Dementia - Information and Doctors

Many people view dementia as a distinct disease. The truth is: On the one hand, the term “dementia” serves as an umbrella term for various conditions, such as vascular dementia.

On the other hand, it refers to a symptom, such as dementia associated with Alzheimer’s disease.

Dementia leads to impaired cognitive function in those affected.

These include:

• Sense of direction
• short- and long-term memory, as well as
• general thinking
• Personality changes

Self-Test: Questions About Orientation

As a general rule, people with dementia remain independent longer if doctors recognize and treat their symptoms early on. For this reason, it’s important to take the first signs seriously and not simply ignore them.

The following questions are meant to help you assess the situation:

• Do you make small mistakes in daily life that you didn’t used to make? Examples: You forget to season your food or to turn on the washing machine after loading it.
• Are you becoming forgetful? Examples: Do you leave a room and forget where you were going? Or do you no longer remember where you put your keys?
• Are you forgetful? Example: When reading long newspaper articles, you’ve forgotten the beginning by the time you reach the end.
• Do you have trouble finding the right words? Example: You want to explain something but forget everyday terms you need to do so. This could be the word “hairdresser” when giving directions, or “potatoes” as a side dish for Sunday roast.
• Do you feel unmotivated? Example: You used to be very active in a sports club. Now you hardly feel like going to your weekly practice or participating in group activities.
• Do you have trouble speaking longer sentences without making mistakes? Do you get tongue-tied and forget what you wanted to say?

Do these problems—or some of them—sound familiar? If so, be sure to talk to your primary care physician about them. It doesn’t necessarily mean you have dementia. Still, it’s important to identify the cause of your symptoms.

Do you feel that your symptoms aren’t being taken seriously, or would you like to receive a reliable diagnosis right away? If so, make an appointment for a “memory clinic” consultation. 

Large hospitals have specialists who can conduct a comprehensive evaluation for cognitive impairments. You can find contacts in your area on the German Alzheimer’s Association’s website.

Medicine distinguishes between different types of dementia.

• Alzheimer’s dementia: Alzheimer’s disease is the cause of 50 percent of all dementia cases. It rarely occurs before the age of 65; most people affected are older than 80. This form of dementia is chronic and progressive (long-term and worsening over time).
• Vascular dementia: Minor and major strokes disrupt blood flow to the affected regions of the brain, thereby destroying brain tissue. Minor, recurrent strokes in particular lead to fluctuating symptoms. The person affected may appear confused at times and lucid again shortly thereafter. Unlike Alzheimer’s disease, symptoms begin earlier and often abruptly.
• Mixed forms of 1 and 2
• Metabolic dementia: Dementia occurs as a result of vitamin deficiency or intoxication.

After the onset of dementia, those affected live an average of two to seven years.

Doctors also classify the symptoms associated with dementia into various categories.

In the early stages, dementia resembles depression, so neither the person affected nor their family members suspect dementia. For this reason, the following sections provide initial guidance.

Cognitive Impairments

A key characteristic is memory loss, which progressively worsens as the disease advances. There is a high risk that those affected will not notice these memory problems themselves or, out of embarrassment, will conceal them from those around them and try to cover them up. For these reasons, most patients often do not seek medical help until the disease is at an advanced stage.

Other symptoms, such as difficulty finding the right words or problems with orientation (even in familiar surroundings), are among the signs of cognitive impairment.

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Motor Impairments

As dementia progresses, it can also lead to a loss of motor skills. These symptoms must be distinguished from those of another condition—Parkinson’s disease—which begins with precisely these motor disturbances (tremors).

Motor impairments pose a risk to patients in their daily lives. In particular, the risk of falling increases rapidly. Motor impairments are most commonly recognized by an unsteady gait with small steps.

Behavioral Changes

Behavioral disturbances are an aspect that can be particularly stressful and exhausting for family members.

Patients exhibit various symptoms, such as:

• Disinhibition
• Apathy
• Hallucinations
• Aggression
• Sleep disturbances
• Anxiety or
• depressive episodes

Other behavioral abnormalities include a declining ability to manage one’s own household or to maintain adequate personal hygiene.

