All information about dementia: Symptoms, causes, treatment

Dementia initially affects the short-term memory in particular, later the long-term memory is also disturbed. / Dementia: symptoms, causes, treatment…

Doctors distinguish between primary and secondary dementia. The latter is rarer but often treatable. How to recognize dementia, what forms there are and which therapies can help.

Dementia is the generic term for various clinical pictures that are associated with a loss of cognitive abilities. The word dementia derives from the Latin “demens” and means “away from the mind” or “without mind”. In the case of dementia, the short-term memory is initially disturbed, and later the long-term memory as well. In the late stages, people suffering from dementia are dependent on around-the-clock help in everyday life and care.

The most common form of dementia is Alzheimer’s disease. This causes nerve cells in the brain to die. This also answers the frequently asked question about the difference between Alzheimer’s and dementia. The answer is: Alzheimer’s is a form of dementia. Theoretically, various forms of dementia can be distinguished from one another (see below). In reality, it is often more complicated to make a diagnosis, since mixed forms also occur.

Dementia simply explained:

Primary dementia is a separate disease that originates in the brain. The most common primary dementia is Alzheimer’s disease.
Secondary dementia occurs as a result of another disease (e.g. alcohol addiction).

All forms of dementia involve deterioration in memory and/or other brain functions. Personality changes can also occur.

There are different forms of dementia

Experts refer to all types of dementia that originate in the brain as primary dementia. These are – up to now incurable – diseases that are associated with the death of nerve cells.

These include, for example:

Alzheimer’s disease, in which nerve cells and the connections between them gradually die, causing the brain to shrink.
vascular dementia (due to circulatory disorders in the brain),
Frontotemporal dementia (here nerve cells in the frontal and temporal lobes of the cerebrum gradually die. These are areas that control emotions and social behavior, among other things),
and Lewy body dementia (in which protein residues are deposited in the nerve cells of the cerebral cortex).

Only around ten percent of dementias are secondary dementias. This means that they are caused by medication (such as psychotropic drugs, antidepressants or antiepileptic drugs), severe vitamin deficiency (e.g. vitamin B12) or other diseases. Examples of this are thyroid disorders, depression or alcohol addiction. Depending on the cause, memory disorders can be treated here.

Another classification refers to the brain area where dementia occurs:

cortical dementia and
subcortical dementia

Cortical dementia means changes in the cerebral cortex (cortical) as they occur in Alzheimer’s dementia or frontotemporal dementia. Damage below the cerebral cortex and in the deep brain layers (i.e. subcortical) occurs, for example, in subcortical arteriosclerotic encephalopathy. This is a form of vascular dementia. It is not uncommon for patients to develop mixed forms. Therefore, the division into primary and secondary dementias is clearer.

Dementia: causes

Most dementias are primary dementias. This means that their origin lies in the fact that nerve cells die off in the brain. The cause of this depends on the form of dementia and in some cases of dementia has not been finally clarified.

Possible causes of the most common forms of dementia:

The risk of dementia generally increases with age. Those affected are usually older than 65 years.

Rarely is dementia hereditary. For example, a genetic change can lead to the formation of so-called plaques (deposits) in the brain that promote Alzheimer’s.

Heavy alcohol consumption can promote the development of dementia because it can damage blood vessels and increase blood pressure. Both increase the risk of vascular occlusions and circulatory disorders and thus of (vascular) dementia.

Vascular dementia develops when parts of the brain can no longer be supplied with sufficient oxygen-rich blood and are damaged as a result. The most important causes are therefore factors that increase the risk of vascular diseases, vascular occlusions and circulatory disorders. It can also develop after a stroke. If a vessel is blocked, ruptured or bursts, the brain no longer receives sufficient blood flow and nerve cells die.

Dementia: Symptoms

In the long term, those affected lose their mental abilities. The other symptoms that occur depend on the type of disease. Don’t worry: clumsy things like forgetting the key to the apartment, misplacing your glasses again and again or general memory problems in old age do not have to be the first signs of dementia.

But how can dementia be recognized?

The early symptoms include not only that the affected person’s memory decreases, but also the dwindling of his cognitive abilities. Depending on the form and course of dementia, various symptoms can occur. Sufferers forget what they recently did (e.g. had lunch) or said. And they find it difficult(er) to cope with simple everyday things that previously did not cause them any problems. Examples of this are maintaining a bank account or managing one’s own household independently.

Disorientation problems can also be signs of dementia. For example, those affected can no longer find their way around easily in their own environment or get lost on their way home from the supermarket.

Other possible symptoms are language and word finding problems. People with dementia can no longer remember even simple terms, making conversations with them increasingly difficult.

