Research Into The Impact Of Stress On Dementia
Little is known about how stress might affect the development of;dementia. Research Communications Officer Jess Smith looks at a study exploring the impact of how people respond to stress.
We hear many people say that their dementia – or its symptoms – began shortly after a period of intense stress. Yet there hasn’t been a lot of;research;to really find out how stress influences the development of dementia, if at all.
There is evidence that stress can worsen other conditions, such as heart disease and multiple sclerosis. If we knew more about how stress could affect the;development of dementia, we might be able to improve its management and;treatment.
How Is Mild Cognitive Impairment Diagnosed
First, your doctor will perform a thorough medical history including asking about current and previous diseases and illnesses, current and previous medications, and family history of memory problems and dementia. He or she will also ask you if there have been noticeable changes in your ability to function in your usual day-to-day living and activities.
Your doctor will also look for other causes of the symptoms of mild cognitive impairment . Ruling out other causes usually involves blood tests and possibly brain scans, such as magnetic resonance imaging scan.
Short mental status tests may be given to assess memory, attention, short-term recall, and other brain functions. Sometimes more in-depth thinking skills testing, called neuropsychological testing, is ordered. These tests assess memory, planning, decision-making, ability to understand information, language and other complicated thinking tasks.
No single test should be used to make a diagnosis of mild cognitive impairment or dementia. Your doctors clinical judgment is also necessary. He or she will likely be able to confirm a diagnosis of mild cognitive impairment if you show impairment on the kinds of tests mentioned above but are otherwise functioning well.
Classification Of Clinical Dementia
Clinical dementia status at death was determined differently in the three studies. In MRC CFAS and CC75C , classification was based on all information available for each participant including any interview during the last years of life, a retrospective informant interview after death and the death certificate. MRC CFAS employed the Geriatric Mental State Automated Geriatric Examination for Computer Assisted Taxonomy and CC75C employed the Cambridge Mental Disorders of the Elderly Examination to assess the presence of dementia. Clinical review of all available data for each brain donor was also conducted in CC75C as the CAMDEX was not conducted in later stages of the study.
Vantaa 85+ participants were assessed by neurologists at each interview . They were considered demented if they fulfilled Diagnostic and Statistical Manual of Mental Disorders third edition revised criteria . Health and social work records were used to identify incident dementia between interview and death.
The interval between last clinical examination and death varies between participants, with the majority <2 years. Retrospective interviews and death certificates and linked health and social work records were employed to detect incident dementia between last interview and death. Information on the severity of dementia at death was not available.
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Dementia Is About More Than Just Memory
Popular culture promotes the false idea that dementia is primarily a memory-related condition. The truth is that dementia affects many parts of the brain and body, resulting in a variety of impairments to multiple cognitive functions and, often, movement problems. By giving more attention to these less popular symptoms, researchers are now developing better ways to diagnose and treat the underlying disorders.
Current diagnostic methods for Alzheimers disease and other causes of dementia focus on more than just memory. They are designed to take a wide range of cognitive abilities into account, as are competent self-assessment tools like the BrainTest® app. Perhaps, in the future and with enough research, motor function analysis will become a key part of early dementia detection.
Abnormal Loss Of Cognitive Functioning During Late Adulthood
Dementia is the umbrella category use to describe the general;long-term and often gradual decrease in the ability to think and remember that affects a persons daily functioning.The manual used to help classify and diagnose mental disorders, the Diagnostic and Statistical Manual of Mental Disorders, or;DSM-V, classifies dementia as major neurocognitive disorder, with milder symptoms classified as mild cognitive impairment, although the term dementia is still in common use. Common symptoms of dementia include emotional problems, difficulties with language, and a decrease in motivation. A persons consciousness is usually not affected.;Globally, dementia affected about 46 million people in 2015.;About 10% of people develop the disorder at some point in their lives, and it;becomes more common with age.;About 3% of people between the ages of 6574 have dementia, 19% between 75 and 84, and nearly half of those over 85 years of age. In 2015, dementia resulted in about 1.9 million deaths, up from 0.8 million in 1990.;As more people are living longer, dementia is becoming more common in the population as a whole.
Alzheimers disease , also referred to simply as Alzheimers, is;the most common cause of dementia, accounting for 60-70% of its cases. Alzheimers;is a progressive disease;causing;problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.
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How Alzheimer’s Disease Is Treated
There’s currently no cure for Alzheimer’s disease, but medicines are available that can help relieve some of the symptoms.
Various other types of support are also available to help people with Alzheimer’s live as independently as possible, such as making changes to your home environment so it’s easier to move around and remember daily tasks.
Psychological treatments such as cognitive stimulation therapy may also be offered to help support your memory, problem solving skills and language ability.
Read more about treating Alzheimer’s disease.
Perspectives On Clinical Management
A multidisciplinary team model involving physicians, nursing, physical therapy, and other rehabilitative services, as well as social work and caregiver/family advocacy is often required for the optimal management of patients with psychiatric disorders and dementia. At the authors institution, behavioral care, case management, pharmacologic prescriptions, and physical, speech/language, and occupational therapy are melded into an individualized treatment plan to relieve distress, provide direction, promote adaptation, and optimize quality of life. A healthy partnership with the patient and the caregiver, and their education about psychiatric symptoms, dementia, and the interventions are vital for success.
