Dementia Part I: Risk Factors and Common Symptoms

As dementia progresses, most patients will develop behavioral and psychological symptoms of dementia. These symptoms may be short-lived, intermittent or persistent. Psychotic symptoms are the most disturbing for the patient and caregivers and hallucinations, delusions or even psychotic symptoms. Hallucinations or delusions impact 20 percent of Alzheimer’s Dementia (AD) patients. Hallucinations are perceptions without stimuli and are most often visual. Delusions are fixed, idiosyncratic or false perceptions or beliefs with little if any basis in reality. These are not the result of religious or cultural norms, but rather delusions can be suspicious, paranoid, grandiose, somatic including medical illnesses that don’t exist, self blaming or even hopeless. Psychotic symptoms are often related to the current mood. This may manifest itself as depression or even delusions that one is poor or dead. In mania, grandiose delusions and elevated self-regard are quite common. Some additional risk factors for psychotic symptoms in older adults may include a variety of other instances. Chronic bed rest, cognitive or sensory impairment are common. Social isolation and being of the female gender also can increase psychotic symptoms. Neuropsychiatric symptoms also can be associated with dementia. Up to 40 percent of Alzheimer’s patients have depression even preceding the disease onset. Signs of depression include sadness, loss of interest in usual activities, anxiety and even irritability. If a patient stops eating or withdraws, depression could be the cause. Apathy also highly is prevalent and persistent through the course of Alzheimer’s Dementia. This can cause more functional impairment than expected for cognitive decline. Mania-like behavioral symptoms also may exist. Signs of mania would include pressured or hurried speech, disinhibition, elevated or irritable mood and reduced sleep. Hyperactivity and impulsivity also are symptomatic of mania. Agitation and aggression also is seen in up to 80 percent of Alzheimer’s Dementia patients and is a leading cause of nursing home admission as it can become too much to manage a loved one who has become potentially violent or mean. It’s important to identify and examine the context of the patient’s behavior and if they are harmful to themselves or others. Environmental triggers also may cause agitation or aggression. Overstimulation or being put in unfamiliar surroundings can trigger aggression or agitation, and frustrating interactions also could be a trigger for aggression. When reviewing potential symptoms of Alzheimer’s Dementia, it’s important to determine whether the delusions, hallucinations and other behavior interfere with daily function. In addition, ruling out physical discomfort, such as pain, hunger or infection will be critical before seeking a formal diagnosis of Alzheimer’s Dementia.