Early Signs of Dementia in Men and Woman

What comes to your mind when you hear that someone has dementia?After the age of 50, it is not uncommon to have occasional problems finding the right word or remembering where we put things. But persistent difficulty with memory, cognition, and the ability to carry out everyday tasks may be a sign of something more serious. For many people, the term leads to frightening assumptions.

In fact, dementia is a collection of symptoms, personality changes, or unusual behavior here are 10 early signs of dementia in men :

1. Difficulty performing daily tasks. Everyone makes mistakes, but a person with dementia may have increasing trouble doing things like managing monthly bills or following a recipe, says the Alzheimer's Association. You might also have trouble concentrating on your tasks, take longer to complete them, or have difficulty completing them.

2. Repetition. Asking a question over and over again or telling the same story about a recent event multiple times are common indicators of mild or moderate Alzheimer's disease, according to the Cleveland Clinic.

3. Communication problems. Take note if a loved one has difficulty joining or following conversations, stops dead in the middle of a thought, or has trouble finding words or the names of objects.

4. Get lost. People with dementia may have difficulty with their visual and spatial abilities. According to the Mayo Clinic, that can manifest itself in problems like getting lost while driving.

5. Personality changes. It is cause for concern if a loved one begins to act unusually confused, suspicious, fearful, or anxious; if he gets angry easily or loses interest in activities and seems depressed.

6. Confusion about where and when. Another worrisome sign is disorientation with respect to time; for example, routinely forgetting what day of the week it is, says Jason Karlawish, a professor at the University of Pennsylvania Perelman School of Medicine and co-director of the Penn Memory Center.

7. Putting things out of place. A person with dementia may put things in unusual places and have trouble remembering where they put them, notes the Alzheimer's Association.

9. Loss of interest. Not feeling especially sociable from time to time is one thing, but a sudden and routine loss of interest in family, friends, work, and social events is a warning sign of dementia.

10. Forget old memories. Memory loss that becomes more persistent is often one of the first signs of dementia.

Some people with memory loss or problems with attention, decision making, language, or reasoning may have a problem called mild cognitive impairment (MCI). The disorder causes a marked decline, but the changes are less severe than in dementia, and people can continue to carry out their daily activities, according to the Cleveland Clinic.

Those who have MCI are at higher risk of developing dementia.

What is dementia?

Dementia isn't really a disease, according to the Mayo Clinic. It is a "catch-all" term that encompasses any change in the brain that causes a loss of function that interferes with daily life. It can decrease concentration, the ability to pay attention, language skills, problem solving, and visual perception. Dementia can also make it difficult for a person to control their emotions and can even lead to personality changes.

About 6.5 million people in the United States are living with Alzheimer's disease, the most common type of dementia, though many experts say that number is probably higher. And its prevalence is estimated to hit nearly 13 million by 2050, according to a 2022 report from the Alzheimer's Association. Worldwide, more than 55 million people have dementia, according to the World Health Organization.

If someone shows signs of dementia, it's important to see a medical expert who can run tests and make a diagnosis. A number of often treatable illnesses—from infections to a vitamin deficiency—can cause dementia-like symptoms, so they need to be ruled out first.

If it's dementia, you'll need to plan how you'll care for it, especially as the disease progresses.

Stating that someone has dementia acknowledges these changes in the person, however it does not suggest anything about the reasons for these symptoms. It does not explain the cause.

Memory and Aging

Does any memory loss mean dementia? Isn't memory loss a normal part of aging, something we should all expect?

Recognizing changes in a friend's or family member's memory can be a difficult step. It's not uncommon to claim that it's a normal part of aging as a way of downplaying what it can mean for your family. We truly know that severe memory loss is not a normal part of aging and none of us should ignore or downplay it.

For some of us, the tendency may go to the other extreme: concluding that a friend or family member has Alzheimer's disease. Sometimes (but not always), it is Alzheimer's.