Many struggle with fatigue and sleep problems. The sleep pattern of people with dementia often changes – they often doze off during the day and have trouble falling asleep in the evening despite early tiredness. At night, the REM phases are shortened and you can hardly get into deep sleep. It is not uncommon for the day-night rhythm to reverse over the course of the disease.

Even typical behaviors and personality can change: Some people with dementia become listless, lethargic, fearful or spiteful, aggressive and have outbursts of anger. Others withdraw and no longer participate in social life as they did before.

Those affected often deny mistakes and their declining abilities and do not want to admit the illness.

Specific Alzheimer’s Symptoms

In people with Alzheimer’s disease, the brain shrinks. Those affected initially have problems with their short-term memory.

You forget essential things (“What did I eat earlier?” “What was just said in the conversation?”) and find it difficult to concentrate. Things are put in unfamiliar places (e.g. the toothbrush in the fridge).

Striking word-finding disorders and orientation difficulties are also among the early symptoms of Alzheimer’s. Affected people forget names or can’t find their way back home from the supermarket. Later, the temporal orientation also becomes a problem.

Many Alzheimer’s patients have trouble recognizing smells.

As Alzheimer’s disease progresses, long-term memory declines and distant events fade. Those affected hardly remember the past and even no longer recognize people close to them such as spouses, children or best friends.

In the late stages, Alzheimer’s patients break down extremely. They need help day and night.

Specific symptoms of vascular dementia

Vascular (affecting the blood vessels) dementia is a form of dementia in which there are problems with the blood supply to the brain – especially in the small vessels. It can progress in phases or appear very suddenly after a stroke.

Whether and which symptoms appear depends on the type and location of the damage in the brain. The signs usually appear earlier compared to Alzheimer’s. However, the long-term memory of those affected is preserved longer.

Even in the early phase of vascular dementia, some find it difficult to listen carefully, speak coherently, find the right words and orient themselves, which means that those around them quickly perceive them as confused. There is also fatigue and mood swings.

Due to the brain damage, patients sometimes switch quickly between laughing and crying – even without feeling the associated emotions.

They often find it difficult to concentrate, they have difficulty with simple everyday things that previously gave them no problems. For example, they can no longer manage their household or their banking transactions independently.

Your judgment may decrease.

Sometimes they feel listless to the point of apathy.
Later, neurological deficits such as unsteadiness when walking, slowing down and disturbances of various reflexes can occur. Those affected tend to fall. Numbness and paralysis can also be symptoms of vascular dementia. Those affected lose control of their bowels and bladder. Visual disturbances and depression are common.

Frontotemporal dementia symptoms

Frontotemporal dementia (Pick’s disease) focuses on behavioral and personality changes.

People affected by this are typically easily irritable, aggressive and behave in an uncontrolled and unpleasant to embarrassing manner.

As the disease progresses, memory and speech disorders occur.

Lewy body dementia symptoms

In Lewy body dementia, protein residues are deposited in the nerve cells of the brain.

This form of dementia leads relatively quickly to severe symptoms such as hallucinations and delusions. Affected people see people or animals that are not there. Auditory hallucinations occur less frequently. People with dementia “hear” tones, melodies or voices that nobody else hears.

Your alertness and alertness change rapidly and dramatically throughout the day. Those affected are fit and alert, then again apathetic, confused and disoriented. Memory declines (but not as quickly as in Alzheimer’s dementia). Patients scream, talk, or move while sleeping.

Many sufferers also have Parkinson’s symptoms. Typical symptoms include increased muscle stiffness (rigor), trembling hands when resting (tremor), slowing of movement (akinesia) and a tendency to fall. Some sufferers develop depression or fall into long periods of deep sleep.

Symptoms such as speech and swallowing disorders appear later.

Dementia: course

Dementia progresses differently in each person, which is why there can be no general prognosis. In addition, the course of the disease differs depending on the form of dementia. While vascular dementia usually worsens in stages, Alzheimer’s dementia can be broken down into three stages that flow into one another.

The MMST (Mini Mental Status Test), which is also used in clinical studies as a criterion for defining the severity of dementia, is used for the rough classification.

Let’s take as an example Alzheimer’s dementia, which accounts for two thirds of the cases:

In the first stage, the person suffering from Alzheimer’s dementia is aware of the gradual mental deterioration. He forgets a lot, can no longer learn new things well and his ability to react decreases. Things are put in unfamiliar places (e.g. the toothbrush in the fridge). Mood swings, social withdrawal and language difficulties are typical. The ability to orientate decreases – both temporally and spatially. It is extremely frightening for those affected to notice the first symptoms. Many react ashamed to aggressively.

