The word dementia describes a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language.

Dementia is caused when the brain is damaged by diseases, such as Alzheimer’s disease or a series of strokes or can be associated with other conditions such as Parkinson’s disease or Down’s syndrome.

Dementia is progressive, which means the symptoms will gradually get worse. Viewing dementia as a series of stages can be a useful way to understand the progression of the condition, while appreciating that each individual will experience dementia in a different way and the different dementia subtypes will have different symptoms.

The terms mild, moderate and severe are most often applied to Alzheimer’s disease although all subtypes can be defined as early or severe.

Early stages

During the early stages of dementia the person themselves or their family or friends may notice difficulties in a number of areas.

This may include:

  • Noticeable problems coming up with the right word or name
  • Trouble remembering names when introduced to new people
  • Having noticeably greater difficulty performing tasks in social or work settings
  • Forgetting material that one has just read
  • Losing or misplacing a valuable object
  • Increasing trouble with planning or organising
  • Forgetfulness of recent events Impaired ability to perform challenging mental arithmetic, for example, counting backward from 100 by 7s
  • Greater difficulty performing complex tasks, such as planning dinner for guests, paying bills or managing finances
  • Forgetfulness about one’s own personal history
  • Becoming moody or withdrawn, especially in socially or mentally challenging situations

Later stages

During the later stages of dementia most people will become increasingly frail due to the progression of the illness. They will also gradually become dependent on others for all of their care.

Knowing what to expect can help everyone to prepare. It can enable the person with dementia to think about the kind of treatment and care they might want, and allows them to write an informed Advance Decision before they reach this stage so they can have input into how they will be cared for.

Other areas for planning ahead include arrangements for decisions about property and legal affairs. Knowing what to expect also allows carers and family to think about these aspects too.

Mild cognitive impairment

Mild Cognitive Impairment (MCI) is a term used to describe a condition involving problems with cognitive function (mental abilities such as thinking, knowing and remembering). People with MCI often have difficulties with day-to-day memory, but such problems are not bad enough to be defined as dementia. People with MCI have an increased risk of developing dementia, but some don’t develop dementia and a few will even get better.

Unusual behaviours

There is a wide variety of changed behaviours that can pose difficulties for a carer trying to provide support to someone with dementia. These may vary with the stage and sub-type of dementia.

These behaviours include:

  • Angry (aggressive) behaviour such as shouting angrily or hitting out at others
  • Anxiety and / or depression
  • Excessive walking (wandering behaviour) when people spend long periods of time walking either repetitively or walking long distances
  • Repetitive behaviours such as saying words, asking questions or making sounds, rocking, rubbing parts of the body repeatedly
  • Vocally disruptive behaviours such as shouting, swearing, screaming or grunting.
  • Dis-inhibited behaviours ranging from taking clothes off, masturbating or making sexual advances.

There are also many other behaviours such as being withdrawn and unresponsive, suspiciousness of other people, making accusations, sleep disturbance etc which carers and care staff can struggle to know how best to respond.

These behaviours are often described as ‘difficult’. People with dementia can sometimes be labelled according to the behaviour. For example ‘he is a wanderer’. This ‘label’ can have a negative impact on both how the individual is perceived and how the person is supported.

Source : DementiaRoadmap