One of my biggest struggles is not remembering the simple things: a name, a single word, or even where I’ve put my keys. I get so frustrated because the answer is RIGHT THERE, and I just can’t pull it. I just wish my brain would act right.

—Mom

Every day that passes, we eat, drink, work, play, breathe, and love, and we turn another page in the chapters of our lives. As those chapters come close to an inevitable end, we all go through changes that differ from person to person. That is the process of aging. Although some of us may approach it with resistance, the process is unavoidable, with no respect to gender, location, or race. Because of the aging process, we can look back at our childhood days and laugh at our decisions, the good, the bad, and the ugly.

Normal Aging

How do forgetfulness, gray hair, mood fluctuations, and changes in food preferences differ from signs of dementia? Significantly. There is a broad line between normal aging and dementia, and every caregiver should learn the difference to spot when these signs cross the line. Listed are some of the effects of “normal” aging:

reduced functional capacity of organs

slowed cell division

reduced cardiac efficiency

the gradual buildup of fat in arteries

reduced hearing capacity

weakened bones

reduced joint flexibility

slowed metabolism

gradual death of nerve cells in the spinal cord and brain

reduced eyesight

constipation

reduced skin elasticity

urinary incontinence

slowed nail growth

loss of hair color and increased hair loss

increased susceptibility to diseases and infections

weight loss

What to do About it

Although we cannot stop or pause aging, making lifestyle changes helps reduce our risk for conditions and diseases that become common in old age. The following tips may help improve the quality of life for both you and your LO.

Exercise

When some people hear about exercise, they think about heavy workouts for weight loss, but the benefits of living an active life extend to mental fitness. Mental and physical activities improve heart and brain health, among other advantages.

Balance Your Diet

He who eats right extends his life expectancy. It’s as simple as that. Vegetables, lean protein, fruits, healthy fats, and whole grains provide a lifelong subscription to healthy living. A nutrient-rich diet shields you from the wrath of various health hazards. Avoid processed foods as they may contain harmful substances. Find a way around trans fats and hydrogenated oils because the processes they go through to extend shelf life diminish their quality, making them unhealthy.

Socialize

Invite those old friends over and tease each other over childish mistakes from a long-buried past! When they leave, and you are alone again, those memories shape a priceless smile in place of a miserable countenance. People who choose to be alone often overthink their past, present, and future instead of living. When you build a social network; create new friendships while maintaining ties with friends and family, you reduce stress levels and slow aging.

Visit Your Doctor

At any life stage, strive to make medical consultations a habit. Visiting your doctor helps keep your overall health in check. As you grow older, you may want to control your blood pressure levels, improve bone health, and many other changes. The good news is: You can now visit your doctor without leaving the warmth of your home!

Dementia

As we age, we go through a series of changes. One of these changes is a loss of brain neurons, a change that also occurs in individuals with dementia. The speed at which healthy individuals lose neurons draws the line between normal aging and dementia.

Dementia describes persistent conditions that interfere with normal mental processes, causing decreased cognitive function. It ranges from a point where it affects an individual’s normal function, interfering with daily activities, to an extent when the afflicted individual can only depend on those around them for basic living needs.

Apart from aging, several other factors can cause dementia, including brain injuries. It is also important to know that not everyone with dementia has Alzheimer’s disease. Before diving into Alzheimer’s disease specifically, it is important to note several other forms of dementia.

Lewy Body Dementia

A buildup of protein bodies called Lewy bodies blocks the brain from producing sufficient amounts of certain neurotransmitters, brain chemicals responsible for communication among neurons. Acetylcholine is the chief chemical in transmitting nerve impulses, contraction of smooth muscles, and more. The collection of Lewy bodies causes an acetylcholine deficiency, affecting a person’s memory and learning processes. Lewy bodies also affect the production of dopamine, another chemical that relays messages between brain neurons. The neurotransmitter dopamine plays a significant role in regulating one’s sleep patterns, mood, motivation, etc.

Lewy body dementia stems from the deposition of these protein bodies, causing degeneration of brain tissue. The disease manifests itself through some of the following symptoms.

