CLINICAL TOPICS

Dementia

Overview

Incidence and Prevalence

Signs and Symptoms

The symptoms of dementia can be different depending on the diagnosis and the stage of the disease. Although late-stage signs and symptoms may be similar across etiologies, characteristic early symptoms can vary considerably. For example, individuals with frontotemporal dementia and Huntington's disease experience behavior changes and depression; those with primary progressive aphasia experience gradual loss of language function but relatively well-preserved memory; and individuals with Binswanger's disease (a type of vascular dementia) experience stroke-related neurological symptoms, including dysarthria and dysphagia (Hegde, 2006). Cultural values, views of the aging process, and beliefs relative to cognitive decline may influence a family's decisions about therapeutic services and may at times inhibit or delay seeking help until symptoms are beyond early or mild stages (Hart, Gallagher-Thompson, Davies, DiMinno, & Lessin, 1996).

Signs and Symptoms

In general, individuals with dementia experience a gradual loss of memory and other cognitive functions. As the disease progresses, early symptoms intensify, eventually affecting the ability to communicate effectively and function independently. Examples of common signs and symptoms of dementia are listed below.

Attention

Common attention deficits include

  • being easily distracted,
  • having difficulty attending, unless input is restricted/simplified,
  • experiencing decreased information-processing speed-thinking/processing takes longer than usual.

Learning and Memory

Common learning and memory deficits include

  • episodic memory deficits, including difficulty remembering specific autobiographical events, situations, and experiences;
  • short-term/working memory deficits—rapid forgetting of information recently seen or heard;
  • difficulty acquiring and remembering new information (e.g., appointments or events, new routines).

Reasoning and Executive Functioning

Common reasoning and executive functioning deficits include

  • difficulty setting goals and planning, including reliance on others to plan activities and/or make decisions;
  • poor judgment and impaired reasoning and problem-solving abilities, such as making decisions without regard to safety;
  • difficulty multi-tasking and handling complex tasks—need to focus on one task at a time;
  • difficulty responding to feedback, self-monitoring, and correcting one's own errors;
  • lack of inhibition;
  • lack of mental flexibility.

Perceptual Abilities

Common perceptual deficits include

  • difficulty completing previously familiar activities or navigating in familiar environments;
  • inability to recognize familiar people, common objects, sounds, etc.;
  • inability to find objects in direct view, independent of visual acuity.

Language

Common language deficits include

  • less concise (empty) discourse with fewer ideas;
  • economy of utterances and stereotypy of speech;
  • repetitious/perseverative language (e.g., asking the same question repeatedly);
  • word-finding difficulties, including long latencies, paraphasias, and word substitutions;
  • difficulty recalling names of family and friends;
  • tangential language;
  • circumlocution;
  • grammatical errors, including omission or incorrect use of articles, prepositions, auxiliary verbs, etc.;
  • use of jargon and loss of meaningful speech;
  • difficulty following and maintaining conversation;
  • in bilingual patients, errors in selecting and maintaining appropriate language during conversation (Friedland & Miller, 1999);
  • regression to primary language in bilingual patients (Mendez, Perryman, Pontón, Cummings, 1990);
  • language comprehension deficits;
  • difficulty following multi-step commands;
  • impaired ability to compose meaningful written language;
  • reading comprehension difficulties.

Social Cognition and Behavior

Common social cognition and behavior deficits include

  • inappropriate behavior outside of socially acceptable range,
  • inability to read facial expressions and other social cues,
  • loss of empathy,
  • mood fluctuations, including agitation and crying,
  • restlessness,
  • depression,
  • negative reaction to questioning,
  • combativeness/hostility/aggressiveness,
  • compulsive or obsessive behaviors,
  • erratic or strange behaviors,
  • loss of initiative/motivation,
  • paranoia and delusions of persecution.

Impact of Cognitive Changes

Communication

Cognition and language are intrinsically and reciprocally related in both development and function. An impairment of language may disrupt one or more cognitive processes (e.g., attention, perception, memory, and executive functioning) and, similarly, an impairment of one or more cognitive processes may disrupt language and affect the individual's ability to communicate effectively.

Individuals who forget what they have recently heard, seen, or thought may have difficulty following a conversation; they often lose track of the topic, miss the point, and/or repeat themselves. With more significant memory decline, individuals may become disoriented to time and place and have difficulty remembering recent events. Verbal output may be reduced and less substantive, and they may become less efficient in expressing information. Attention, executive functioning, and processing deficits can affect the ability to actively engage in conversation, keep track of topic changes, and process information accurately and in a timely manner.

Feeding And Swallowing

In addition to the effects of neuromuscular and/or motor planning deficits associated with some conditions, the cognitive decline associated with dementia can impact feeding and swallowing. Individuals with dementia may forget to eat meals, initiate eating less often, or take in less food and drink than they normally would during meals, due to distractions in the environment. Reduced intake may eventually compromise nutrition. In addition, individuals with dementia may not attend to food in the mouth or may not remember to chew and initiate a swallow, placing them at risk for choking and aspiration pneumonia (Bourgeois & Hickey, 2009).

Causes

Roles and Responsibilities

Assessment

Treatment

Resources

References

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