DICE approach to the examination, formulation, and management of dementia-related behavioral problems. A two-part flow diagram is shown, illustrating the socially dynamic context of the DICE approach , the progression in its implementation, and the recursive routines for managing high-acuity states. The bidirectional arrows in the triad emphasize the reciprocity of the dynamics that shape many behavioral problems encountered in dementia care.Modified with permission from Kales HC, et al, BMJ.www.bmj.com/content/350/bmj.h369. © 2015 British Medical Journal Publishing Group.
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Mental Illness Vs Dementia In The Elderly
When people think of dementia, its common to think of it as a mental illness due to the effects the condition has on the brain. However, there are distinctions that should be made between dementia and mental illness in order to properly diagnose the individual. While dementia does affect mental health, it is not a mental illness, but a disorder of the brain that causes memory loss and trouble with communicating.
Proper diagnosis of mental illness or dementia in the elderly is vital in order ensure that appropriate treatment is provided as soon as possible. Misdiagnosis of mental illness in seniors can occur easily since symptoms are so similar to dementia, like confusion and erratic behavior.
What Causes Mild Cognitive Impairment
All possible causes of mild cognitive impairment have not been completely discovered. In a small number of cases, another condition may be causing the symptoms seen in mild cognitive impairment. Some of the possible conditions include:
- Depression, stress, and anxiety
- Diseases or conditions that affect blood flow in the brain
- Low vitamin B12 levels or other nutrient levels
- Eye or hearing problems
- An infection
- Side effects of certain prescription or illegal drugs
- History of alcoholism
Many of these causes of mild cognitive impairment are treatable.
Most cases of MCI, however, are due to a variety of diseases, such as Alzheimers or Parkinsons disease.
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Common Mental Illnesses In The Elderly
If a senior is displaying signs of mental illness, its important to recognize the symptoms and seek treatment as soon as possible. Some of the common mental illnesses the elderly experience are:
- Depression. Depression is considered the most common mental disorder among seniors. Social isolation plays a major role in emotional wellness, so when a senior spends long periods alone because they are unable to drive or live far away from friends and family, depression can easily set in. It is also a symptom of dementia and tends to get overlooked as a treatable ailment.
- Late onset bipolar. Most bipolar patients are diagnosed in early adulthood. Late onset bipolar can be difficult to diagnose because of its similarities to dementia symptoms like agitation, manic behavior and delusions.
- Late onset schizophrenia. This disorder also presents a challenge to diagnose. It can manifest in adults after age 45 and appears as the patient ages. Symptoms are similar to dementia, once again, with hallucinations and paranoia the most common, but these symptoms are milder than when this illness appears in younger adults.
Mental illnesses are treatable, but the trick is a correct diagnosis. Even if a senior had good mental health throughout their entire life, the risk of mental illness in later years is still there. Seek medical treatment as soon as possible if there are any noticeable changes beginning to occur.
What Increases The Risk For Dementia
- AgeThe strongest known risk factor for dementia is increasing age, with most cases affecting those of 65 years and older
- Family historyThose who have parents or siblings with dementia are more likely to develop dementia themselves.
- Race/ethnicityOlder African Americans are twice more likely to have dementia than whites. Hispanics 1.5 times more likely to have dementia than whites.
- Poor heart healthHigh blood pressure, high cholesterol, and smoking increase the risk of dementia if not treated properly.
- Traumatic brain injuryHead injuries can increase the risk of dementia, especially if they are severe or occur repeatedly.
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Common Forms Of Dementia
There are many different forms of dementia. Alzheimer’s disease is the most common form and may contribute to 6070% of cases. Other major forms include vascular dementia, dementia with Lewy bodies , and a group of diseases that contribute to frontotemporal dementia . The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
Who Is At Risk
The risk of cognitive problems increases as you get older. Because of genetic factors, you are at greater risk if a close family member has had cognitive impairment or dementia. Women are at greater risk.
Having any of these health conditions puts you at increased risk: raised cholesterol, diabetes, high blood pressure, atherosclerosis , stroke or transient ischaemic attack . Having previously had depression increases the risk of cognitive impairment later in life.
The lifestyle factors mentioned in the previous section are also important.
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What Are The Best Hearing Aids For Dementia
For patients living with both dementia, hearing loss should never be ignored, as it may exacerbate dementia symptoms, increase their disorientation;and make their environment less safe .;
While there are no hearing products made specifically for dementia patients,;there are plenty of devices out there that can still be helpful. They;range from the relatively simple, such as;a wearable microphone to premium hearing aids.;
Hearing loss makes living with diseases like;Alzheimer’s;even more challenging. For people currently affected by dementia,;hearing aids or other hearing devices are recommended to improve their quality of life and make communication easier.;;
If you are the caretaker of someone with Alzheimer’s or a similar disease that affects cognition, you are wise to investigate what hearing devices might work best. A hearing care provider will be your ally in this journey, as they’ll know the latest products;that may work for your loved one. You’ll also be able to discuss your loved one’s specific needs, habits and abilities with the hearing care specialist.
