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Signs & Symptoms

The elderly represent a growing proportion of the population and their numbers continue to increase.  As there are more people growing older, medical conditions associated with aging, such as dementia, will become increasingly prevalent.  It is estimated that dementia is present in 8% of Canadian seniors over the age of 65 years.  If projections are correct, by the year 2031 over three-quarters of a million Canadians will suffer from dementia.  As such, it is clear that the impact of aging and dementia on our society will only increase in the future.

Family groupDementia can affect a person’s ability to remember, think and reason.  These problems are commonly referred to as the cognitive effects of dementia.  In addition to change in cognition, dementia may also cause changes in personality and behaviour.  A person with dementia may say or do things that are not typical of how they would normally act.  As a result of having dementia, a person will have a gradually worsening in their ability to take care of themselves and may rely on others to help them with their daily activities.  In this respect, the presence of dementia has significant impact on not only the person with the disease, but also their caregivers and loved ones.

There can be confusion regarding how the term “dementia” differs from Alzheimer’s disease.  Many people think that these two terms refer to the exact same condition.  Alzheimer’s disease refers to a specific disease that it characterized by the accumulation of a type of protein in the brain called amyloid.  Alzheimer’s disease usually starts off by causing problems with a person’s ability to remember recent events or conversations, but over time, it can progress to affect long-term memory and other areas of thinking function as well.  Alzheimer’s disease may be the most common cause for dementia, but it only one of many potential diseases that can cause this condition.

The onset of symptoms associated with dementia can be dramatic or the changes that a person experiences may be more gradual and subtle.  It is quite common for healthy older adults to complain about their memory; however, if a person’s problems are significant enough to interfere with their ability to perform their daily tasks, they may benefit from a further evaluation.  Part of the challenge of getting an assessment is that the person who has the change in their memory may not even notice that there is a problem.  They may only come to medical attention because their family members or acquaintances observe a change and insist that it is checked out.  

Answering questionsA thorough evaluation by a health care professional trained in dementia assessment can be extremely helpful in confirming the diagnosis of dementia and offering an opinion as to what is the most likely disease that is causing the problem.  While presently there is no cure, once a diagnosis is made, the proper support and treatment for the patient and their family can be offered.  Thus, a timely diagnosis may help patients maintain their independence and functional ability for a longer period of time, translating into improved quality of life.
When a person is referred for an assessment for dementia, different team members may be involved in the evaluation.  The initial assessment will commonly involve a physician, but other health care professional are frequently involved as well.  For instance, some teams work with genetic counselors, nurses, occupational therapists, psychologists or social workers.  Together, they gather the information that they need to offer the patient and their families the most thorough and complete evaluation possible.  They may possess special areas of expertise that will help in providing the best support for the patient and their families.

There is no one single test that currently exists that allows us to make a definite diagnosis of dementia.  However, with the method of evaluation that is currently being used by trained professionals, in most cases, the diagnosis of dementia and the type of dementia can be readily determined.  The most pertinent information used to make the diagnosis of dementia comes from the detailed description of the problem that the person is experiencing.  As part of the assessment, patients will be asked to describe the nature of their difficulties.  Questions will be asked to see if there are problems in areas such as memory, attention, language, planning skills, or personality.  How long has the problem been present?  Did the problem start suddenly or was it more of a gradual onset?  Has it been stable or getting worse over time?  Are there any other associated features of the problem that started about the same time as the difficulties with thinking?  This could include challenges with walking, balance or incontinence.  The presence of medical conditions will also be assessed.  Heart disease, stroke, high blood pressure, high cholesterol, diabetes or irregular heart rate may influence the possibility of certain types of dementia.  Symptoms indicating the possibility of a psychiatric disorder like depression or anxiety will be sought.  Patients are asked to bring in all their medications, both prescription and over-the-counter, for a review.  A detailed look at medications may reveal some that can worsen memory problems.  Risk factors that are felt to influence the likelihood of dementia will be identified.  These may include things like positive history of dementia in a family member.  

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