Dementia: An Overview

Lesson Outline

Learn the basics of dementia, including causes, symptoms, stages, treatments, safety issues, caregiver wellness, supports, and how to promote brain health.

What is dementia?

Cognition is our ability to interact with the world around us, encompassing functions such as learning and memory, language, visual and spatial perception, executive function, and social function. When certain areas of the brain become damaged, one or more of these cognitive functions may be weakened. When this impairment is severe enough to affect a person's ability to function independently day-to-day, then they have developed dementia.

It's important to note that dementia-like symptoms, such as memory problems or confusion, can also result from reversible conditions like depression, delirium, vitamin deficiencies, concussions, medication side effects, drugs or alcohol, or other medical conditions. Therefore, seeing a healthcare professional to identify the underlying cause of memory and thinking problems is essential for an accurate diagnosis and the best treatment.

Learn more about cognition and dementia.

What is mild cognitive impairment?

As we age, some cognitive abilities gradually decline. We may not remember as much when learning new information, process things as quickly, or find it more challenging to learn complex tasks. However, we continue to make lifelong memories, and our vocabularies and wisdom may even improve into later life. These changes associated with normal aging are subtle and do not impact a person's ability to function independently. Mild cognitive impairment (MCI) is diagnosed when people, their families, or friends notice a decline in memory and thinking skills that impacts function, though they are still able to be independent.

Learn more about mild cognitive impairment.

Types of dementia

Dementias are most often caused by toxic proteins or blood vessel damage in the brain. The signs and symptoms can vary based on the cause and the area of the brain affected. Alzheimer disease is the most common cause of dementia. There can also be overlap or similarities between different types of dementia, and it is not uncommon for people to have mixed dementia, which is a combination of two or more disorders, such as Alzheimer disease and vascular dementia.

Diagnosing dementia can be challenging, as there is no single test to confirm it, and signs and symptoms may change over time. Early diagnosis is important, as knowing the likely cause of dementia can help predict its progression and identify appropriate strategies to improve the quality of life for those experiencing the condition.

Learn more about the different types of dementia.

Stages of dementia

Dementia is a progressive neurological disease often characterized by three stages: mild, moderate, and severe. As the disease progresses, a person becomes less independent and more impaired. In the mild stage, individuals may struggle with making decisions or learning new skills. In the moderate stage, the impairment increases, and the need for support grows. In the severe stage, care needs are very high, with issues such as incontinence, psychiatric symptoms, and responsive behaviours creating challenges for caregivers. Memory continues to worsen, and individuals may experience decreased movement and mobility, having trouble walking or standing without assistance.

In the most advanced stages, issues with eating and swallowing often lead to complications such as malnutrition, weakness, or aspiration pneumonia. People with severe dementia are likely to have more difficulties with verbal communication, making non-verbal communication increasingly important. Families can help by using advanced care plans and assisting with communication challenges. People with dementia often have a shorter life expectancy, with the cause of death frequently resulting from another acute illness, such as pneumonia, or complications from falls, such as hip fractures, rather than the dementia itself.

Treatment

Currently, there are no cures for the most common causes of dementia, such as Alzheimer disease. However, there are treatments that fall into two major categories: symptom management and disease modification. Symptomatic treatments aim to help maintain function by addressing cognitive problems, changes to personality and behaviour (also known as responsive behaviours), and mental health symptoms such as depression, anxiety, delusions, or hallucinations. Disease-modifying treatments attempt to stop or prevent the neurological damage caused by the disease. It is also important to be proactive in addressing factors that promote brain health, even after a diagnosis of dementia.

Learn more about how dementia is treated.

Behavioural, emotional, and psychiatric symptoms

The behavioural changes, as well as psychiatric signs and symptoms that often occur with dementia, can be particularly distressing for caregivers. Changes in behaviour may include agitation, repetitive calling out, sleep disturbances, and wandering. Emotional and psychiatric symptoms may include apathy, delusions, paranoia, hallucinations, depression, or anxiety.

