Story by: David Steen Martin on September 16, 2021
Symptoms of dementia in older adults aren’t reflected in the occasional mental slip, but a more substantial decline — the kind of drop in mental ability that interferes with daily activities and affects independence.
Misplacing a pen or forgetting someone’s name is a normal loss of memory for someone who is older. Symptoms of dementia in older adults reflect changes in how their brain works — they may struggle to use a telephone or a television remote control they had mastered long ago.
“It really comes down to having evidence of cognitive decline from a previous level of ability,” said Rachel N. Hart, D.O., geriatric medicine physician with Norton Neuroscience Institute Memory Center.
Dementia affects about 1% of people in their 60s and the percentage doubles every five years or so. Among people in their 90s, 40% have dementia. About half of people with dementia go undiagnosed.
Symptoms of dementia in older adults can include difficulty finding the right word, trouble with common tools like the remote control, inability to recognize formerly familiar items or people, and loss of “executive function,” or ability to plan, which affects things like the ability to balance a checkbook.
Day-to-day activities that could be affected by dementia include working, shopping, driving a car, cooking, doing finances, dispensing medications and maintaining a home. Dementia symptoms also can include difficulty with basic activities like dressing, bathing, eating and toileting.
Dementia is diagnosed using tests like the Montreal Cognitive Assessment, which gives a score out of 30 and can indicate whether someone has mild, moderate or severe impairment.
To be diagnosed with dementia, mental difficulties also can’t be the result of some reversible medical condition like major depression. To rule out other potential causes of cognitive troubles, a number of tests may need to be performed.
Lifestyle modifications can help with dementia. These include exercise, adequate sleep, establishing and keeping consistent routines, and avoiding excessive stimuli. Keeping the brain active and continuing to socialize are also helpful.
There are two classes of drugs that have been approved for treating dementia, cholinesterase inhibitors and NMDA-receptor antagonists. Both types of medications are considered memory enhancing. They’ve been shown to slow the progression of dementia, but they aren’t a cure.
“They’ve not been shown to reverse the memory loss that’s already present for a patient with dementia,” Dr. Hart said.
Talk to your primary care provider about age, family history and ways to prevent dementia.
Other medications can help with other symptoms of dementia in older adults. Antidepressants can be used to treat anxiety or agitation. Antipsychotics can be used to treat delusions or paranoia. Mood stabilizers can help in people with dementia who risk harming themselves or their caregivers.
Dementia should not be confused with delirium, an extreme, confused state caused by some sort of illness. Hyperactive delirium can result in agitation and restlessness, while hypoactive delirium can leave people drowsy and inactive. Some people will have both types of delirium during a single day.
Depression is common among older adults and it can be mistaken for dementia. Depression is defined as having five or more of the following for two weeks: poor concentration, loss of interest, sleep disturbance, low energy, sense of guilt, change in appetite, a change in behavior causing either a slowing down or agitation, and suicide or thoughts of death.
Dementia, delirium and depression are three separate, distinct syndromes, but all three can coexist in the same person. People with dementia have a higher risk for delirium, and many people with dementia also have depression, according to Dr. Hart.
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