Dementia: Symptoms and treatment

Memory loss is not always caused by dementia. Other types of memory loss include age-related memory loss and mild cognitive impairment.

Dementia-related memory loss is ongoing and tends to get worse over time. People living with dementia may forget things very quickly and may:

• not know where they are
• repeatedly ask the same question
• forget what happened moments earlier

They may be able to remember:

• some things and not others
• events from long ago but not recent ones

Age-associated memory loss

With memory loss related to aging, difficulties with memory may happen but:

• don't noticeably disrupt your daily life
• don't affect your ability to complete tasks
• it is possible to learn and remember new things

Some examples of age-related memory loss may include:

• taking longer to learn new information
• forgetting the name of an acquaintance
• having difficulty finding the right words in a conversation
• not remembering details of an event that took place a year ago

Mild cognitive impairment

People with mild cognitive impairment have memory loss symptoms that go beyond age-related memory loss; however, these symptoms aren't severe enough to interfere with normal daily activities and routines. While those with mild cognitive impairment are at higher risk of developing dementia, not all of them will develop it.
Talk to a health care provider if you have concerns about memory loss in yourself or someone you care about.

The ability to focus on a conversation or activity may decline as dementia progresses. People living with dementia might walk away in the middle of a conversation or a task. This may be the result of a:

• reduced ability to filter out distractions like background noise
• lack of interest

Some people living with dementia can speak fluently and at length. Others may have increasing difficulty communicating their thoughts. This is known as expressive aphasia, and symptoms may include:

• leaving words out of a sentence
• difficulty saying some sounds or words
• substituting sounds or words that don't fit
• using basic language (for example, short and simple sentences)

If someone living with dementia can't remember the names of familiar objects or people, they might:

• describe it
• use a synonym
• use a word that sounds similar but isn't accurate

People living with dementia may have difficulty understanding things they hear or read. They might not realize that their sentences don't make sense. This is known as receptive aphasia and its symptoms may include:

• trouble understanding what people say and write
• misinterpreting words, gestures, pictures or drawings
• disorganized speech (for example, words may not be in the right order)
• responding in a way that doesn't make sense to others (for example, making up words)

People living with dementia may experience changes in their mood and behaviour. These changes are different from person to person and may get worse over time.
Changes in mood may include:

• anxiety
• depression
• loss of interest in activities they used to enjoy

'Responsive behaviours' are actions, words or gestures that are in response to something in the social or physical environment. Some examples of responsive behaviours for people living with dementia may include:

• shouting
• agitation
• irritability
• hallucinations
• sleep disruptions
• hitting or grabbing
• making sudden noises
• searching (sometimes called wandering)

Responsive behaviours can be triggered if someone living with dementia feels:

• sick
• frustrated
• grief or loss
• lonely or bored
• afraid or unsafe
• discomfort or pain
• tired or exhausted
• overwhelmed or rushed

They can also be caused by:

• sensory overload
• uncomfortable lighting
• loud or disruptive noises
• side effects from medication
• losing possessions or independence
• unfamiliar situations or surroundings
• changes or reductions in physical and mental abilities

People living with dementia may lose fine motor and coordination skills. Even if they understand and know what they want to do, they might not be able to do it. For instance, they may find it challenging to button their shirt or make certain sounds (saying "rayround" instead of "playground" for example). This is called apraxia.

Apraxia may progress gradually or quickly. Loss of coordination and manual skills can lead to difficulties with activities such as:

• eating
• bathing
• dressing
• using a phone
• pouring a drink
• using buttons or zippers

Dementia can affect the internal clock that keeps us on a regular eating and sleeping schedule. People living with dementia may find it hard to judge the passage of time, especially when symptoms become more severe. They might:

• repeatedly ask what the time is
• want to leave a place as soon as they arrive
• feel they've been alone for hours when it's only been a few minutes

An inability to keep track of time can result in them avoiding social activities. They may worry about:

• being late
• missing the bus
• overstaying their welcome

People living with more severe symptoms of dementia may feel confused about where they are as the condition progresses. This often leads to searching (sometimes called wandering) or getting lost, even in familiar places. They may search due to:

• excess energy
• discomfort or pain
• boredom or irritability
• a change of environment
• looking for a place or person
• confusion between night and day

People living with dementia may find it increasingly difficult to do activities that require organization, planning, abstract thinking or concentration. Familiar tasks such as grocery shopping, cooking, using the television remote, and keeping track of payments may become more challenging.

While symptoms vary and often get worse over time, there are non-drug therapies that may help manage symptoms such as cognitive issues and changes in mood and behaviour. These therapies are often used before choosing medication.

For some people, cognitive stimulation therapy can maintain or improve thinking ability through activities that stimulate the brain. Health professionals who conduct this type of individual or group therapy may include:

• psychologists
• social workers
• occupational therapists

Other types of non-drug therapies that may help with mood and behaviour changes include:

• massage
• art programs
• music programs
• social programs, like:
  • book clubs
  • intergenerational clubs
• animal-assisted therapy

Some techniques that might reduce symptoms include:

• reassurance from others
• keeping an active social life
• having a variety of activities to take part in
• meaningful engagement, such as continuing favourite activities and finding new ones
• being in familiar settings (avoid changing the location of objects or furniture in the home)
• identifying and addressing personal triggers that cause distress and impair functioning, such as:
  • immediate surroundings
  • certain times of the day
  • distractions in the environment

There are 4 medications approved by Health Canada to treat dementia:

• Aricept™ (brand name) or Donepezil (generic name)
• Exelon™ (brand name) or Rivastigmine (generic name)
• Reminyl ER™ (brand name) or Galantamine (generic name)
• Ebixa^®(brand name) or Memantine (generic name)

These drugs do not cure or slow the progression of dementia. Instead, they aim to temporarily improve:

• memory
• communication abilities
• ability to perform daily activities
• awareness of time, place and self

Non-drug approaches (e.g., therapies and programs) are often the first approach to addressing changes in behaviours. However, health care providers may prescribe medication to treat dementia-related symptoms or conditions, such as:

• psychosis
• depression
• sleep disturbances
• responsive behaviours (such as hitting, grabbing or repetitive actions)