Recognizing and Responding to Symptoms

Symptoms of Dementia and Interventions

The following is not an exhaustive list of changes and interventions, but rather it is an introduction to the types of changes and interventions you may encounter. You should work with your primary care provider and other team members to bring up symptoms, discuss possible interventions, and follow through with recommendations to maximize your quality of life.

Dementia may include motor (movement) symptoms.

Your ability to move, balance, catch yourself when you trip, swallow, even your ability to move your eyes or use your facial muscles to express your emotions may be affected. Examples of dementias with motor symptoms include, but are not limited to, Lewy Body Dementia and Progressive Supranuclear Palsy.

You may benefit from interventions that address these symptoms such as:

• physical therapy
• occupational therapy
• use of a walker
• installation of grab bars or a ramp
• medication to help reduce some motor symptoms

Your doctor may order a swallow study to see if you are silently aspirating (liquid is ending up in your lungs because the muscles involved in swallowing are not working properly). A speech therapist can teach you techniques for swallowing that limit aspiration risk and risk of pneumonia. They may make recommendations for changes in eating and drinking, e.g., cut food very small, avoid thin liquids, to prevent choking and aspiration.

The focus is always on safety. You may not like using a walker, for example, however, most people dislike even more having a broken hip or a head injury from a fall.

Dementia may include personality changes.

You were the life of the party, now your family can’t get you off the couch to do anything and you aren’t depressed. You were polite and appropriate socially, now you say embarrassing things and things that upset others when you are out in public, even to strangers. You’ve always been careful with money but you went and spent $13,000 on multiple pairs of cowboy boots over the weekend on your spouse’s credit card and don’t understand why they are so upset. You were predictable in the past, now you are impulsive and seem to do things without thinking. You were an easy-going person, who would get upset on occasion, but now you are irritable, defensive, and anger more quickly.

You may benefit from interventions such as:

• Have set daily and weekly routines written out on a white board or a daily list that you can check off, to reduce apathy.
• Your family may wish to carry pre-made business cards to discreetly hand to waitstaff or others to alert them that you have a dementia and to thank them for their patience if you say or do something socially inappropriate.
• You you may benefit from having your spouse manage finances to prevent financial losses due to impulsive spending.
• Your family may benefit from learning how to not challenge some behaviors and you may find that limiting your time spent doing difficult tasks reduces frustration and irritability.
• Medications may also help limits the effects of some of these changes.

Dementia may include changes in mood.

Some people may become more anxious or depressed due to an awareness of the changes that come with dementia. Others may have mood changes due less to a response and more to those areas of the brain being affected, which, in addition to anxiety or depression, may also include, for example, becoming completely unconcerned, even when concern is warranted, or becoming obsessive.

You may benefit from:

• Participation in support groups (link to support groups)
• Regular social interaction with family and friends
• Medication management of mood
• Behavioral interventions such as keeping to a routine, exercising regularly, getting the right amount of sleep, and practicing relaxation exercises. (link to mindfulness, link to tai chi, link to yoga poses)

Dementia may include changes in other functions.

You may have hallucinations. Your sleep may be disrupted so that you sleep less, sleep more, reverse day and night, or become much more active while sleeping. Your appetite or food preferences may be affected, for example you devour anything sweet, eating entire bags of candy found in the house. Rarely, you may pocket food instead of swallowing it, which is continuing to stuff food in your mouth like a chipmunk, a choking hazard.

Medication management and behavioral interventions are usually recommended for these types of changes, e.g., keeping low-calorie snacks available, having reminders to swallow with supervision while eating, and medication to improve sleep, decrease restlessness, or control hallucinations.

Dementia will include changes in thinking, which may include:

• Memory
  Typically people will begin to have trouble making new memories, forgetting recent events or conversations, while older memories remain intact. As dementia progresses, there may be loss of visual memory, so that people become lost first in unfamiliar places, and eventually in places familiar to them.
• Working Memory
  Working memory is your ability to hold on to information while do you something with it, then you will let go of it. For example, saying to yourself and remembering a phone number or a code while you enter it, then forgetting it once you are done. The average adult can hold 7 items in working memory, and with aging, that number decreases, and with dementia it decreases even more.
• Attention
  Focus and concentration may be affected, including divided attention (having to keep track of two things at once).
• Language
  People may experience more difficulty finding the word they want to say in conversation, they may make more mistakes when speaking, mixing up the order of parts of words. Others may begin to have difficulty with language comprehension, not understanding instructions or what someone else is asking them to do. This is different than not being able to remember a list of instructions and having to keep looking at them or ask repeatedly what they were.
• Visuospatial skills
  Construction
  Spatial location
• Executive functions and abstract reasoning
  Reasoning
  Inhibition
  Sequencing

Dementia will affect your ability to complete your daily tasks:

• bill paying
• driving
• following recipes
• fixing things around the house.

Could it be something else?

In some cases, yes.

Your doctor will want to order a number of tests to eliminate other causes of these changes. In addition to the possibilities below, untreated sleep apnea, poorly controlled diabetes, urinary tract infections, exposure to toxic substances, and other conditions may also be explored as possible contributors to changes in thinking.