Sleep Difficulties

Although sleep challenges may go unnoticed by other people who are not close to the patient, these are common in individuals with Lewy body dementia. Some obstacles are easy to manage, but others require specialized intervention from knowledgeable healthcare professionals.

insomnia

REM sleep disorder

restless leg syndrome

increased daytime sleepiness

Mood and Behavioral Fluctuations

Patients with Lewy Body disease may show negative changes in behavior and mood, and these changes worsen as the disease progresses. Some of these changes in behavior and mood include:

extreme distrust of the surrounding people

depression

reduced interest in usual events or activities or events

signs of paranoia such as suspecting that people are hiding things or talking behind their back

less motivation for social interaction

delusions, or firm opinions and beliefs that lack evidence

restlessness or agitation and similar habits that include irritability, repeating words or phrases, and pacing

anxiety and feeling disturbed in the absence of a LO

Movement Challenges

While some patients with Lewy body dementia may experience movement problems in the early stages of the disease, others may not have these until several years afterward. Signs of movement difficulties may start as minor changes in handwriting, then progress to apparent symptoms such as tremors and challenges in walking. Without proper diagnosis, minor signs of movement challenges in Lewy body dementia are easy to miss. Hence, it is crucial to know various other symptoms that signal disturbed movement in patients with Lewy body dementia.

swallowing difficulties

muscle stiffness or rigidity

trouble balancing and repeatedly falling

slow movement, frozen stance, or shuffling walk

loss of coordination

illegible handwriting

shaking or tremors even in a relaxed state

reduced facial expression

stooped posture

Other Symptoms

Individuals suffering from Lewy body dementia can also experience significant changes in the part of the brain that regulates functions such as those of the muscles, heart, and glands. The patient may experience:

fainting

blood pressure problems

body temperature fluctuations

dizziness

In its early stages, this form of dementia can be challenging to diagnose, so doctors first carry out routine tests to rule out other health conditions that have similar symptoms. If, after routine tests, the healthcare providers have reason to suspect dementia, then they will perform further tests to evaluate the patient’s cognitive functioning.

Several drugs help keep symptoms in check. Depending on the symptoms in question, one may require medicines to improve their movement, ease sleep, or drugs that work on thinking issues. Some lifestyle changes, such as eating healthy foods, practicing better sleeping habits, and exercising regularly, help patients cope better with the disease.

Frontotemporal Dementia

As the name suggests, Frontotemporal Dementia is another neurodegenerative disease caused by damage to the temporal and frontal lobes of the brain.

Located close to the temples, the temporal lobe plays a vital role in acquiring memory, processing sensory input, perception, etc. Significant damage to the temporal lobes can cause speech and spatial reasoning problems. The frontal lobe controls executive functions such as planning and decision making, as well as emotional regulation. It also manages operations related to communication, concentration, and consciousness. Each side of the temporal lobe handles the opposite side of the body; that is, damage on the right side of the temporal lobe would manifest on the left side of the body.

The signs and symptoms of this disease vary based on which side of the frontal or temporal lobe suffered damage. They usually progress at a steady rate, but sometimes, because of various factors, symptoms may worsen rapidly. Frontotemporal dementia presents itself in the forms listed next.

Behavioral Variant Frontotemporal Dementia

This form of frontotemporal dementia involves changes in behavior, judgment, and personality. Frontotemporal dementia patients may show difficulties with cognition, but their memory may remain unaffected.

Symptoms include:

problems in organizing and prioritizing activities or tasks

trouble with planning and sequencing events or steps

saying or doing the same things repeatedly

reduced interaction with family

doing or saying inappropriate things without considering how the people around may interpret such behavior

movement and language problems over time

losing interest in activities they once enjoyed

Primary Progressive Aphasia (PPA)

Changes in communication skills are common in this form of frontotemporal dementia. Patients find it difficult to use language to write, read, speak, or understand general conversations. Challenges with judgment, memory, and reasoning may not manifest right initially, but they usually develop with time.

To better understand the symptoms of primary progression, we can categorize it into three classes as follows:

Semantic PPA

A patient gradually loses understanding of some words.

They may not recognize everyday objects or faces of familiar people.

Agrammatic PPA

Increased speaking difficulties

They may leave out words that link verbs and nouns (such as from, with, and to).

Gradual, complete loss of speech

Gradual movement difficulties

Logopenic PPA

Patients may experience difficulties choosing the right words during conversations despite understanding sentences and phrases.

They may have trouble expressing ideas despite retaining good grammar skills.

Frontotemporal dementia does not have designated tests that one can just carry out to determine whether they have it. Doctors order usual tests and conduct physical examinations to rule out conditions with similar symptoms and signs to diagnose properly. If necessary, they then assess the patient’s reflexes, muscle strength, and other important functions. The healthcare providers also test the patient’s problem-solving, attention, and counting skills to determine the level of cognitive damage, if any. Doctors then order a computed tomography (CT) scan, or magnetic resonance imaging (MRI) to locate the damaged areas and assess, in real-time, the level of damage made to the brain.