Medium stage: The symptoms mentioned increase and it becomes more and more difficult for those affected to cope with everyday life on their own. They can no longer dress or wash themselves and now need help. The language works increasingly poorly as a means of communication, it becomes indistinct. More and more often, relatives lack the meaning behind the fewer and fewer words. The sense of time and the ability to orient oneself now disappears completely. People with dementia can no longer control their emotions. Mood swings increase. Depending on the type and situation, they can lead to aggression and depression.

Final Stage Dementia: In the final stage, Alzheimer’s dementia sufferers are completely dependent on care and support. You no longer recognize even loved ones, you can no longer communicate. They find it increasingly difficult to walk. There are also swallowing disorders. Many can no longer control their bladder and bowels. Occasionally, epileptic seizures occur. If a patient is bedridden, the dementia usually worsens quickly. In addition, infections such as pneumonia often follow, from which those affected can die.

Many Alzheimer’s patients and their relatives are concerned about life expectancy with dementia: Depending on when the diagnosis is made, it is three to ten years – from the first symptoms to the death of the patient.

Dementia: Diagnosis

In order to diagnose dementia, the family doctor will first talk to the patient in detail – and, after consultation, possibly also to their relatives. For example, he asks the person concerned:

How well can you remember something?
Has your mood and behavior changed?
Do you take any medication, and if so, what kind?
Do you suffer from previous illnesses?
A physical exam and blood tests follow to rule out other causes of the symptoms. Such as secondary dementia due to severe vitamin B12 deficiency or thyroid dysfunction.

There are also neurological (relating to the nervous system) checks and imaging procedures such as MRI (magnetic resonance imaging). Positron emission tomography (PET) or single photon emission computed tomography (SPECT) is indicated rarely, for example when Lewy body dementia is suspected. These nuclear medicine examinations provide information about metabolic and protein changes in the brain.

If Alzheimer’s is suspected, a liquor diagnosis, i.e. an examination of the cerebrospinal fluid, can provide clarity.

Important to know: A statement can only be made as to whether and what form of dementia it may be if discussions, tests and examinations are combined.

Which doctor?

If dementia is suspected, the family doctor is the first point of contact. If the fear that dementia is likely is confirmed, the doctor will recommend an appointment with a neurologist or a specialist in neurology and/or psychiatry. Many clinics also have memory outpatient clinics and consultation hours that specialize in diagnosing and treating dementia.

Since dementia can be extremely distressing for those affected and their families, doctors advise that specialists be consulted at an early stage to prevent the disease from getting worse.

Dementia: Early detection

An important component of the early detection of dementia is the examination by the family doctor or in a memory clinic. Neuropsychological dementia tests also record the brain performance of those affected and provide information as to whether dementia is present and, if so, how severe it is. Important: Each test is just one piece of the puzzle to approach the diagnosis.

A test recommended in the guideline is the Montreal Cognitive Assessment Test (MoCA). It tests orientation, memory, language, attention as well as self-regulation and control of behavior.

For example, the person to be tested should draw a circle and place the twelve digits of a clock. Then he should enter a certain time with the hour and minute hands in the clock (dementia clock test). This task is only successful if the patient has the necessary cognitive performance (remembering, visual orientation, etc.). An indication of the onset of dementia is when the patient marks the hour hand correctly but places the minute hand incorrectly.

Or the test person has to remember four words that are repeated after a while. There are also simple arithmetic problems. Or he should say what the date is today and name as many words as possible that begin with “K” within one minute.

Depression tests are also used for early detection.
In order to rule out other causes of the symptoms such as a tumor or cerebral hemorrhage and to look for signs of circulatory disorders, imaging procedures such as computed tomography (CT) or nuclear spin tomography (MRI) are standard if dementia is suspected. For example, experts can use MRI images from a magnetic resonance imaging (MRI) scanner to see whether the brain has shrunk in certain areas. If vascular dementia is suspected, the doctor will arrange for an ultrasound examination of the vessels in the neck.

Dementia: Treatment

The earlier dementia therapy begins and the better it fits into everyday life and the patient’s inclinations, the higher the chances of success in delaying the progression of dementia. But: primary dementia cannot be cured. Existing brain damage cannot be reversed. The treatment focus is on the best possible quality of life for the person concerned.

Whether and which drugs are suitable depends on the form and severity of the dementia. Certain medications can alleviate and slow down the symptoms.

Especially in Alzheimer’s disease, there are two drugs that can slow down the loss of memory (anti-dementia drugs):

Acetylcholinesterase inhibitors inhibit the enzyme in the brain that breaks down the neurotransmitter acetylcholine, which is important for the communication between nerve cells. Alzheimer’s patients make too little of it. Therefore, the drug helps in the early stages of the disease to improve brain performance and to keep it longer.

