Dementia: Symptoms and treatment – Canada.ca

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

Dementia-related memory loss are permanent and tend to get worse over time. People with dementia can forget things very quickly and they may:

• don’t know where they are
• asking the same question over and over
• forget what happened moments ago

They may be able to remember:

• some things and not others
• distant events, but not the most recent.

Age-related memory loss

In the case of age-related memory loss, memory difficulties can occur, but:

• does not significantly interfere with daily life
• does not interfere with the ability to perform tasks
• it is possible to learn and remember new things

Examples of age-related memory loss may include:

• take more time to learn new information
• forget the name of an acquaintance
• have 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 experience symptoms of memory loss that go beyond age-related memory loss; however, these symptoms are not severe enough to interfere with daily activities and routines. Although people with mild cognitive impairment have a higher risk of developing dementia, not everyone will.

Speak to a healthcare provider if you are concerned about memory loss in yourself or a loved one.

The ability to concentrate during a conversation or activity may decrease as dementia progresses. People with dementia may drift away in the middle of a conversation or task. This may be due to one of the following factors:

• a reduced ability to filter out distractions such as background noise
• a lack of interest

Some people with dementia can talk easily and at length. Others may find it increasingly difficult to communicate their thoughts. It is expressive aphasiathe symptoms of which may be as follows:

• omit words in a sentence
• have difficulty pronouncing certain sounds or words
• substitute sounds or words that are not suitable
• use basic language (e.g. short, simple sentences)

If a person with dementia cannot remember the names of familiar people or objects, they may:

• describe them
• use a synonym
• use a word that sounds similar, but is not exact

People with dementia may have difficulty understanding what they hear or read. They may not realize that their sentences don’t make sense. This is thereceptive aphasia, the symptoms of which may include the following:

• difficulty understanding what people say and write
• misinterpretation of words, gestures, pictures or drawings
• disorganized speech (e.g. words may be out of sequence)
• response that does not make sense to others (e.g. making up words)

People with dementia may have changes in mood and behavior. These changes are different from person to person and can get worse over time.

Mood swings can include the following:

• anxiety
• depression
• loss of interest in activities the person previously enjoyed

‘Reactive behaviors’ are actions, words or gestures in response to something in the social or physical environment. Here are some examples of responsive behaviors that a person with dementia may experience:

• cris
• agitation
• irritability
• hallucinations
• sleep disturbances
• blows or grabs
• sudden noises
• research (sometimes called wandering)

Responsive behaviors can be triggered if a person with dementia:

• feels sick
• is frustrated
• experiences grief or loss
• feels lonely or overwhelmed by boredom
• is afraid or feels in danger
• feels discomfort or pain
• is tired or exhausted
• feels overwhelmed or rushed

These behaviors can also be caused by the following factors:

• sensory overload
• uncomfortable lighting
• loud or disruptive noises
• medication side effects
• loss of property or independence;
• unfamiliar situations or surroundings
• changes or reductions in physical and mental abilities

People with dementia may lose fine motor skills and coordination. Even if they understand and know what they want to do, they may not be able to do it. For example, they may have difficulty buttoning their shirt or making certain sounds (saying “pain” instead of “plain”, for example). It’s called theapraxie.

Apraxia can progress gradually or rapidly. Loss of coordination and manual dexterity can lead to difficulty in the following activities, for example:

• manger
• take a bath
• get dressed
• use a phone
• pour yourself a drink
• use buttons or zippers

Dementia can interfere with the internal clock that allows us to have regular eating and sleeping times. People with dementia may have trouble judging the passage of time, especially when symptoms worsen. They could:

• keep asking what time it is
• want to leave a place as soon as they arrive
• feeling like you’ve been alone for hours when it’s only been a few minutes

An inability to keep track of time can cause them to avoid social activities. They may worry about:

• to be late
• miss the bus
• stay longer than expected

People with more severe symptoms of dementia may also not know where they are as the condition progresses. This often leads to finding one’s way (this is sometimes called wandering) or getting lost, even in familiar places. They can wander due to the following factors:

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

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

Although symptoms vary and often worsen over time, there are non-drug therapies that can help manage symptoms such as cognitive issues and mood and behavior changes. These therapies are often used before resorting to medication.

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

• psychologists
• social workers
• occupational therapists

Other types of non-drug therapies can help modify mood and behavior:

• massages
• arts programs
• music programs
• social programs, such as:
  • book clubs
  • intergenerational clubs
• animal-assisted therapies

Here are some techniques that may reduce symptoms:

• to be comforted by others
• maintain an active social life
• have a variety of activities to participate in
• having meaningful participation, such as pursuing favorite activities and discovering new activities
• be in a familiar environment (avoid changing the location of objects or furniture in the house)
• identify and address personal triggers that cause distress and impair functioning, such as:
  • immediate surroundings
  • certain times of the day
  • distractions in the environment

There are four drugs 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. Rather, they aim to temporarily improve:

• Memory
• communication skills
• the ability to perform daily activities
• the notion of time and place as well as self-awareness

Non-drug approaches (eg, therapies and programs) are often the first approach to addressing behavior change. However, health care providers may prescribe medications to treat dementia-related symptoms or conditions, such as:

• psychosis
• depression
• sleeping troubles
• reactive behaviors (such as hitting, grabbing, or making repetitive gestures)