There is currently no cure for frontotemporal dementia, but healthcare professionals prescribe medication to treat symptoms. Patients may use antidepressant and antipsychotic medications to treat anxiety and fight compulsive behaviors.

Vascular Dementia

Also called Multi-Infarct Dementia, Vascular Dementia refers to a decline in cognition skills due to reduced or blocked blood supply to the brain, causing oxygen and nutrient deprivation and, eventually, death of the brain cells.

Patients with vascular dementia experience different symptoms depending on the location and severity of blood flow impairment in the brain. Symptoms of vascular dementia can be sudden, or they may develop gradually, progressing over time. They may also overlap with other dementia forms, such as Alzheimer’s disease. However, unlike Alzheimer’s disease, patients with vascular dementia often show symptoms that involve difficulties in problem-solving and changes in the speed of thought, rather than loss of memory. When symptoms follow a recent stroke and clearly seem related, the condition may be referred to as post-stroke dementia.

Vascular dementia patients may experience:

challenges in paying attention to details or concentrating on the same activity for a long time

depression

a decline in the ability to organize actions or thoughts

agitation and restlessness

reduced ability to plan and communicate ideas or logically analyze situations

confusion

reduced thinking speed

apathy

unsteady gait

reduced or complete loss of bladder control

Doctors perform neurocognitive tests to evaluate the patient’s judgment, planning, memory, and other cognitive skills. When healthcare providers scan and test patients, they often find brain abnormalities that show proof of prior strokes, but this does not mean that every individual who has experienced a stroke will also suffer from dementia.

White matter is a system of deep neural connections that links brain lobes. In people with vascular dementia, doctors may also detect changes in the white matter.

Symptoms of vascular dementia are manageable with the proper medications. Doctors may prescribe drugs that prevent stroke to reduce the chances of additional damage to the brain. Lifestyle changes also help reduce the risk of getting related health complications. These good health practices include weight management, watching alcohol consumption, and staying away from cigarettes.

Mixed Dementia

In some instances, a patient may exhibit signs of more than one form of dementia, called Mixed Dementia. Symptoms of mixed dementia differ based on the affected brain regions, forms of dementia involved, and severity of damage to the brain.

Other Conditions

Apart from the neurological diseases discussed above, various conditions cause dementia in patients. Because some conditions shield themselves behind illnesses with similar symptoms, you must learn about other conditions that cause dementia and how they occur.

Creutzfeldt-Jakob Disease

A malformation of proteins called prions causes other prion proteins in the brain to misfold, giving rise to rare neurodegenerative diseases known as prion diseases. Creutzfeldt-Jakob disease (CJD) is the most common form of prion disease in humans and causes dementia. Unlike many other forms of dementia, CJD causes dementia that progresses fast. Malformed prion proteins destroy brain cells, causing an unusually rapid decline in cognitive function. The disease is generally classified into the following types.

Sporadic Creutzfeldt-Jakob Disease

Spontaneously develops, usually between 60 and 65 years of age.

Familial Creutzfeldt-Jakob Disease

Stems from chromosomal changes in the biological makeup of prion protein.

Develops in individuals who would have genetically inherited the chromosomal abnormalities.

Manifests in individuals at a younger age than the sporadic Creutzfeldt-Jakob disease.

Acquired Creutzfeldt-Jakob Disease

This disease is caused by external exposure to abnormal prion protein resulting from some medical procedures or food infected with bovine spongiform encephalopathy, a neurodegenerative disorder in cattle.

Symptoms

As with the discussed forms of dementia, different people with Creutzfeldt-Jakob disease may experience various symptoms, and the severity differs from each individual. At some point in the progression of the disease, patients with this disease experience:

disorientation

muscle stiffness, twitches, and involuntary jerky movements

confusion and depression

indifference, irritability, and mood swings

hallucinations or double vision

walking difficulties

memory loss and poor judgment

Diagnosis

Like most other conditions that cause dementia, there is no designated test to precisely diagnose Creutzfeldt-Jakob disease in living humans. Still, a series of tests can help reveal if a person is likely to develop Creutzfeldt-Jakob disease.

