Dementia Today.net

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Living with Dementia

Normal Aging & Dementia

  • - Dementia
  • Jun 02, 2011

Various criteria are used to diagnose dementia and to characterize its severity. For example, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association (1994), specifies three main criteria for dementing disorders: (1) memory impairment and impairment of at least one other cognitive domain (e.g., aphasia, apraxia, agnosia, executive dysfunction); (2) sufficient severity to lead to impairment in social or occupational functioning; and (3) decline from a previously higher level of functioning. Table 1.1 compares the criteria for MCI and dementia.

A widely adopted scale that covers these multiple dimensions of the diagnostic criteria is the Clinical Dementia Rating (CDR; Berg 1988; Morris 1993).

The CDR quantifies the severity of dementia in six domains: memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care. Ratings are based on the report of individuals, a spouse or other caregiver, and all available information (tab. 1.2). Clinical Dementia Rating scores range from 0 (healthy adult) to 3 (severe dementia).

Dementia can result from a number of etiologies, including dementia of the Alzheimer type, Lewy body disease, vascular insults, human immunodeficiency virus, Parkinson disease, Huntington disease, and Pick disease. It can also result from a number of general medical conditions, some of which are at least partially reversible (e.g., depression, hypothyroidism, and vitamin B12 deficiency;).

Dementia
Comparison of criteria for mild cognitive impairment and dementiaTable 1.1. Comparison of criteria for mild cognitive impairment and dementia

Now, contrast the abilities and skills of normal aging stated above with what you can expect with dementia. A person with dementia depends on others for those daily activities that will keep them independent. He or she will not be able to recall incidents of memory loss and may only complain about memory problems if specifically asked. These occasions of memory loss will become more of a concern for close family members than for the person. In addition, there may be a noticeable decline in memory for recent events or the ability to maintain a conversation. A person with dementia has considerable difficulty finding and using the right word. The person may use close substitutions for the word he/she wants or may use a description instead of the actual word. The ability to find the right word continues to decline in dementia. The person may lose his/her way in what was very familiar territory and sometimes may take hours to find their way back. Also, a person who has even early dementia will not be able to use common appliances and will be unable to learn how to operate even simple new devices.

Do you know the difference between normal aging and dementia? If not, the Alzheimer's Association publishes the following list: 10 Warning Signs of Dementia. If you are concerned about your ability to think, to remember, or to concentrate, ask yourself the following questions: Clinical Dementia Rating scoresTable 1.2. Clinical Dementia Rating (CDR) scores

1. Memory Loss: Forgetting recently learned information is one of the most common early warning signs of Alzheimer's disease. Do you forget things more often or find yourself unable to recall information later? Do your friends or family tell you that you keep repeating the same question over and over again?

2. Difficulty Performing Familiar Tasks: Do you have difficulty planning or completing everyday tasks? Do you lose track of the steps involved in preparing a meal, placing a telephone call, or playing a game?

3. Problems with Language: Do you often forget simple familiar words or substitute unusual words? Do you mimic actions when you can't remember the words to describe them? People with dementia may be unable to think of the word "toothbrush" for instance and instead ask for "that thing in my mouth" or mimic the action of brushing their teeth.

4. Disorientation to Time and Place: Do you ever get lost in your own neighborhood, forgetting where you are or how you got there? Have you ever been unable to find your way home?

5. Poor or Decreased Judgment: Has anyone told you lately that you dress inappropriately, wearing several layers on a warm day or little clothing in the cold? Do you ever show poor judgment, like giving away large sums of money or engaging with telemarketers who tell you you've won a sweepstakes?

6. Problems with Abstract Thinking: Do you ever have unusual difficulty performing complex mental tasks, like forgetting what numbers are for and how they should be used?

7. Misplacing Things: Do you ever put things in unusual place, such as your watch in the sugar bowl or your keys in the freezer?

8. Changes in Mood or Behavior: Do you experience rapid mood swings, from calm to anger or tears, for no reason?

9. Changes in Personality: The personalities of people with dementia can change dramatically. Have you become extremely confused, suspicious, fearful or dependent on family members?

10. Loss of Initiative: Have you become very passive, sitting in front of the TV for hours, sleeping more than usual? Have you lost interest in your usual activities?

To find out more about the 10 Warning Signs of Dementia, visit the Alzheimer's Association website at www.alz.org



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Laura A. Flashman, Ph.D.,
Heather A. Wishart, Ph.D.,
Thomas E. Oxman, M.D.,
and Andrew J. Saykin, Psy.D.

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REFERENCES
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  3. Krasuski, J.S., G.E. Alexander, B. Horwitz, et al. 1998. Volumes of medial temporal lobe structures in patients with Alzheimer's disease and mild cognitive impairment (and in healthy controls). Biological Psychiatry 43 (1):60-68.
  4. Kuhl, D.E., R.A. Koeppe, S. Minoshima, et al. 1999. In vivo mapping of cerebral acetylcholinesterase activity in aging and Alzheimer's disease. Neurology 52:691-99.
  5. Laakso, M.P., H. Soininen, K. Partanen, et al. 1995. Volumes of hippocampus, amygdala and frontal lobes in the MRI-based diagnosis of early Alzheimer's disease: correlation with memory functions. Journal of Neural Transmission, Parkinson Disease and Dementia Section 9 (1):73-86.
  6. Lange, K.W., B.J. Sahakian, N.P. Quinn, et al. 1995. Comparison of executive and visuospatial memory function in Huntington's disease and dementia of Alzheimer type matched for degree of dementia. Journal of Neurology, Neurosurgery, and Psychiatry 58 (5):598-606.
  7. Lauter, H. 1985. What do we know about Alzheimer's disease today? Danish Medical Bulletin 32 (Suppl. 1):S1-21.

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