Understanding and Managing Dementia

Recent studies show that 1 in 10 people over 65 and 1 in 2 over 85 will develop dementia. As people age, they are more likely to forget things - this is age-related memory loss. Unlike dementia, age-related memory loss generally does not significantly impact daily life and activities.

What is Dementia?

Dementia is a general term describing the loss of memory, language, problem-solving, and other thinking abilities. There are approximately 400 types of dementia, all of which are degenerative and progressive brain diseases.

Dementia Symptoms may include loss of short-term memory, getting lost in familiar locations, repeating questions, impulsive behavior, lack of interest in others, loss of interest in activities, using unusual words for familiar objects, and new difficulty in managing finances and other household tasks.
Dementia Behaviors: Someone with dementia may exhibit changes in personality or behavior, such as irritability, aggressiveness, hallucinations, wandering, eating difficulties, and changes in sleep. Medications may help, but your loved one may often act this way because they cannot express themselves and find the situation stressful.
Diagnosing Dementia: Although dementia cannot be cured, there are benefits to diagnosing it early, such as addressing symptoms and planning for the future. Start by speaking with your loved one’s physician. Infections, medications, and health conditions can cause forgetfulness or change behavior and can be treated. A physician may review a person's medical and family history, perform a physical examination, order imaging and lab work, and refer to a neurologist for further cognitive and neurological tests.

Common Dementias

Alzheimer's Disease is the most common dementia and affects the parts of the brain that control thought, memory, and language. Beginning with mild memory loss, it can eventually lead to the inability to carry out simple tasks. Alzheimer’s is identified by protein plaques and tangles in the brain.
Vascular Dementia is caused by decreased blood flow to the brain affecting memory, thinking, or behavior. Symptoms may develop gradually or suddenly after a stroke or major surgery. There may be short periods of improvement.
Lewy Body Dementia leads to a decline in thinking, reasoning, and movement. Symptoms may include spontaneous changes in attention and alertness, recurrent visual hallucinations, sleep behavior disorder, slow movements, tremors, or rigidity.
Frontotemporal Dementia, a group of disorders that affect the part of the brain associated with personality, behavior, and language, is rare and occurs at a younger age than other dementias. Some people may have dramatic changes in their personalities.
Korsakoff Syndrome is a rare memory disorder due to a lack of thiamine (vitamin B1) and is associated with alcoholism and malnutrition. Symptoms include mental confusion, vision problems, coma, hypothermia, low blood pressure, and lack of muscle coordination.

Reducing the Risk of Dementia

There is no cure, but the risk of cognitive decline can be reduced by staying mentally active, maintaining social connections, exercising, managing health conditions, and eating a healthy diet. Studies have shown the benefits of Vitamin D, walking, controlling blood pressure, and following Mediterranean or DASH diets.

Dementia Medications

Aricept®, Exelon®, Razadyne®, Namenda®, and Namzeric® are several of the drugs that may temporarily slow cognitive decline by improving communication between nerve cells and helping the brain to process information, whereas newer medications such as Leqembi® are designed to slow cognitive decline in the early stages of Alzheimer’s by targeting the amyloid-beta plaques in the brain.

MANAGING DEMENTIA BEHAVIORS

Try to understand what is causing the new behavior. Is something acting as a trigger? This can be a task they are trying to complete, a question asked of them, a change in their environment, someone else's actions, pain, or being hungry or thirsty. Use a log to track the frequency and help identify the trigger.
Make changes to the environment or how you speak to your loved one to minimize the behavior. Creating a routine, keeping them engaged in activities, and listening to music can create a calm atmosphere.
Wandering and becoming lost are common among people with dementia and can be alarming. However, you can take steps to reduce the risk of wandering.
Sundowning refers to a state of confusion occurring in the late afternoon and lasting into the night, which can cause confusion, anxiety, aggression, pacing, or wandering. Tips for Coping with Sundowning
Safety concerns occur due to changes in judgment and behavior and increased forgetfulness. However, some measures can be taken to reduce risks - some as simple as moving hazardous items, while others may include adding alarms, timers, and other devices.

These training videos created by the Multicampus Programs in Geriatric Medicine and Gerontology at UCLA provide practical tools to create a safe and comfortable environment.

ENGAGEMENT

While it is important for someone with dementia to remain engaged in activities and have social contact, it can often be difficult for friends and family to know how to engage with someone with dementia.

Take the initiative and reach out to friends and family and schedule time to get together,
Modify activities that your loved one enjoyed before their dementia progressed. For example, if they enjoyed cooking, find a simple task they can do to "assist" with the meal preparation. Have them fold (and refold) laundry or "organize" something by putting things in a box.
Other ideas include looking at photographs, listening to music, walking, playing simple games such as cards or dominoes (and remembering to be flexible with the rules).

Check for local day programs and social activities designed for people with dementia.

COMMUNICATION TIPS

Conversing with someone who may repeat the same question or live in the past can be difficult and frustrating. Remember that this is about connecting with your loved one and meeting them where they are at the moment.

Redirection is helpful when someone repeatedly asks the same question or wants to do something they cannot do. For example, if they say something like, “I need to leave home now and see my mother,” you can respond with, “Ok, we will leave after lunch,” “tell me about your mother,” or “she called and said she is going out. We will see her tomorrow.”
Therapeutic lying is OK, especially if the truth will upset them, and they will not remember the conversation.
Do not correct them if they are saying something that seems nonsensical to you. Continue the conversation, even if it seems illogical to you.
Avoid saying, “remember” or “I already told you.”
Do not tell them that they are wrong or argue with them. Agree with them and change the subject.
Do not remind them that a loved one is dead. If they ask about someone who is no longer living, redirect them.
Rephrase questions as commands. Instead of “Do you want to go for a walk?” say, “Let’s go for a walk.”
Use simple phrases and break down tasks into clear actions. Try “Go to the closet and get your blue coat” instead of “Go put your coat on.”