Electroencephalogram (EEG) measures electrical activity at the brain level and shows the patterns

Brain magnetic resonance imaging (MRI) detects specific brain abnormalities related to Creutzfeldt-Jakob disease

Lumbar puncture (spinal tap) checks for particular proteins in the spinal fluid

Protein misfolding cyclic amplification (PMCA) detects malformed protein aggregates

Huntington’s Disease

Another disease that causes dementia in patients is Huntington’s disease (HD). It is a progressive disorder of the brain caused by a defective gene. When it strikes, it affects the central nervous system, causing challenges in thinking, moving, and social interaction. Individuals born to families with a history of HD and who inherit the defective gene eventually develop Huntington’s disease.

Symptoms

Huntington’s disease usually manifests between ages 30 and 50, although symptoms can still appear earlier or later. The main sign of the disease is loss of movement control in the arms, legs, and upper body. It also affects reasoning, memory, judgment, and plan execution. Patients with HD eventually struggle with depression, anxiety, and irritability.

Diagnosis

Individuals eager to know if they have HD can take a genetic test to determine whether they carry the defective gene, even if they do not have any outward symptoms.

Normal Pressure Hydrocephalus (NPH)

In some unfortunate cases, excess cerebrospinal fluid pools in some parts of the brain, causing a brain disorder called normal pressure hydrocephalus. The fluid buildup could stem from tumors, infection, head injuries, or hemorrhaging. Due to the excess cerebrospinal fluid, brain ventricles enlarge to the extent that disturbs and damages the surrounding brain tissue. The disorder impairs one’s thought processes and physical abilities. NPH gets its name because measured cerebrospinal fluid pressure usually remains normal despite the extra fluid.

Specialists can treat normal pressure by surgically inserting a shunt to drain the excess fluid from the brain. A successful surgery resolves walking challenges, but thought processes usually remain an issue.

Symptoms

Individuals with normal pressure hydrocephalus may show:

walking difficulties

mild dementia

loss of bladder control

Diagnosis

Healthcare providers perform the following tests to confirm whether a patient has normal pressure hydrocephalus. Depending on the patient’s presentation and other factors, they may carry out one or more tests.

Brain imaging

Specialists use a computed tomography scan or magnetic resonance imaging to detect changes in the brain ventricles.

Clinical examination

Neurologists clinically examine patients with suspected normal pressure hydrocephalus to evaluate the damage and rule out other conditions like Alzheimer’s.

Cerebrospinal Fluid Tests

The following tests are also crucial as they are used to estimate shunt responsiveness:

lumbar puncture

external lumbar drainage

cerebrospinal fluid outflow resistance

intracranial pressure monitoring

isotope cisternography

Korsakoff Syndrome

Vitamin B, also called thiamin, helps maintain brain function by facilitating energy production. Brain cells fail to produce enough energy to support brain processes without enough thiamin. Severe thiamine deficiency disturbs the processing of brain signals and affects the storage and retrieval of memories. When thiamine deficiency interferes with normal brain functioning, brain cells suffer significant damage accompanied by microscopic bleeding. Damage resulting from the considerable thiamin crisis causes a central nervous system disorder called Korsakoff syndrome. The condition also results from various other causes ranging from serious health issues such as advanced cancers to something as simple as poor food choices. Korsakoff syndrome can also occur in individuals who struggle with proper food absorption or alcohol misuse.

Korsakoff syndrome often follows another neurological syndrome called Wernicke encephalopathy (WE). Wernicke Encephalopathy is a life-threatening emergency characterized by fatal brain disruption, abnormal eye movements, and lack of coordination. Although WE usually precedes Korsakoff syndrome, individuals without prior WE history can still develop Korsakoff syndrome.

Symptoms

Despite most patients being able to hold conversations and socialize as normal, they may encounter:

trouble retaining new information

long-term memory gaps

difficulties remembering recent events

hallucinations

In many cases, the patients may unintentionally fabricate the lost information to fill in the blanks in memory.

It is sometimes challenging to diagnose Korsakoff syndrome as its symptoms may hide behind other health problems such as head injuries and alcohol intoxication. Since there are no specific imaging or laboratory tests to determine if an individual has Korsakoff syndrome, the job lies in the hands of a specialized healthcare provider.

Alzheimer’s Disease

And finally, Alzheimer’s disease. Alzheimer’s disease is an irreversible neurological disease that disrupts normal brain function, altering one’s behavior, memory, and thought processes.

