Elderly Dementia

Causes, Signs, Symptoms and More

Caring for an individual with elderly dementia can be challenging but the more you know about dementia, the better off you - and your loved one - will be.

Elderly dementia is the progressive loss of mental abilities - including memory, attention, language and problem solving - that is severe enough to interfere with a person's daily functioning.

It is not a disease itself, but a medical term to describe a group of symptoms that might accompany certain diseases or conditions.

The four main types of elderly dementia are: Alzheimer's Disease, Vascular Dementia (Multi-Infarct dementia falls under this type), Lewy Body Dementia and Frontotemporal Dementia.

You may also see dementia in diseases such as Pick's Disease, Parkinson's Disease and Creutzfeldt-Jakob Disease.

Dementia is often irreversible but the progression can sometimes be slowed by medications, physical activity and brain wellness activities.

Dementia can be reversible if caused by a brain tumor, thyroid or heart disease, infections, depression or substance/alcohol dependence.

Overview

Elderly dementia is a symptom of a disease process - whether that's Alzheimer's, Parkinson's or another disease - causing a gradual decrease in brain cells and functioning.

This causes issues with memory, reasoning, planning and can even change an individual's personality.

Although dementia can occur at any age, it is primarily experienced by the elderly. Approximately 40% of seniors over 80 years of age have some symptoms of dementia.

However, it's difficult to determine what is normal age related memory issues and what is elderly dementia.

Sometimes the term dementia is used incorrectly to describe other issues such as delirium, psychosis, depression and even side effects of medications.

The cost of dementia is enormous. Not from income loss for the elderly with dementia but for the caregivers, often adult children who take time away from work to care for their parents.

Causes

Elderly dementia is caused by brain cell death in the part of the brain responsible for thoughts, memories, actions and personality.

Although there are over 70 conditions that cause dementia, the most common cause is Alzheimer's Disease. Alzheimer's accounts for 50-75% of people with dementia.

Vascular dementia makes up about 5-30% of people with dementia. This type of dementia is caused by a decrease in blood flow to the brain, mostly due to small strokes (multi infarct dementia). These small strokes are also referred to as transient ischemic attacks.

Due to the nature of vascular dementia, the symptoms can appear more abruptly than Alzheimer's disease. Symptoms can also progress with the occurrence of additional strokes.

Conditions that can cause elderly dementia include:

Vasculitis from Syphilis
Lyme Disease
Subdural Hematoma
Subarachnoid Hemorrhage
Systemic Lupus Erythematosus
Parkinson's Disease
Hypercalcemia
Pick's Disease
Down Syndrome
AIDS
Lewy Body Dementia
Long Term Alcohol or Drug Use
Head Trauma
Hypothyroidism
Huntington's Disease
Brain Tumors
Creutzfeldt-Jakob Disease
Hydrocephalus

Signs and Symptoms

Individuals may have some or all of the following symptoms:

1) Memory Loss

Usually the first symptom to be noticed
They may begin to forget where they put their keys, etc.
It begins with short term memory loss
Long term memory can also be affected but usually in later stages
Disorientation is also related to memory and includes not knowing where the person is, who the person is or what time it is
However, they may retain a great deal of their skills and long-practised procedures. They may also retain highly positive or highly negative emotional feelings

2) Difficulty Planning

They may have difficulty planning activities or tasks

3) Difficulty with Language and Comprehension

They may be unable to understand instructions or longer complex sentences
In later stages, they may have difficulty forming thoughts into words
However, we should never assume that an individual with dementia is not aware of what is going on and what people are saying, even if they appear to be unaware

4) Poor Judgement

They may not fully understand the consequences of their actions
They may neglect their personal hygiene
Their behavior may change
An example of poor judgement is not dressing appropriately for the weather

5) Disoriented

They may not know the time of day, day of the week or recognize a location
They may be awake all night and take naps during the day

6) Decreased Attention Span and Increased Restlessness

They may lose interest quickly
They may start to wander
For example, they may start cooking something but become distracted and wander away from the kitchen

7) Personality Changes

They may become less interested in their hobbies
They may become more passive, depressed or anxious
They may have sleep issues
Their personality may change or they may exaggerate previous personality traits
They may become disinhibited and engage in destructive, inappropriate behavior
In later stages, they may have hallucinations, delusions and/or paranoia

8) Motor Changes

In later stages, they may be unable to perform motor movements such as walking safely

Types

There are many types of elderly dementia, including:

1) Alzheimer's Disease

Is the most common type of dementia and is the result of the loss of nerve cells that are vital for memory and other mental functions.