However, other conditions are similar to those symptoms. They also cause cognitive and memory problems that interfere with activities of daily living. Some affect both young and old people.

Some are reversible, others are not.

Certain conditions can cause reversible dementias. Drug interactions, depression, nutritional deficiencies, and thyroid gland abnormalities can cause temporary episodes of dementia or delirium. Fortunately, through early identification, proper treatment can reverse these cases.

Irreversible dementias are degenerative, and Alzheimer's disease is the most common. Other degenerative dementias may resemble Alzheimer's disease, however they have distinct features that require special attention and a variety of treatments.

From the many causes of dementia, and the respective treatment for each, we can learn why a clear and timely diagnosis is essential.

How is dementia diagnosed?

The diagnosis of dementia requires a general medical and neuropsychological evaluation. As a first measure, the process determines if the person has a cognitive problem and its severity. After diagnosis and identification of the cause, the doctor may recommend treatment. And patients and caregivers can plan ahead.

A medical evaluation for dementia usually consists of several steps.

Review of medical history or onset of symptoms.

1. Doctors may ask you or the person you care for questions such as:

• What problems have you observed or identified?

• In what order did these changes occur?

• How long have the symptoms been present?

• How does this affect the person's ability to function in daily life?

The patient may not be able to remember the sequence of events or the severity of the problem. That is why a caregiver, or someone who knows the person, should accompany the patient and provide this information to the healthcare team.

2. Medical history and medications

Details of the medical history can identify an increased risk of a particular type of dementia. A medication review helps doctors identify specific drugs or drug interactions that may be contributing to cognitive problems. Again, it is crucial that someone who can accurately provide this information is present with the person during the appointment.

3. Neurological examination

Neurological exams are done to identify symptoms that may indicate specific types of dementia or other conditions, such as stroke or Parkinson's disease, that have a higher risk of becoming a cognitive problem.

4. Lab tests

Your doctor will want to rule out possible nutritional deficiency, infection, or hormonal imbalance, all of which can cause cognitive symptoms. Examples of these include:

• Thyroid imbalances

• Vitamin B12 deficiency

• Syphilis

Common chronic conditions like high cholesterol and high blood pressure put a person at risk of developing dementia. The doctor may order other laboratory tests to detect this risk.

5. Tomography of the brain

A CT scan or MRI evaluates the anatomy of the brain to identify conditions that can cause cognitive changes, such as a brain tumor or stroke. Imaging tests can also serve as a baseline or historical reference for brain size and blood vessel changes monitored over the course of treatment.

6. Mental status test

Also known as neuropsychological tests, these paper-and-pencil questionnaires assess many areas of cognitive ability:

• Memory

• Language

• Problem resolution

• Reasoning

The health care team compares the test results with those of patients of a similar age, educational level, and ethnic background. This helps to identify the relative frequency and severity of the problems experienced.

The Diagnosis defines treatment

The diagnostic process for dementia in recent years has become more accurate. Specialists analyze the collected data and determine if there is a problem, how advanced it is, and often the cause of the dementia.

Whether the cause is a reversible or irreversible condition, it defines the treatment and medical care plan for your friend or family member.

A clear diagnosis is imperative.

What are reversible dementias?

In older people, a variety of diseases and disorders can cause impaired cognitive functioning. An illness or a reaction to a medication can cause a change in mental state. They are sometimes called "pseudodementias." A medical evaluation can determine if a dementia is reversible or treatable.

Conditions and circumstances can cause reversible symptoms of dementia:

Drug Reactions

• A common reason older people experience dementia-like symptoms is an adverse reaction to a medication.

• All medications, prescriptions, over-the-counter remedies, and herbal supplements should be monitored by the physician to reduce possible side effects.

Endocrine abnormalities

• Symptoms caused by low or high levels of thyroid hormones, parathyroid disorders, or adrenal abnormalities can be confusing by being similar to those of dementia.

