indicated that it may also reduce the impacts of burnout, anxiety, and depression on clients.