Expert Insights: Understanding Dementia’s Causes, Symptoms, Treatments, and Care Options

Dementia is the term for a group of progressive brain conditions, meaning they worsen over time. People with dementia often experience a slow erosion of typical cognitive functioning, with signs and symptoms including memory impairment, aphasia (difficulty using or understanding words), and the inability to plan or execute.

Over 55 million people around the world have dementia, with an astounding 10 million new cases each year.^[01] However, it’s important to remember that dementia is not a normal part of aging. Many people may experience some forgetfulness as they age, but signs of dementia are much more apparent. With dementia, changes in the brain lead to a decline, which can be severe enough to impede independent life, affect behaviors, and alter feelings or relationships.^[02]

“If you know one person with dementia, you know one person with dementia — all the stories, signs, and symptoms vary, and experiences are so different,” says Maureen Bradley, a senior living expert at A Place for Mom with 18 years of experience as director of a memory care community, who’s now pursuing a doctoral thesis on nonpharmacological interventions for cognitive decline in seniors. “Dementia is variable from person to person, even within a day. One moment they may remember, another they may not,” Bradley explains.

Alzheimer’s disease is the most common form of dementia, accounting for up to 80% of cases in seniors. Other types of dementia include Lewy body, frontotemporal, and vascular dementias.^[03]

In general, diseases and injuries that damage brain cells cause dementia. The exact causes, however, depend on the type of dementia and are still largely unclear, though scientists continue to make progress.

With Alzheimer’s disease, changes in the brain from aging, genetics, and lifestyle interfere with brain cells’ ability to communicate effectively, which can affect a person’s behavior, thoughts, and feelings.^[04] Alzheimer’s disease progressively damages brain cells in the hippocampus — the part of the brain responsible for memory and learning — hindering someone’s memory and ability to think and carry out even basic daily living tasks in later stages of the disease.

Other leading types of dementia, such as Lewy body dementia and frontotemporal dementia, have unknown causes.^[05,06]

Age is the main risk factor for dementia, particularly Alzheimer’s disease, and the risk of a dementia diagnosis increases significantly over the age of 65.^[07] Nearly 73% of dementia cases occur in people 75 or older.^[08]

Family history can be another key risk factor for Alzheimer’s and other forms of dementia. Research reveals that people who have a parent or sibling with dementia are more likely to develop the condition.^[03]

“There is a hereditary element if it runs in your family,” Bradley explains. “Diet and exercise are also a factor. Exposure to chemicals, brain injuries, and more can contribute. Truthfully, they don’t really know — people go against those odds all the time.”

Other factors researchers have noted include but are not limited to the following:

• High blood pressure^[09]
• Type 2 diabetes^[10]
• Bipolar disorder^[11]
• Chronic or severe elderly depression^[12]
• Drinking in excess with existing mild cognitive impairment^[13]
• Social isolation^[14]
• Taking anticholinergics, benzodiazepines, and other drugs linked to dementia risk

Some warning signs of dementia include but are not limited to:^[15,16]

• Difficulty speaking, comprehending, reading, writing, or recalling words
• Losing interest in activities or events
• Behavioral or personality changes
• Memory loss or confusion
• Losing track of time or money
• Repeating questions, phrases, or behaviors
• Agitation or stress
• Experiencing hallucinations, delusions, or paranoia
• Withdrawal from family and friends

Individuals with dementia may be the first to notice these changes in themselves. In other cases, friends, family members, physicians, or health care practitioners may see differences in memory or behavior before the individual realizes it themselves.^[15]

Learning to spot dementia symptoms early can make a huge difference in your aging relative’s future care. If you notice new or unusual behaviors, use your phone or a journal to keep track of patterns and severity. Schedule an appointment to discuss these changes with your loved one’s physician.

Let our care assessment guide you

There isn’t a single test to conclusively diagnose dementia, as our understanding of the disease continues to evolve. Some methods, however, include a brief mental status exam from a primary doctor, or further evaluation by a neurologist or other specialist. There are also a few other potential tests a doctor can order.^[17]

“Two common tests include the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA),” Bradley says. “They’re both 30-question quizzes performed by your primary care provider that screen for cognitive decline. They can’t tell you what kind of dementia you have — you need a neurologist to do imaging and go from there.”

Geriatricians may also note warning signs during regularly scheduled physicals. They can perform a mental status exam called the General Practitioner Assessment of Cognition (GPCOG) in the office. This provides a reliable baseline to track memory loss over time.

The GPCOG measures short-term recall, spatial reasoning, and concentration and may test a senior’s ability to:^[18]

• Draw a complete clock
• Remember a list of words provided
• Answer questions about current events
• Recall the current date
• Repeat back recently shared information

Additional biomarkers and tests used by neurologists, radiologists, and other specialists for diagnosing Alzheimer’s and other dementias may include:^[17]

• Blood tests to check for brain-derived proteins
• Cerebrospinal fluid test or lumbar puncture to measure changes
• Brain imaging, including MRI, CT, or PET scans
• Genetic testing

Pursuing a dementia diagnosis can be scary. It’s challenging to admit that cognitive decline may be affecting an aging loved one. But seeing a doctor as soon as possible is important for getting a timely diagnosis — and for ruling out other possibilities. Many treatable conditions, like thyroid issues, nutritional deficiencies, and infections, can also cause memory loss similar to dementia.^[02] Plus, an official dementia diagnosis can be vital for future treatment and discussion of when it’s time for memory care.