Metabolic alterations

• Kidney and liver failure, electrolyte (blood chemical) imbalances, hypoglycemia (low blood glucose), hypercalcemia (high calcium), and diseases of the liver and pancreas can cause confusion and changes in appetite. sleep and emotions

emotional stress

• Depression or profound life changes such as retirement, divorce, or the loss of a friend or family member can affect a person's physical and mental health.

• It is important to inform the doctor about the major circumstantial events in life that could cause stress.

Visual and hearing ability

• Undetected vision or hearing problems may lead to inappropriate responses and could be misinterpreted.

• The health care team should perform vision and hearing tests to identify any present problems.

Infections

• The confusion may be a symptom of an infection.

• Bring any signs of confusion to the attention of the physician.

Nutritional deficiencies

• Deficiencies in the B vitamins (folate, niacin, riboflavin, and thiamine) can lead to cognitive impairment.

What about degenerative or irreversible dementias?

If diagnoses rule out reversible dementia and the health care team determines that the person has degenerative or irreversible dementia, it is important for families and medical personnel to identify the cause of the problem.

This helps ensure that the affected person receives appropriate medical care. It also allows families to plan their care and find support and resources.

These are the most common degenerative dementias:

Alzheimer disease

• Alzheimer's disease is the most common cause of dementia in people older than 65, although it also occurs in much younger people. Alzheimer's affects approximately 35 percent of people over the age of 85.

• Currently, researchers definitely do not know what causes the disease and there is no cure.

• Symptoms differ from person to person, however, decline in memory, thinking, and the ability to function properly progress over a period of a few years and culminate in severe loss of mental function.

Ischemic vascular dementia (IVD)

• IVD is the second most common dementia.

• It is characterized by an abrupt loss of function or a general decline in cognitive abilities that interferes with "executive functions," such as planning and completing tasks.

• When the symptoms come on suddenly, the person would usually have had a stroke.

• For others, the condition develops slowly with a gradual loss of function and/or thinking.

Dementia with Lewy bodies (DLB)

• Lewy body dementia is a progressive degenerative disease.

• It presents symptoms similar to Alzheimer's and Parkinson's.

• People affected by this disease have behavioral and memory symptoms that can fluctuate, as well as motor problems commonly seen with Parkinson's disease.

• Common symptoms include REM sleep disturbances and hallucinations.

Frontotemporal dementia (FTD)

• FTD is a degenerative condition of the front (anterior) part of the brain that can sometimes be seen on brain scans.

• The frontal and anterior temporal lobes of the brain control reasoning, personality, movement, speech, language, people skills, and some aspects of memory. The symptoms can lead to a misdiagnosis as a psychological or emotional problem.

• FTD often occurs after age 40 and usually before age 65.

• The symptoms appear in two seemingly opposite ways: Some people are hyperactive, restless, distractible, and uninhibited (showing poor social judgment); others become listless, inert, and have a limited range of emotions.

Creutzfeldt-Jakob disease

• Creutzfeldt-Jakob disease (CJD or Jakob-Creutzfeldt disease) is a fatal and rapidly progressive brain disease.

• It is part of a group of diseases called transmissible spongiform encephalopathies, which are caused by an agent known as a prion (“pree-on”).

• This condition can be very difficult to diagnose as it has many different symptoms including behavioral changes, movement changes, cognitive changes and general changes in states of well-being such as insomnia, loss of appetite and migraines.

Parkinsonian dementia

• “Parkinsonism” is the name given to a collection of symptoms that include tremor, stiffness, slowness of movement, and an unsteady gait.

• Many neurological disorders have features of parkinsonism, including several of the dementias.

• When parkinsonism occurs without the presence of any other neurological abnormalities and there is no recognizable cause, the disorder is called Parkinson's disease after the English physician who first described it in 1817.

Progressive Supranuclear Palsy (PSP)

• People with PSP usually exhibit three symptoms: Gradual loss of balance and difficulty walking; loss of control of voluntary eye movements; and dementia.