As mentioned earlier, primary care physicians are usually the first point of contact for people with memory problems. To accurately assess the symptoms, the primary care physician refers the patient to a neurologist or psychiatrist.

At the neurologist’s office, the doctor takes a detailed medical history (anamnesis).

Cognitive function can be assessed, for example, using the DemTect, a dementia screening test.

The Mini-Mental State Examination (MMSE) is also an option. This test provides initial, reliable indications of dementia.

Imaging techniques, such as MRI (magnetic resonance imaging) or the nuclear medicine PET scan (positron emission tomography), provide information about organic changes in the brain.

Before a doctor diagnoses dementia, they must rule out other conditions (differential diagnosis).

These include so-called “pseudo-dementias.” The term describes symptoms that resemble those of dementia.

For example, severe depression is often accompanied by difficulties with concentration and memory.

Psychomotor retardation is also observed in people with depression. These phenomena could also indicate dementia.

When investigating the causes, medical professionals distinguish between two types of dementia.

In primary forms of dementia, the focus is on pathological changes in the brain. Alzheimer’s disease or vascular dementia lead to the degeneration of nerve cells and trigger the typical symptoms.

In secondary forms of dementia, the condition develops as a result of external factors or certain pre-existing conditions.

Examples of triggers for secondary dementia include:

• Brain hemorrhages following accidents
• Tumors
• Alcohol and other drugs, as well as
• Various medications

Of course, rising life expectancy also leads to an increase in cases of dementia.

Alzheimer’s disease and vascular dementia are incurable.

The appropriate treatment usually consists of a combination of:

• Medications
• psychotherapy, and
• Specialized training

Treatment can slow the progression of the disease and thus improve quality of life.

Patients can take the medications either in tablet form or as a solution. For some time now, doctors have been increasingly relying on transdermal patches that continuously release their active ingredients. This is a great relief for family members and nursing staff alike.

The following therapeutic components complement medication-based treatment:

• In the early stages, doctors recommend guided memory training. This training strengthens patients’ memory and their ability to orient themselves. 
• In the advanced stages, this therapy is generally not recommended. The reason: As symptoms of impairment become increasingly severe, the “successes” from the training also fail to materialize. This could have a very negative impact on patients’ mental well-being and overall quality of life.
• Biography work: The “I-Pass” is frequently used here. Patients answer simple questions about themselves and record the answers in their “I-Pass.” The benefit of this approach is that it helps the nursing staff understand what the patient is trying to communicate through certain behavioral patterns. This is particularly important in the advanced stages, when patients are often no longer able to communicate effectively.
• In addition, there are occupational, physical, and music therapies

Many people wonder whether dementia can be prevented. There is no one-size-fits-all answer to this question.

The following factors have a positive effect on cognitive function and overall well-being:

• A balanced diet
• Sufficient exercise
• Social interactions and
• Brain exercises

Certain pre-existing conditions increase the risk of dementia and therefore require early and consistent treatment.

High blood pressure is the primary concern. The pressure on the blood vessels primarily contributes to vascular dementia. This also applies to atherosclerosis (hardening of the arteries).

A chronic, progressive illness always represents a major upheaval in one’s life. There are various resources available for those affected and their families, ranging from regional support groups to professional associations and online forums.

The German Alzheimer’s Association (Deutsche Alzheimer Gesellschaft e. V.) offers comprehensive support. Those affected can find detailed information on the topic on the website.

For personal questions, a free email counseling service and the “Alzheimer’s Hotline” are available.

In the association’s online forum, those affected can exchange experiences and support one another in a safe environment.

Family members, for example, can find expert assistance at the regional Caritas centers for family caregivers. These centers support family members in all matters.

A dementia diagnosis presents major challenges for those close to the person with dementia and raises many questions. Professionals are available to advise and support you during this time.

Conclusion: Dementia presents an enormous challenge. To help overcome it, a network of competent support providers stands ready to assist those affected and their family members.