While there’s currently no cure for dementia, a combination of therapies, lifestyle adjustments, and medication for certain symptoms can improve your loved one’s quality of life and potentially slow cognitive decline. Appropriate stimulation through activities and daily interaction with friends and family can also help reduce agitation.

Treatment options depend on the different stages of dementia. People with early- and middle-stage dementia benefit from memory activities, creative pursuits, and productive tasks that fit their ability levels. Seniors with late-stage dementia still need sensory stimulation from basic activities, sounds, lights, and textures.

Read more:Treatment for Dementia: What You Need to Know

A dementia diagnosis is life-changing. Taking the time to come to terms with the diagnosis and learn about the condition is important for both the person with dementia and their caregivers.

Steps to move forward after a dementia diagnosis include seeking medical treatment, finding extra help through family members or support groups, and planning for the future.

“Early diagnosis is really important, as it means having time to plan. And the older adult has a chance to be part of plans,” Bradley notes.

Dementia care comes in many forms: family members providing assistance at home as needed, hiring an in-home caregiver, arranging respite care in a community for a short period of time, or living 24/7 in a memory care community.

Many people want to remain aging in place for as long as possible. Keep in mind, however, that receiving care from family members at home may only be a temporary solution. As a person’s symptoms worsen over time and their needs increase, professional help becomes necessary.

Memory care

Memory care communities provide specialized housing and 24-hour care for seniors with Alzheimer’s disease and other dementias. Key services and features that make memory care facilities different from other types of senior housing include specialized staff training, memory-enhancing therapies and activities, a secure environment, and more.

Many families choose memory care for their senior loved ones, since these communities are tailored to the specific needs of people experiencing cognitive decline. Memory care communities are equipped to help seniors experiencing challenges that often accompany mid-to-late-stage dementia. Staff are trained to address common dementia behaviors while supporting residents’ safety and well-being.

Memory care communities may offer some of the following activities, services, and amenities to support their residents:

• Acupuncture
• Aromatherapy
• Art classes
• Massage
• Meditation and mindfulness
• Music therapy
• Occupational therapy
• Outdoor gardens and other design features for calming or safety

These elements of memory care may help delay the progression of dementia and improve residents’ daily experiences.

“In facilities, they’re seeing improvements in people diagnosed with dementia when they’re around their peers,” Bradley says. “The day-to-day quality of life can be improved, and it can help to keep them enjoying their life.”

Talk with a Senior Living Advisor

Assisted living

Seniors in the earlier stages of dementia with only mild symptoms may find assisted living communities to be an appropriate environment. Assisted living staff are available around the clock to help with tasks such as medication management and keeping routines like meals and showers consistent. Socialization through activities in assisted living can also be very beneficial.

However, the main differences between assisted living and memory care are the security of the building and dementia-specific treatments. So if your loved one with dementia is prone to wandering, assisted living won’t be as safe as a memory care community — or a dedicated memory care unit in an assisted living community — where residents can’t leave the grounds unattended. Assisted living staff also aren’t typically trained in specialized techniques such as reminiscence therapy and managing aggression.

Home care

In-home care services can be ideal for seniors with dementia who are set on aging in place. Living in a familiar environment and maintaining routines are two ways to help reduce agitation and improve quality of life for people with dementia.

Be sure the caregiver you hire has experience working with seniors with dementia, and have a list of your loved one’s symptoms available to share. Some services provided by in-home care for dementia include:

• Companionship (including reading aloud, chatting, and in-home activities)
• Transportation to appointments
• Assistance with activities of daily living (ADLs) like dressing, bathing, and grooming
• Meal preparation or delivery
• Cleaning and organizing

Nursing homes

Nursing homes provide 24/7 skilled nursing care and cater to seniors with significant health conditions and care needs. These facilities typically require a doctor’s order, a functional assessment, and physical examination for admission.

Because nursing homes don’t provide the same resources as memory care and typically aren’t designed for seniors with dementia, they may not be the best option for seniors with mild to moderate cognitive decline. However, if someone with dementia requires regular skilled nursing care and monitoring for an ongoing medical condition, plus full assistance with ADLs, then a nursing home could be the right fit.

Respite care

Respite care, or short-term care, allows family caregivers to step away from caregiving temporarily. Regular respite can help prevent the potentially serious mental and physical health consequences of full-time dementia caregiving. Respite care may be offered by local community centers, religious organizations, or senior living facilities and generally lasts between one day and several weeks.

“It’s imperative to have time away from the person with dementia,” Bradley emphasizes. “There’s no other way around that. The family caregiver will need to get a break and create balance.”

As you begin your journey with a dementia diagnosis, A Place for Mom can help. Our Senior Living Advisors can help you determine what type of care best suits your loved one’s needs, even as those needs change. We help you evaluate your loved one’s budget, care needs, and preferences to find the right fit, whether that be home care or a memory care community. Plus, our service is available at no cost to your family.

Every family is unique and deserves the best care available to them. Here are a few valuable resources to guide you through the process:

• Join an in-person or online caregiver support group.
• The Alzheimer’s and Related Dementias Education and Referral (ADEAR) Center offers information about research and clinical trials, as well as potential treatments and patient care. You can also reach ADEAR by phone at 1-800-438-4380.
• For publications, educational material, and information about local services, you can reach the Alzheimer’s Foundation of America online or by phone at 1-866-232-8484.
• Look up help near you using the Alzheimer’s Association’s local resource database.