• Although experts consider these three symptoms to comprise the hallmarks of PSP, patients with this disorder also experience other symptoms common to degenerative brain diseases. These include difficulties with movement, speech, and swallowing, as well as changes in behavior.

• In part because it is relatively rare, PSP is often misdiagnosed as Parkinson's disease. But their response to treatment and clinical symptoms are different, so an accurate diagnosis is essential.

Normal Pressure Hydrocephalus (NPH)

• Gait unsteadiness, urinary incontinence, and dementia are the signs and symptoms typically found in patients with PHN.

• Considered a rare cause of dementia, it affects people over 60 years of age.

• The precise incidence of PHN is difficult to determine as the condition does not have an agreed formal definition.

• Some doctors base the diagnosis on radiographic evidence (CT or MRI, for example); other health professionals rely more on clinical indications. Still others use a combination of signs and symptoms that they have found to be reliable.

• Traditionally, treatment consists of the surgical implantation of a shunt in order to reduce the pressure caused by the accumulation of cerebrospinal fluid.

Huntington's disease (HD)

• Huntington's disease is a fatal disorder characterized by involuntary movements (chorea) and cognitive decline (dementia).

• It is caused by a genetic mutation that can be passed from parent to child.

• HD is a disease with profound neurological and psychiatric characteristics that affects the deep structures of the brain, particularly the basal ganglia, responsible for movement and coordination. The structures responsible for thought, perception and memory are also affected. This is probably due to the connections of the basal ganglia with the frontal lobe of the brain.

• As a result, patients may experience uncontrolled movements (such as twisting and turning), loss of intellectual abilities, and emotional and behavioral disturbances.

Mixed dementias

• Sometimes two of these conditions can occur simultaneously. This is commonly seen in Alzheimer's disease and vascular dementia, as well as Alzheimer's disease and Lewy body dementia.

Medical Treatment for Dementia

There are no cures for degenerative or irreversible dementias. Therefore, medical treatments are mainly focused on maximizing the cognitive and functional abilities of the individual.

Specific treatments vary depending on the cause of the dementia:

• For patients with Alzheimer's disease and Lewy body disease, there are medications available called cholinesterase inhibitors. These can temporarily improve symptoms by increasing chemicals involved in memory and thinking skills. Another medication is Memantine, which can temporarily improve symptoms by decreasing abnormal activity in the brain. New drugs are being developed and studied and may be approved by the FDA. They may be restricted to people in the early stages of dementia or only available to those participating in clinical trials. A neurologist can help determine if these are appropriate and assess the risks and benefits.

• Treatment for vascular dementia focuses on controlling risk factors such as high blood pressure and high cholesterol.

• Before a physician would consider prescribing other medications to control symptoms (eg, sleep disorders, movement problems, depression, or agitation), they would need to have some precautionary discussions about the risks and benefits with the patient, their caregiver, and their family. . Also, behavioral interventions and non-pharmacological interventions would have to be tried first.

• Treatments vary depending on the cause. Depending on the type of dementia, certain medications are contraindicated and may actually make symptoms worse. For these reasons, an accurate diagnosis is a fundamental factor.

Research into the causes and treatments of dementia continues apace. We await new innovations that may one day defer, cure, or even prevent these debilitating disorders.

Communicating Dementia with Health Care Providers

Good communication with the primary care provider or neurologist affects the well-being of the person with dementia and their caregiver.

Communicating your concerns and describing the changes you have observed will prompt the provider to investigate. In some cases, you may find yourself “educating” medical personnel about the symptoms of the person you are caring for.

It is important that your concerns are taken seriously and that you are treated with respect and dignity.

If you are not getting the care you think is necessary, please bring your concerns to the attention of the provider. Ask for a referral to a resource in the community that specializes in evaluating people with cognitive conditions. The objective is to form an association in order to maintain the quality of health of the person with dementia and to solve the problems that arise.

What exactly is the role of a caregiver?

Partner with the healthcare team

Establish a good working relationship with the primary care physician. This helps ensure continued good care and support.

