According to the Mental Health Foundation (MHF), dementia is a term used to describe a range of conditions that affect the brain. It’s caused when the brain is damaged by diseases, such as Alzheimer’s, or by a series of strokes. Dementia mainly affects people over 65, and the likelihood of developing it increases with age. If you, or someone you care about, has recently been diagnosed with dementia, you may feel overwhelmed by different emotions. You may be shocked, afraid of the future, or sad about changes you may have to make in your life or things you may miss out on. You may even feel relieved that your symptoms have an explanation.
Dementia affects everyone differently. It usually gets worse over time. Common symptoms include:
- memory loss
- difficulty with concentrating, planning, or organizing
- language difficulties, such as problems finding the right word or following a conversation
- visual perception problems, such as judging distances or seeing objects in three dimensions
- orientation problems, such as losing track of the day or date or getting lost in familiar places
For example, people with dementia may have mood changes, becoming irritable, tearful, anxious, depressed, or agitated. In the later stages, they may experience physical symptoms such as muscle weakness, weight loss, and changes in appetite and sleeping habits. Some of these symptoms have other causes, such as stress, depression, dehydration or even a urinary tract infection. Speak to your doctor so you can get the right treatment.
Memory Loss and Dementia
According to the Better Health Channel, there is a difference between memory loss as a normal part of aging and memory changes seen as a symptom of dementia. Normal forgetfulness may include misplacing the car keys or walking into the kitchen and forgetting why you went there. The person with dementia may lose the car keys and then forget what they are used for. Memory loss in a person with dementia is persistent and progressive (it continues to get worse), not just occasional. It may affect a person’s ability to continue to work or carry out familiar tasks. It may mean having difficulty finding the way home. Eventually, it may mean forgetting how to dress or how to bathe.
The loss of memory can progress and affect the memory of:
- events – the person may forget part or all of an event
- words or names – the person progressively forgets words and names of people and things
- written and verbal directions – the person progressively loses the ability to follow directions
- stories on TV, in movies, or in books – the person progressively loses the ability to follow stories
- stored knowledge – over time, the person loses known information such as historical or political information
- everyday skills – the person progressively loses the capacity to perform tasks such as dressing and cooking.
Some key points about normal forgetfulness include:
- As we get older, the most common change that we complain about is memory change.
- Memory change associated with healthy aging doesn’t interfere with everyday life in any dramatic way.
- Everyone is different and the effect of getting older on memory is different for each person.
- Research suggests that while you do lose some nerve connections in the brain, it is possible to grow new nerves and maintain the functions you have by exercising your mind.
- Research also suggests that immediate memory and lifetime memory do not change as we get older.
Working Memory Changes in Dementia
- avoiding stressful situations – providing emotional support, reducing background noise and distractions, and exercising can all help to reduce stress and improve memory
- maintaining a regular routine – keeping to a routine can help with a sense of security and reduce confusion
- trying memory aids – using memory aids like lists, diaries, and clear written instructions can help if the person with dementia is happy to use them.
Depression in Dementia
Depression makes it harder for a person with dementia to remember things and enjoy their life. Depressive symptoms have been reported to occur in approximately 40 to 50 percent of people with Alzheimer’s disease. People in long-term residential care appear to be particularly at risk of depression.
Other things that may contribute to a person’s depression include:
- the side effects of medication
- reaction to a diagnosis and the perceived impact on lifestyle
- physical illness
- social isolation
- environmental factors, such as the inability to screen out unwanted stimulation like loud noises and crowds.
Depression may make it harder for a person with dementia to remember things and enjoy their life. It can also add to the difficulty of caring for someone with dementia.
Symptoms of Depression in Dementia
It can be very difficult to know if a person with dementia is depressed. Because many of the symptoms of dementia and depression are alike, it can be difficult to tell the difference.
Some of the typical signs of depression in dementia are:
- loss of interest and pleasure in previously enjoyed activities
- lack of energy
- poor sleep
- loss of appetite and weight
- expressing feelings of worthlessness and sadness
- being unusually emotional, tearful, angry, or agitated
- increased confusion.
Treatment for Depression in Dementia
If you suspect that depression may be affecting a person with dementia, speak with the person’s doctor, who will be able to carry out a thorough examination to rule out other medical problems. Medication such as an antidepressant may be prescribed and can be very helpful in improving the symptoms of depression. It may also improve appetite and sleep problems. The doctor can also arrange for any appropriate referrals or for specialized psychiatric assessment. Treatment can significantly improve the person’s mood and ability to participate in activities. It is important to investigate and treat depression, whenever it is suspected. Antidepressants can have side effects that should be discussed with the doctor before starting treatment. If it causes side effects, the medication may need to be changed. If the medication is ineffective, it should not be continued. Usually, a trial of at least two weeks of treatment is necessary to tell how useful the medication is going to be.
Managing Depression in Dementia
Some suggestions for dealing with depression in a person with dementia include:
- Try to keep a daily routine for the person with dementia.
- Incorporate daily exercise, because this has been proven to have a positive impact on symptoms of depression.
- Limit the amount of noise and activity in the environment if this causes a problem. This will help avoid overstimulation.
- Large group situations can make some people feel worse, while others may benefit from the stimulation of a busy, active gathering. It is important to know what the person has enjoyed in the past because it is likely that similar activities will still appeal.
- Have a realistic expectation of what the person can do. Expecting too much can make both the person with dementia and the caregiver feel frustrated and upset.
- Be aware of when the person is usually least tired and do any important tasks at that time.
- Be positive. Frequent praise will help both the person with dementia and the caregiver feel better.
- Include the person in conversation to the extent that they feel comfortable.
Psychosis and Dementia
People with dementia sometimes experience a range of conditions in which they do not experience things as they really are. Although hallucinations and delusions are imaginary, they seem very real to the person experiencing them and can cause extreme anxiety, paranoia, and even panic. Some people can also misidentify other people or themselves. For example, they might feel frightened when they cannot recognize their reflection in the mirror. Speak with the person’s doctor about potential medications. Antipsychotic medications sometimes used to treat these disorders can have side effects such as stiffness, shakiness, or drowsiness. Newer antipsychotic medications have fewer side effects but can still cause drowsiness. Sometimes, where delusions and hallucinations are causing a major problem, a trial of medication may be appropriate.
Things that you can do to help manage hallucinations and false ideas in dementia include:
- Do not argue – it is better to acknowledge that the person may be frightened by delusions and hallucinations.
- Do not scold the person for losing objects or hiding things.
- Investigate suspicions to check their accuracy.
- Attempt to distract the person if possible.
- Try to respond to the underlying feelings that may be at the bottom of the statements that the person makes.
Controlling the environment of the person with dementia can also help. For example, try to maintain a familiar environment and routines, increase the lighting around the house and use night lights. Some hallucinations and delusions can be ignored if they are harmless and do not cause the person to become agitated. Do not take accusations personally and be aware that the person is not able to control this behavior.
Dealing with dementia-related behaviors day in and day out is not easy. It is essential that you seek support for yourself from an understanding family member, a friend, a professional, or a support group. Remember that you are not alone.
This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.