It is a progressive degenerative disease that currently has no cure. It affects both men and women.

Brain cells shrink or disappear and are replaced with dense plaque. Thread like tangles appear in existing brain cells which eventually kills the brain cell. Individuals with Alzheimer's have lower levels of brain chemicals that carry messages between nerve cells.

2) Vascular Dementia

Second most common form of dementia and is caused by a single or multiple strokes (also called infarcts).

A stroke is a loss of brain functioning due to loss/decrease of blood flow. They can be large or small and the damage depends on where in the brain they occur.

Is preventable since strokes can also be prevented. The main risk factors include: high blood pressure, narrowing of the heart arteries, heart disease, diabetes, obesity, smoking, and high cholesterol.

Symptoms vary depending on which part of the brain the stroke affects but may include language, vision and memory.

3) Lewy Body Dementia

The third most common form of dementia and accounts for 15-20% of dementia. Lewy bodies are abnormal circular structures found in the brain that have a dense protein core.

It shares features with both Alzheimer's disease and Parkinson's disease.

Little is known about how it develops or what are the risk factors.

Similar to Alzheimer's disease, it includes a progressive loss of language, memory, reasoning and other higher mental functioning.

Progression is more rapid than Alzheimer's disease and delusions and hallucinations are common for those with Lewy Body Dementia.

An individual with Lewy Body Dementia may have Parkinson's disease motor features such as rigidity/stiffness, tremors, stooped posture and shuffling gait.

4) Parkinsonian Dementia

Parkinson's disease is a slow progressive neurological condition that affects the brain cells that control muscle movement.

Features include rigidity/stiffness, slowness, tremors and difficulty with balance.

Movement is normally controlled by a brain chemical called dopamine, which carries signals between nerve cells. In individual's with Parkinson's, many of the cells that produce dopamine have died and the remaining cells cannot produce enough.

Some individuals with Parkinson's disease develop dementia. There are two types of Parkinson's dementia: 1) those with Lewy Bodies in the brain and brainstem and 2) those with Lewy Bodies in the brainstem and Alzheimer changes in the brain.

5) Mixed Dementia

Individuals can have a combination of dementias - usually Alzheimer's and Vascular Dementia.

It is thought that hypertension is a risk factor for both Vascular and Alzheimer's.

Individuals with mixed dementia have a higher frequency of depressed mood and difficulty with gait/movement.

Depression vs Dementia

It can be difficult to determine if an individual has depression or elderly dementia as the symptoms are similar.

However, it is important to differentiate the two as depression is often treatable and therefore the symptoms can be reversed.

Depression in the elderly is often unrecognized and undiagnosed.

Symptoms of depression include:

Sad hopeless mood daily for two or more weeks
Increased anxiety
Loss of interest in enjoyable activities
Feelings of low self esteem, worthlessness
Feelings of isolation
Sleep disturbance
Low energy

There are several depression screening tools that health care professionals may use, including: Geriatric Depression Scale and Cornell Scale for Depression in Dementia.

Delirium vs Dementia

Whereas elderly dementia is usually a slow gradual decline, delirium is an acute confusional state characterized by a sudden change in attention and cognition.

Approximately 33% of elderly in the hospital have delirium.

Causes of delirium include: presence of dementia, changes in electrolytes, organ disease, medication side effects, infection, injury, pain, stress, and being in an unfamiliar environment.

Prior alcohol use results in a threefold increase in the risk of delirium.

Medications are the most common reversible cause of delirium.

Mild Cognitive Impairment vs Dementia

Mild Cognitive Impairment (MCI) is used to describe individuals with memory loss but do not have elderly dementia.

This includes elderly who are experiencing short term memory loss but it does not affect their daily functioning.

It can be caused by aging and not any particular underlying illness or disease. Some believe that it is the early stages of Alzheimer's disease and most individuals with MCI will eventually be diagnosed with Alzheimer's.

It is thought that increasing mental stimulation (reading/word games) and physical exercise reduces the risk of MCI.

Diagnosis

Family, friends or health care professionals may suspect that someone has dementia based on what they observe.

Doctors can then do a full medical exam and history.