Being present during the general medical examination that rules out treatable conditions and provides information about the current state of health. Doing so provides a foundation for planning care, both now and in the future.

Ampliar conocimientos y habilidades.

Un diagnóstico preciso supone el inicio de un proceso de capacitación para los cuidadores y las familias para que se puedan satisfacer las necesidades y se localicen y utilicen los recursos. La demencia irreversible requiere un nivel de atención que aumenta a medida que avanza la enfermedad. A través de la capacitación y el uso de los recursos disponibles, las familias pueden aprender nuevas habilidades para manejar las necesidades cambiantes en la prestación de servicios médicos.

Proteger la seguridad en el hogar, aprender técnicas de manejo del comportamiento y abordar asuntos legales y financieros, son pasos importantes que las familias pueden tomar para manejar la demencia, y existen recursos disponibles que pueden ayudar. Muchos grupos de apoyo para cuidadores, algunos se incluyen en Internet, ofrecen apoyo emocional y práctico. Es posible que los cuidadores necesiten informarse sobre el cuidado a largo plazo y recurrir a los miembros de sus comunidades para encontrar la ayuda que necesitan. La siguiente lista de recursos ofrece más información sobre dónde empezar a buscar ayuda.

Asuntos y decisiones familiares.

Cada familia es diferente. Ya sea que el cuidado de una persona con demencia se brinde en el hogar, en un centro de vivienda asistida, en una unidad de cuidados especiales para la enfermedad de Alzheimer, o en un hogar de ancianos, depende de los recursos familiares y las necesidades del paciente. Si bien la colocación en un centro de apoyo no es infrecuente en las últimas etapas de la demencia, cada familia aborda la experiencia del cuidado de la manera que más le convenga.

Muchas familias brindan atención en el hogar a una persona con demencia. Si bien esta puede ser una experiencia provechosa y gratificante, también puede ser estresante. Los estudios han demostrado que cuidar a alguien con un trastorno cerebral puede ser más estresante que cuidar a alguien con una discapacidad física. Es esencial que los cuidadores se tomen el tiempo para cuidarse física y emocionalmente.

The History of Dementia

The disorders that we include today in the concept of dementia have suffered very different considerations by scholars and by society itself throughout history. We go on to recall, very briefly, the times in history in which the greatest interest in dementia was shown.

The word insanity appears as far back as the Roman Empire, literally meaning "madness, out of one's mind." Thus we find it for the first time in the work De Rerum Natura, by Titus Lucrecius, in the 1st century BC, and it is in the Encyclopaedia of Celsus -also from the 1st century BC- when it is used for the first time in a context doctor.

Cicero defended in his work De Senectute that memory loss in old age was the consequence of a disease unrelated to aging itself.

A century later, Aretaeus of Cappadocia already speaks of senile dementia.

At that time, any type of intellectual or behavioral disorder was called dementia, and it is necessary to take into account that then the average life expectancy at birth was about 30 years.

It is in this century when the organic nature of dementia begins to emerge clearly. In 1822, Bayle presented his clinicopathological work, in which he demonstrated that the physical and mental symptoms of progressive general paralysis (PGP), a treatable infectious disease that causes dementia and that had been brought by the Spaniards under Columbus from Haiti, they were due to chronic arachnoiditis. This changed the concept of dementia, which began to be considered the result of an organic disease.

In Wilhelm Griesinger's Treatise on Psychiatry (1845) mention is made of a classification of apathetic dementia, under the general title of States of Mental Weakness. Senile dementia was an example of such a condition, which was believed to be caused by disease of the cerebral arteries.

Binswanger introduced the term presenile dementia in 1898. The term dementia was beginning to be defined: it appeared both in senile age and before it, and was caused by an organic brain disease, which differentiated it from neuroses.

By 1900, senile dementia, arteriosclerotic dementia and some forms of subcortical dementia were already well identified, including that described by George Huntington on Long Island in 1872.