Stages of Alzheimer’s Disease

Alzheimer’s disease develops slowly, worsening gradually over the years. As time goes on, the condition eventually disturbs most areas of the brain, such as those controlling language, judgment, and other cognitive functions.

When researching, you may find it classified into three or seven stages, but we will discuss five. Although this book focuses on the early stages of the disease, learning and understanding other stages is an integral part of your caregiving journey. By learning how the stages vary and progress, you understand the changes that await your LO and can prepare to the best of your capacity. Alzheimer’s disease progresses continuously, so you should realize that the discussed stages are only for reference and comprehension.

Stage 1

Alzheimer’s disease is so cunning that it develops subtly, causing minor brain changes that can go unnoticed for years. In research settings, the early signs can be identified before symptoms manifest. This stage of normal outward behavior is called the preclinical phase. Neither the patient nor the caregiver notices signs of Alzheimer’s disease during the preclinical stage, and the patient can remain in this stage for years.

Only special imaging tests can show whether one has the disease during this stage. With the current advancements in technology, it is possible to identify deposits of the characteristic feature of Alzheimer’s disease, a protein called amyloid-beta, using advanced imaging techniques. With a doctor’s recommendation, some individuals seek genetic testing to determine their risk of developing Alzheimer’s disease.

Stage 2

The changes in behavior at this stage are very minimal, and you might still miss them. Patients in this phase may misplace minor items or forget words they do not usually use, which is why changes at this stage are difficult to address. People at this stage of Alzheimer’s disease continue to live and work as expected, without needing extra help with simple activities.

Later during this phase, patients develop mild cognitive impairment, causing mild but noticeable changes in their thinking and memory.

They may experience memory lapses regarding simple information, such as recent events, appointments, or conversations. Patients at this stage may also have challenges judging the amount of time needed to complete tasks, and others may find it hard to make proper decisions.

Stage 3

During the third stage of Alzheimer’s disease, your LO shows clear, unmistakable signs of cognitive decline. Healthcare professionals diagnose most patients at this stage when caregivers or family members worry about the symptoms interfering with their LO’s daily activities. The patient may forget the names of new people just after meeting them, repeat the same questions you have already answered, or may display more difficulties in planning tasks.

Stage 4

Patients grow more forgetful and confused by the time they reach this stage. They may occasionally lose track of location and time and show difficulties remembering their phone number, address, or other personal details. It also becomes a challenge to choose appropriate clothes for different events, so they may need extra help to complete daily tasks and care for themselves.

Stage 5

In the advanced phases of Alzheimer’s disease, your LO may forget people’s names, faces, or both. As the damage progresses, patients mistake familiar people for others. Delusions eventually kick in with the progression of this stage, and your LO might think they should go to work or visit a particular friend. In reality, however, they may not have a job, or the friend in question could be deceased. This is a difficult phase as your LO may need help with sensitive tasks such as using the bathroom and dressing up.

Later during this stage, your LO undergoes severe cognitive decline and loses basic abilities such as eating, sitting up, or walking. This is when they need genuine, extensive care the most because they may even lose the ability to tell when they are hungry or thirsty.

Although challenging, many families resort to special facilities such as nursing homes or memory care centers when they realize they cannot provide as much care and attention as their LO needs.

Symptoms of Alzheimer’s Disease

The disease manifests differently in different stages and people. Symptoms may vary from occasional anxiety to loss of impulse control and even seizures. It is an essential part of positive caregiving to learn more about these signs as it helps determine how fast or slow the disease is progressing. When you know the rate at which the disease develops, you can appropriately adjust the amount of attention you give the patient. Let’s take a look at some of the symptoms:

Early-onset Alzheimer’s Disease

Visual processing challenges

They may have trouble understanding or estimating distance.

They may encounter difficulties reading things that they once could read without problems.

Forgetfulness

They may mistake days of the week and lose track of dates.

They may lose track of recent conversations.

They may forget where they put essential items.

Poor judgment

They may encounter challenges in handling financial matters.

They may find it overwhelming to follow instructions such as recipe methods.

Loss of independence or control

Physical problems

They may have difficulties in:

Walking

Speaking

Swallowing

Decreased expression

Patients may have challenges describing objects.

They may have difficulties recalling words they once knew.

They may have trouble putting ideas into words.

Getting lost

Patients may leave the house and forget where they want to go.

They may have trouble finding their way in once-familiar places.

Personality changes

Now that we have explored dementia and covered the basics of Alzheimer’s disease, we will dissect caregiving elements in the chapters ahead, one after the other.