Dementia is marked by a gradual impoverishment of thought and other mental activities that eventually affect almost every aspect of life.
The most common symptoms of dementia are:
- Frequent and progressive memory loss. People with dementia begin to forget more and more, and the most recent events seem to be forgotten most quickly. Occasionally though, clear "pockets of memory" are still present, and these are usually triggered by familiar faces, smells, touches, songs, or rituals.
- Language difficulties: People with dementia are often unable to understand instructions or to follow the logic of moderately complex sentences. He or she may not understand his or her own sentences, and have difficulty forming thoughts into words. Occasionally, everyone has trouble finding the right word, but a person with dementia often forgets simple words or substitutes unusual words, making speech or writing hard to understand.
- Confusion: This behaviour causes a person with dementia to become "estranged" from others and to be unpredictable in interactions. Confusion can also occur "acutely", that is, suddenly and limited in time (for example, triggered by a hospital stay). In addition to this general confusion, people with dementia are disoriented in time and place. They often forget the current time and get lost in a familiar environment.
- Inability to perform familiar tasks. People with dementia often find it hard to complete everyday tasks that are so familiar we usually do not think about how to do them. In particular, people with dementia have great problems carrying out activities in the proper sequence. For instance, they may not know in what order to put on their clothes.
- Difficulty with abstract thinking. People with dementia often show unusual difficulty performing mental tasks. For instance, planning tasks, making decisions, or organising projects become more and more difficult. They also lose the ability to make simple monetary transactions such as paying a bill.
- Misplacing belongings. Anyone can temporarily misplace his/her wallet or keys. A person with dementia may put things in unusual places such as an iron in the fridge or a wristwatch in the sugar bowl.
- Rapid mood swings: People with dementia become extremely moody, switching between emotions within a matter of seconds for no apparent reason. Alternatively, a person with dementia may show less emotion than s/he used to do previously.
- Behavioural changes: A person with dementia may seem different from his/her usual self in ways that are difficult to identify or explain. A person may become suspicious, irritable, depressed, apathetic, anxious, or agitated, especially in situations where memory problems are causing difficulties.
- Apathy/ lack of initiative: A person with dementia may become very passive, sitting in front of the television for hours, sleeping more than usual, or appear to lose interest in hobbies.
While there are some common symptoms of dementia, it is important to remember that everyone is unique. Some people may show all of these symptoms, while other may only exhibit some of them, but to a greater extent.
Progression2Mild or Early-Stage dementia
Dementia usually begins gradually with very minor changes in the person's abilities or behaviour. In this phase, such signs are often attributed to stress or bereavement or, in older people, to the normal process of ageing. Mostly, one only realises by looking back that these signs marked the beginning of dementia. During the early phase of dementia, the person may:
- Become more forgetful of details of recent events
- Be more likely to repeat themselves or lose the thread of a conversation
- Be slower to grasp complex ideas and take longer to complete routine jobs
- Have difficulty handling money
- Show poor judgement and make poor decisions
- Blame others for 'stealing' lost items
- Lose interest in hobbies or activities
- Be unwilling to try new things
- Be unable to adapt to change
- Become more self-centred and less concerned with others and their feelings
- Be more irritable or upset if they fail at something
- Appear more apathetic, with less sparkle
As dementia progresses, the changes become more marked and disabling.
People with dementia slowly move from forgetfulness into confusion. The person lives more and more in his/her own, dreamlike world in which present and past blend together and in which the rules and structures of the 'old world' - what is right, what is important - lose importance. At this stage people with dementia increasingly see themselves not as confused in a logical environment, but as oriented in a very unfamiliar environment.
During the moderate phase of dementia, the person may:
- Be increasingly forgetful of recent events. Memory for the distant past seems better, but some details may be forgotten or confused
- Repeat the same question or phrase over and over
- Be confused regarding time and place
- Become lost if away from familiar surroundings
- Forget names of family or friends
- Fail to recognise people or confuse them with others
- Forget saucepans and kettles on the stove. May leave gas unlit
- Wander around streets, perhaps at night, sometimes becoming lost
- Behave inappropriately - for example, going outdoors in their nightwear
- See or hear things that are not there (hallucinations)
- Become very repetitive
- Be neglectful of hygiene or eating
- Become angry, upset or distressed through frustration
Some people at this stage become very easily upset, angry or aggressive, perhaps owing to frustration, or they may become overly attached to a certain person.
At this moderate stage, the person will need more support to help them manage their day-to-day living. They may need frequent reminders or help to eat, wash, dress and use the toilet.Severe or Late-Stage dementia
At this stage, a person with dementia becomes severely disabled and will need even more help, gradually becoming totally dependent on others for nursing care.
Loss of memory may be almost complete, with the person unable to recognise familiar objects or surroundings or even those closest to them, although there may be sudden flashes of recognition. Patients are also less able to establish and maintain eye contact and appear to see through people. They may even stop recognizing themselves in the mirror.
Access to their 'bubble'-like world in which they hide and retreat becomes more difficult as language deteriorates. Repetitive movements might emerge, like rocking, undressing, or walking up and down.
Although they can't speak anymore, they are sometimes able to sing hymns and say prayers (automatisms).
At this stage, the person may:
- Be unable to remember - for even a few minutes - that they have had, for example, a meal
- Gradually lose their ability to understand or use speech
- Be incontinent
- Show no recognition of friends and family
- Need help with washing, bathing, using the toilet or dressing
- Show difficulty in eating and sometimes swallowing
- Fail to recognise everyday objects
- Be disturbed at night
- Be restless, sometimes looking for a long dead relative
- Be distressed and aggressive, especially when feeling threatened or closed in
- Become increasingly physically weak, starting to shuffle or walk unsteadily, eventually becoming confined to a wheelchair
- Have uncontrolled movements
Eventually, immobility will become permanent and, in the final weeks or months, the person will be bedridden.
Although the person with Alzheimer's may seem to have little understanding of speech and may not recognise those around them, they may still respond to affection, to people talking in a calm soothing voice, or they may enjoy scents, music or stroking a pet.
Symptoms and stages of Alzheimer's disease3
Alzheimer's disease(AD) is a progressive disease. This means that the structure and chemistry of the brain become increasingly damaged over time. The person's ability to remember, understand, communicate, and reason will gradually decline. Traditionally, AD is divided into three stages, depending on the severity of the symptoms.
It is important to bear in mind that:
- There is no linear progression. Some symptoms may appear earlier or later than indicated here, or not at all. Likewise, some patients are switching back and forth between stages in a cyclical fashion.
- The stages may overlap. Some people with AD may need help with one task but may be able to manage another activity on their own. Sometimes, it seems they are in two stages at the same time.
- Some symptoms, such as wandering, may appear at one stage and then vanish, while others, such as memory loss, will worsen over time.
- There is no average length of time spent in each stage. The progression through the stages is highly individual.
The way AD progresses for each person will depend on many factors - the type of dementia, the age of onset, the presence of other illnesses, the level of support and care available, and so on. Each patient's course will be unique, and what happens to one patient will not necessarily happen to another.