July 13, 2014

About Dementia, Alzheimer’s Foundation of America
Symptoms of dementia are divided into two categories: cognitive, or intellectual, and psychiatric.
Differentiating them is important so that behavioral problems that are caused by loss of cognitive functioning are not treated with anti-psychotic or anti-anxiety medications.
The clinical symptoms of dementia vary, depending on the type of disease causing it, and the location and number of damaged brain cells. With Alzheimer's disease, manifestation of all of these symptoms is quite probable; with other types of dementia, it is possible to have some or all of these symptoms.
Cognitive, or intellectual, symptoms are amnesia, aphasia, apraxia and agnosia.
Amnesia is defined as loss of memory, or the inability to remember facts or events. We have two types of memories: the short-term (recent, new) and long-term (remote, old) memories. Short-term memory is programmed in a part of the brain called the temporal lobe, while long-term memory is stored throughout extensive nerve cell networks in the temporal and parietal lobes. In Alzheimer's disease, short-term memory storage is damaged first. 

Aphasia is the inability to communicate effectively. The loss of ability to speak and write is called expressive aphasia. An individual may forget words he has learned, and will have increasing difficulty with communication. With receptive aphasia, an individual may be unable to understand spoken or written words or may read and not understand a word of what is read. Sometimes an individual pretends to understand and even nods in agreement; this is to cover-up aphasia. Although individuals may not understand words and grammar, they may still understand non-verbal behavior, i.e., smiling.
Apraxia is the inability to do pre-programmed motor tasks, or to perform activities of daily living such as brushing teeth and dressing. An individual may forget all motor skills learned during development. Sophisticated motor skills that require extensive learning, such as job-related skills, are the first functions impaired by dementia. More instinctive functions like chewing, swallowing and walking are lost in the last stages of the disease. 

Agnosia is an individual's inability to correctly interpret signals from their five senses. Individuals with dementia may not recognize familiar people and objects. A common yet often unrecognized agnosia is the inability to appropriately perceive visceral, or internal, information such as a full bladder or chest pain. 

Major psychiatric symptoms include personality changes, depression, and hallucinations and delusions.
Personality changes can become evident in the early stages of dementia. Signs include irritability, apathy, withdrawal and isolation.

Individuals with dementia may show symptoms of depression at any stage of the disease. Depression is treatable, even in the latter stages of dementia. 

Psychotic symptoms include hallucinations and delusions, which usually occur in the middle stage of dementia. Hallucinations occur in about 25 percent of dementia cases and are typically auditory and/or visual. Sensory impairments, such as hearing loss or poor eyesight, tend to increase hallucinations in the elderly with dementia. Delusions affect about 40 percent of individuals with dementia.
Hallucinations and delusions can be very upsetting to the person with dementia. Common reactions are feelings of fear, anxiety and paranoia, as well as agitation, aggression and verbal outbursts.
Individuals with psychiatric symptoms tend to exhibit more behavioral problems than those without these symptoms. It is important to recognize these symptoms so that appropriate medications can be prescribed and safety precautions can be taken.

Psychotic symptoms can often be reduced through the carefully supervised use of medications. Talk to your primary care doctor, neurologist or geriatric psychiatrist about these symptoms because they are treatable.

I reread this article and I realize that it does not say that psychiatric disorders should not be treated with medication. Whew! It says that cognitive disorders should not be treated with medication. I feel better now!

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