Apathy, a lack of feeling, emotion, interest, and concern, is a result of changes in the brain, particularly in areas responsible for motivation and executive functioning, such as the frontal lobe and limbic system. These brain changes can reduce the ability to initiate activities, feel pleasure, or engage emotionally, leading to a lack of interest or motivation. Understanding that apathy is not a choice made by the person with dementia may help caregivers cope with it. Depression and anxiety can also affect a person's thoughts, behaviours, feelings, and sense of well-being.

For some people with dementia, talking about their feelings may be helpful. There are drug and non-drug treatments available for both depression and anxiety, and the healthcare team can help assess the best form of treatment.

Responsive behaviours

The behavioural changes associated with dementia are often called ‘responsive behaviours,’ as they may be responses to specific situations, interactions with particular people, physical sensations or emotions, or unmet needs. These behaviours may be uncharacteristic of the person's usual behaviour, such as aggressive behaviour in a typically gentle person. The responses result from changes in the brain that affect memory, judgement, orientation, mood, and behaviour. It's important for the health care team and care partners to try to assess if there might be pain, a medical illness, or other important changes that might be triggering the behaviours.

Several non-medication strategies can help, including avoiding places or situations that might trigger responsive behaviours, using distraction or changing the environment, being aware of body language and tone of voice, maintaining regular schedules and routines, and improving sleep. Healthcare professionals can help evaluate non-medication strategies and the benefits and risks of using medications for responsive behaviours. Generally, non-medication strategies are the first-line approach, as medications are not the most effective way of treating responsive behaviours and carry risks of adverse effects. It is important to carefully assess and review the risks and benefits of using medications with the person who has dementia and their substitute decision-maker if they are no longer capable of making their own decisions.

Home supports and safety

The impact on cognitive function means that many everyday tasks become risky for those with dementia. For example, if people lose the ability to recognize their environment, they may become disoriented, wander, and become lost. Driving is a complicated skill, and even mild cognitive impairment may render a person medically unfit to drive. Cooking and smoking can become fire hazards, and taking medications correctly may become challenging. Managing finances may also become difficult due to impaired judgement and planning abilities. Fortunately, many supports are available to help those with dementia who may be at risk.

Caring for the person with dementia at home

Caring for a person with dementia at home presents many challenges. Sometimes, the person with dementia may not be willing to accept care, and family caregivers may be reluctant to seek help even when feeling overwhelmed or experiencing burnout. It is essential to consider the needs of both individuals. Various types of help are available in the home and community, including support from healthcare professionals for services such as nursing care, physiotherapy, and counselling for incontinence and nutrition. Assistance with daily personal care tasks, such as taking medicines, bathing, dressing, and toileting, is also available. Homemaking activities, such as housecleaning, shopping, and paying bills, and end-of-life care, including advanced care planning, pain management, palliative care approaches, medical supplies, equipment, and respite care, may also be provided. As the disease progresses, needs will change, but supports are available throughout the various stages.

Promoting brain health and caregiver wellness

Research has shown that several actions can help promote brain health to prevent, delay, or slow the progression of dementia by addressing risk factors and building brain reserve. These actions include physical activity, weight management, a healthy diet, managing blood vessel health by monitoring and controlling blood pressure, cholesterol levels, and diabetes, avoiding smoking and excess alcohol, and maintaining cognitive and social activities. Other specific health conditions, such as depression, hearing and vision loss, sleep issues, and medication side effects, can also impact a person's risk of cognitive impairment.

Being a caregiver for a person with dementia is one of the most challenging roles in society. Caregivers are more likely to experience physical and psychological stress, anxiety, and depression. Key aspects of caregiver wellness include maintaining good health, taking regular breaks, finding support, avoiding social isolation, and understanding dementia better. With increased knowledge about dementia and practical and emotional supports, caregivers can lead the best lives possible.

Learn more about how to promote brain health.