For example, hearing aids may not always be the best solution. Most premium hearing aids are designed to be discreet, so they may be too small and too easy to lose for a patient with dementia, especially if they have dexterity problems. Hearing aids;also require that a person remember to keep the batteries fresh and the device clean;and in good working condition. Instead, assistive listening devices may work better.;
Eating And Swallowing Difficulties
Swallowing function changes as we age. These changes may be more pronounced in individuals with dementia, and swallowing difficulties may appear sooner . Overall, 13%57% of individuals with dementia have swallowing impairment . Rates of swallowing impairment for individuals with dementia in long-term care may be as high as 53%60% .
Difficulties are not limited to swallowing dysfunctioncognitive and behavioral changes associated with dementia can also have an impact on eating. Early on, individuals may have difficulty shopping for groceries and planning and preparing meals independently . They may forget to eat, initiate eating less often, or have difficulty determining the need to eat . As the disease progresses, they may become more distracted during mealtime or have difficulty self-feeding, recognizing foods, or using various eating utensils .
Eating and swallowing difficulties may place an individual at greater risk for choking and aspiration pneumonia and may eventually result in malnutrition, dehydration, and weight loss .
Alzheimer’s disease is the most common cause of dementia, accounting for approximately 70% of all cases .
The remaining cases are accounted for by vascular dementia, Lewy body dementia, Parkinson’s disease, frontotemporal dementia, and mixed dementia types . See ASHA’s resource on common dementias.
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What To Do If A Loved One Is Suspicious Of Having Dementia
- Discuss with loved one.;Talk about seeing a medical provider about the observed changes soon. Talk about the issue of driving and always carrying an ID.
- Medical assessment.;Be with a provider that you are comfortable with. Ask about the Medicare Annual Wellness exam.
- Family Meeting.;Start planning, and gather documents like the Health Care Directive, Durable Power of Attorney for Health Care, Estate Plan.
Whats The Outcome For People With Mild Cognitive Impairment
Researchers believe that most patients with mild cognitive impairment will go on to develop dementia. MCI is a stage between the mental decline seen in normal aging and the onset of early dementia.
It is not yet possible to know the rate of decline in a particular person with mild cognitive impairment. Researchers continue to study the mental and medical changes that occur in patients with mild cognitive impairment in the hopes of better predicting who might be at an increased risk of developing and the speed at which they develop — specific types of dementia.
Last reviewed by a Cleveland Clinic medical professional on 03/18/2019.
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Signs And Symptoms Of Dementia
As we age, many of us experience lapses in memory. It can be worrying and confusing to realize that something you once took for granted isnt working as well as it used to. But not all memory changes indicate dementiaand dementia impacts more than just memory. Symptoms can also affect visual and spatial skills, executive functioning, language, and mood or personality. To meet the diagnostic criteria for dementia, youd need to experience difficulties in at least one of those areas in addition to memory loss.
Common signs and symptoms include:
Can Alzheimer’s Disease Be Prevented
As the exact cause of Alzheimer’s disease is not clear, there’s no known way to prevent the condition.
But there are things you can do that may reduce your risk or delay the onset of dementia, such as:
- staying physically fit and mentally active
These measures have other health benefits, such as lowering your risk of cardiovascular disease and improving your overall mental health.
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Psychiatric Symptoms And Diagnostic Considerations
The clinical history is the linchpin of the diagnostic examination of patients presenting with cognitive or behavioral symptoms, and interviewing a source who has an intimate knowledge of the patient is imperative. The goal of taking the patients clinical history is to capture all symptoms, describe how the syndrome has developed over time, and make contrasts between the current state and the patients lifelong cognitive capacity, temperament, conduct, and habits.
The following are key elements of the clinical history:
Interviewing the source privately facilitates candor and disclosure. This author typically asks the patients permission to speak with their source.
Developing the chronology of symptoms defines the syndrome and the place of psychiatric symptoms within the context of the disease.
Cataloging the symptoms and their severity defines the degree of disability and distress.
Identifying preceding or concurrent psychiatric states helps clarify whether the patient has a primary psychiatric disorder.
Describing the context in which current psychiatric states emerged may point to modifiable environmental, behavioral, or social factors.
Interrogating other physiologic systems allows detection of systemic derangements that may mimic psychiatric disorders.
Documenting disabilities is vital for planning treatments and rehabilitation and for securing public assistance, disability benefits, and other resources.
What Are The Signs And Symptoms Of Dementia
Because dementia is a general term, its symptoms can vary widely from person to person. People with dementia have problems with:
- Reasoning, judgment, and problem solving
- Visual perception beyond typical age-related changes in vision
Signs that may point to dementia include:
- Getting lost in a familiar neighborhood
- Using unusual words to refer to familiar objects
- Forgetting the name of a close family member or friend
- Forgetting old memories
- Not being able to complete tasks independently
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