Memantine, a glutamate antagonist, is used in the later stages. It blocks the docking sites in the brain for the neurotransmitter glutamate, of which people with Alzheimer’s often have too much. The result: nerve cells perish. Memantine can protect those affected from irreversible damage.
Important: The doctor must regularly check whether acetylcholinesterase inhibitors and memantine help the person concerned. Possible side effects of the medication include dizziness, headaches and gastrointestinal problems.

There is also evidence that tablets with a special extract from ginkgo leaves (Ginkgo biloba EGb761) can improve memory in people with dementia.

People with dementia often develop depressive moods. If this is the case, the attending physician can prescribe mood-enhancing and drive-enhancing antidepressants.

If people with dementia suffer from hallucinations, paranoia or if their behavior changes and they become aggressive and restless, neuroleptics can help for a short time.
In people with vascular dementia, it is important to prevent further vascular damage. If the fat levels are high, the doctor can prescribe lipid-lowering drugs. Elevated blood pressure also needs to be controlled.

An important part of the treatment of dementia are also therapies that promote memory, maintain skills, strengthen self-confidence and help to cope with everyday life. Depending on the symptoms, this includes the following approaches:

Special memory training that neither under nor overwhelms those affected. This includes autobiographical work – for example, the caregiver looking at photo albums with the person with dementia to remember the past. The pictures should be captioned as a reminder.

behavior therapy
occupational therapy
speech therapy
Accompanying psychotherapy

Reality orientation with aids (such as notes or labeled photos) and the dementia-friendly design of the home (also called milieu therapy)
Physiotherapy and gait training
music therapy
toilet training
Despite all the support options, at some point people with dementia will no longer be able to cope with their everyday life on their own. They need support and care. Important questions to be answered are, for example: What help does the person concerned need and who can provide it? Is care at home an option and what are the alternatives?

Dealing with dementia

Diagnosis of dementia – what should I do now? Once dementia has been diagnosed, it is initially a shock for patients and their families. After all, primary dementia cannot be cured. Those affected and those around them have to learn to live with the fact that their own performance or that of a loved one will gradually decrease.

Support and advice on the subject of dementia and how to deal with it are offered, for example, by the long-term care insurance funds, long-term care support bases, charitable associations, consumer advice centers or social and health authorities.

Many memory outpatient clinics at large clinics also organize informational lectures for dementia patients and their relatives. Contact points for people with Alzheimer’s and their relatives are also the German Alzheimer Society, the Alzheimer Research Initiative e.V. or the German Seniors’ League.

Relatives also learn here how best to deal with the dementia patient.

Helpful communication rules for dementia include the following:

Specifically, experts advise relatives to maintain eye contact when speaking to the patient. Short, simple sentences are easier for those affected to understand.

If possible, ask questions that can be answered with “yes” or “no”.

Admittedly, it is not always easy, but it is all the more important to remain patient and approachable. Even if the patient keeps asking the same questions. Additional touch helps some people with dementia to communicate better.

Avoid reprimanding and criticizing the patient. Discussions usually lead to nothing, except for a bad mood.

Tips for meaningful activities for people with dementia:

As a relative, ask yourself: what is important to the dementia patient, what does he like and what activities have been important to him so far? What skills do you need to keep for as long as possible?
Involve the dementia patient in everyday life. This can be light housework, a walk or things that give him pleasure.

Reminders are helpful. Look at old photos from good times. If more recent images come into play, experts advise commenting on them to avoid uneasy feelings in those affected if they have no memory of them. It also helps if you write your name and date on the photo.

Important: The focus must be on practicing and strengthening skills that the dementia patient possesses. Learning something new is hardly possible for people with progressive dementia.

Another challenging issue in dementia is food refusal. Those affected often feel neither hunger nor thirst. Doctors advise setting up meals in a comfortable atmosphere and coaxing them to encourage them to eat.

Dementia – help for relatives:

Social services, advice centers and self-help organizations offer support for social and legal issues.

You can find out where relatives of dementia patients can find a self-help group in your area from NAKOS (National Contact and Information Center for stimulating and supporting self-help groups).

If relatives need help with care, they can be relieved by outpatient care services, among other things.

Prevent dementia

Many people wonder what dementia prevention looks like? An important measure is to reduce risk factors. Being overweight, smoking and lack of exercise, for example, increase the risk of a stroke and thus of vascular dementia.

And how can I specifically reduce the risk of dementia?

A healthy lifestyle is particularly important:

sufficient physical exercise,
a balanced diet,
smoking cessation,
moderate consumption of alcohol
maintaining social contacts with other people and hobbies
as well as the treatment of underlying diseases
There is still no drug that can prevent dementia. Many doctors also advise against ginkgo remedies for prevention.