Dementia

What is Dementia?

Dementia is the term used for loss of intellectual and social function to the extent that this interferes with the person's daily life. For centuries, people called it "senility" and considered it an inevitable part of aging. It is now known that dementia is not a normal part of the aging process and that it is caused by some underlying condition.

Dementing illnesses can affect adults of any age. Although it is not a normal part of ageing, dementia is most likely to occur in later years.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), dementia can be diagnosed if the patient has impaired memory and at least one of the following cognitive deficits:^[1]

• Aphasia - Difficulty expressing oneself in speech or writing or difficulty in understanding either.
• Apraxia - Impaired ability to carry out motor activities despite intact motor function.
• Agnosia - Failure to recognize or identify objects despite intact sensory function.
• A decline in executive functioning - That is, problems with planning, organizing, sequencing, and abstracting.

To be diagnosed as dementia, these cognitive deficits must significantly affect a person's social or occupational functioning and represent a significant decline from previous levels of functioning. And the deficits must not result exclusively from delirium. Delirium comes on suddenly, and in addition to memory impairment, is characterized by attention deficits, impaired consciousness, and perceptual problems like hallucinations or delusions.

Symptoms of dementia vary in severity, order of appearance and with the type of dementia. But all dementias involve some impairment of memory, thinking, reasoning and language. Personality changes and abnormal behavior may also occur as dementia progresses.

Reference:

• 1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, DSM-IV (4th ed.). Washington, DC: Author.

---

Levels of Impairment and Symptoms of Dementia

Mild Impairment

• Recent memory loss at times
• Mild difficulty with verbal expression
• Decreased concentration
• Slowed learning and reactions
• Seeks and prefers the familiar; avoids the unfamiliar
• Difficulty with planning and decision making
• Some errors in judgement and calculation
• Lack of spontaneity and lessening of initiative

Moderate Impairment

• Chronic, recent memory loss
• Increased inability to comprehend and carry on a conversation
• Difficulty in writing and using objects correctly
• Visual-spatial perception problems
• Possible delutions, hallucinations and agitation
• Repetitive actions
• May get lost at times, even inside the home
• Needs reminder to perform activities of daily living

Severe Impairment

• Inability to carry on any conversation
• Difficulty with wayfinding
• Misidentifies persons or objects
• Bladder incontinence
• Unsteady gait
• Needs help with most or all activities of daily living

Terminal

• Mute or few incoherent words
• Bedridden or wheelchair bound
• Minimally connected to surroundings
• Little spontaneous movement
• Difficulty in eating and swallowing
• Seizures, muscle twitching
• Cachexia
• Requires total care