Family history of cerebrovascular disease can provide clues to the causes of the symptoms.

Simple tests assessing the seniors' cognitive abilities can track the progress of the elderly dementia.

If dementia is suspected, a complete review of medications and assessment of chronic diseases should be completed.

This will help rule out treatable causes of dementia such as vitamin b12 deficiency, hypothyroidism and others.

Sometimes significant events can trigger the onset of dementia, such as:

Traumatic event such as a loss of a spouse
An accident such as a motor vehicle accident or a broken hip
Major surgery under general anesthetic

Thorough Assessment and Diagnosis

Step One - Simple cognitive screen such as a Mini Mental Status Exam (MMSE) or Montreal Cognitive Assessment (MOCA) (both can be administered by either a Doctor, Nurse or Occupational Therapist)

Step Two - Full medical and chronic disease assessment by Doctor

Step Three - CT Brain Scan. This can assist with determining the cause of dementia and therefore treatment options. For example a brain tumor or small strokes - each resulting in different treatment options.

Possible Treatment

Whenever possible, treatment begins with treating the underlying diseases that are causing dementia.

1) Reversible Causes

This includes underlying causes that are nutritional, hormonal, caused by brain tumors and drug induced

2) Slowing Progress

This refers to elderly dementia caused by mini strokes (vascular/multi infarct dementia)
Reducing chances of further strokes includes smoking cessation, aspirin therapy and treatment of hypertension

3) Compensating

If dementia is detected early, then the individual may be able to use compensatory strategies such as a memory aid/book

Compensatory Strategies for Specific Cognitive Deficits

Decreased Orientation to Time - Encourage use of TV, newspaper, calendar, alarm for medication reminder, establish a routine
Decreased Orientation to Place - Encourage use of TV, newspaper, maps, diary, take familiar routes
Decreased Registration - Use one step instructions, decrease clutter, use physical cueing as well as verbal
Decreased Attention Span - Simplify instructions and the environment, decrease distractions
Decreased Short Term Memory - Encourage use of a calendar, diary, clocks and memory aids
Aphasia, Word Finding Problem and Poor Perception - Simplify the environment, explain tasks and the use of items
Decreased Perception - Help with writing cheques and bills, direct deposit banking, use video or audio tapes instead of writing letters

4) Medications

There are several drugs that may slow the progression of Alzheimer's including tacrine (Brandname: Cognex) and donepazil (Aricept). 40% of patients show a temporary improvement in cognitive ability
There are medications that are used to control delusions, hallucinations and paranoia - called anti-psychotics
Anxiety and agitation can be managed with medications such as Valium
Depression can be treated with antidepressants such as Prozac or Paxil
Medication should be used cautiously and in as low a dose as possible to reduce side effects

5) Behavioural

This type of treatment focuses on understanding and modifying the situation that triggers behaviours.

6) Modifying the Environment

This includes removing safety concerns such as knives, scatter rugs, etc.
It can also involve making a walking circle so the person with dementia can walk around the house or building in a circular path so they do not wander outside
This can reduce agitation and increase safety
There are a wide variety of ways to modify the environment including painting doors the same color as the walls to decrease the risk of an individual exiting the building

7) Increased Level of Care

In the later stages it may involve having the individual move to a seniors home that specializes in working with people with elderly dementia
This is in the best interest of the individual and the caregiver as it can be very stressful to provide care to someone with advanced stages of dementia

Prognosis

Prognosis can vary depending on the type of dementia.

Alzheimer's - individuals may live 1 to 20 years after diagnosis, on average 8 years.

Vascular dementia - death usually results from stroke, infection or heart disease.

Individuals with dementia do not usually die because of elderly dementia but to pneumonia or other health condition.

Prevention

There is no known way to prevent Alzheimer's.

For other elderly dementias, the only way to prevent them is to prevent the underlying cause.

For example, multi infarct dementia can be prevented by decreasing the risk of strokes such as smoking cessation and a healthy diet among many other factors.

Dementia is a Family Concern

Dementia affects families. Everyone in the family has to deal with the loss of the individual's memory, becoming disoriented and other symptoms of elderly dementia.

In the later stages, family members are the ones caring for their loved one who may not seem like the father/husband/wife/mother that they remember.

Caregiving for someone with dementia can be stressful and lead to caregiver burnout.

Tips for Families of Individuals with Elderly Dementia