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Introduction  

Often, individuals, family members, and healthcare workers fail to understand the relationship of neurological symptoms related to dementia. It can be rather challenging to differentiate average age-related memory loss versus early signs of dementia, which may need further diagnosis and treatment.

Many of us tend to become more forgetful as we age and need a bit longer to remember things, become distracted, or have multitasking issues. Even though these changes typically occur during middle age, they can sometimes become a nuisance and even frustrating. But how can one know that these are normal and are not an early symptom and determinants of dementia?

For most individuals, these changes are a typical result of aging. Still, it is essential to understand the differences so diagnosis can be accurate and efficient in treating these individuals who are dealing with dementia.   

With an increasing number of age-related illnesses, it is sometimes difficult to differentiate dementia and average age-related memory loss and verify the proper treatment for family members and nurses caring for this population. However, the differences must be made clear so that adequate understanding, treatment options, and medical interventions can be made accurately for this population. 

Justification of Knowledge 

With the ever-increasing number of diagnosed dementia cases, it is essential to understand the neurodegenerative processes that involve damage to the brain, which can lead to progressive, incapacitating behavioral, cognitive, and motor dysfunctions that typically end with dementia. Such individuals typically have neurological signs that precede the full onset of dementia, and recognizing these distinctions can often be a challenge (5).   

Since both dementia and age-related memory loss have similarities, making clear distinctions can often be a challenge. Caregivers frequently think that their loved one may have dementia when it may be average age-related memory loss and vice versa.   

Dementia syndrome is typically characterized by progressive deterioration of various cognitive functions. Some of the significant neurological symptoms noted are agitation, apathy, depression, delusions, hallucinations, anxiety, irritability, euphoria, and sleep disturbance (2). 

Normal age-related memory loss may be related to the hippocampus, an area of the brain involved in memory formation and retrieval. Certain hormones and proteins that repair and protect brain cells decrease with age, and older individuals typically experience reduced blood flow to the brain, which can affect one’s memory (2).  

 As a normal part of aging, people aged 65 and above typically experience some form of “memory loss” without any underlying health causes;  however, there are noticeable differences when dealing with a form of dementia (1). The differences noted are as follows:  

• Inability to perform routine tasks 

• Difficulty recalling the right words 

• Forgetting the names of family members 

• Misplacing objects 

• Experiencing moods that do not match the situation 

• Issues with balance 
  

Inability to perform routine tasks—The individual may forget how to drive to a location they go to regularly or have difficulty managing their budget. 

Difficulty recalling the right words—The individual may have to wait to consider how to express what he/she wants to say and typically has more difficulty with verbal communication. The individual may also start calling familiar objects by the wrong name.   

Forgetting the names of family members – the individual may need to find the names of family members and those seen daily.   

Misplacing objects—An individual may lose an object, such as car keys or glasses, and be unable to find it later because it does not identify as their own. For example, a person with average “memory loss” will actively search for an object that has been misplaced, while someone with Alzheimer’s may not remember they need glasses.   

Experiencing moods that do not match the situation—The individual will have unexpected mood swings that do not match the current circumstance. Certain medications have side effects that can affect mental function, so it is essential to seek guidance from the individual’s primary care physician to rule out any side effects.   

Issues with balance – the risk of falling increases as dementia progresses, and elderly individuals are eight or nine times more likely to fall than older people who have not been diagnosed with a form of dementia. Fine motor skills also seem to progress as the disease worsens.   

We should be investing our efforts in observing and reporting any potential signs of underlying dementia. Early diagnosis of dementia leads to more effective treatment options and advanced decision-making for interventions needed. Accurate diagnosis of dementia is the ultimate key to proper treatment, and both healthcare providers and caregivers need to provide empathy in caring for these individuals.

As part of reaching these goals, it will be necessary for all those caring for individuals with dementia to become more knowledgeable about dementia, proper care aspects, and the most effective approaches that need to be used with this vulnerable population. In doing so, these practices will provide the necessary support and care required to care for those with dementia successfully.   

The Alzheimer’s Society of Canada noted that about 40 percent of people aged 65 and above would experience some form of “memory loss” without any underlying health causes. It’s simply a part of normal cognitive aging, but there are noticeable differences when dealing with a form of dementia (1). The differences noted are as follows:

• Inability to perform routine tasks 
• Difficulty recalling the right words 
• Forgetting the names of family members 
• Misplacing objects 
• Experiencing moods that do not match the situation 
• Issues with balance  

Inability to perform routine tasks – the individual may forget how to drive to a location they go to regularly, or he/she may have difficulty managing his/her budget. 

Difficulty recalling the right words – the individual may have to pause to consider how to express what he/she wants to say and typically has more difficulty with verbal communication. The individual may also start calling familiar objects by the wrong name.   

Forgetting the names of family members – the individual may misplace the names of family members and those that are seen daily.   

Misplacing objects – the individual may lose an object such as car keys or glasses and not be able to find it later because he/she does not identify as his/her own. An example of this is that a person with normal “memory loss” will actively search for an object that has been misplaced, while a person with Alzheimer’s may not remember he/she needs glasses at all.   

Experiencing moods that do not match the situation – the individual will have unexpected mood swings that do not match the current circumstance. It is important to keep in mind that certain medications have side effects that can affect mental function, so it is important to seek guidance from the individual’s primary care physician to rule out any side effects.   

Issues with balance – the risk of falling increases as dementia progresses, and elderly individuals are eight or nine times more likely to fall than older people who have not been diagnosed with a form of dementia. Fine motor skills also seem to progress as the disease worsens.   

We should be investing our efforts in observing and reporting any potential signs of underlying dementia. Early diagnosis of dementia leads to more effective treatment options and advanced decision-making for interventions needed. Accurate diagnosis of dementia is the ultimate key to proper treatment, and both health care providers and caregivers need to provide empathy in caring for these individuals. As part of reaching these goals, it will be necessary for all those caring for individuals with dementia to become more knowledgeable about dementia, proper care aspects, and the most effective approaches that need to be used with this vulnerable population. In doing so, these practices will provide both the support and care needed to successfully care for those with dementia.

What is Dementia versus Cognitive Aging Memory Loss?   

At one point or another in our lives, we have misplaced a set of keys, totally blanked on remembering someone’s name, forgotten a phone number, or walked into a room to do or get something and forgot and then began wondering what we went in there for. Even though memory lapses can be frustrating, they are most likely not cause for concern. However, cognitive aging memory changes are not the same issue as dementia.   

As one age,  various physiological changes can cause variations in brain functions that one typically doesn’t even consider. A few examples of these are the longer durations of both learning and recalling information; one is slower than it used to be, and it can sometimes take longer to recall events to mind. Memory lapses typically have little impact on one’s daily activities and ability to do what one wants.   

Dementia is marked by a persistent and often disabling decline in two or more intellectual abilities, such as memory, judgment, language, and abstract thinking. The chart below compares regular cognitive aging changes to those that may indicate dementia (2): 

Many times,  other conditions mimic dementia. These diseases, medications, minor head trauma or injury, emotional disorders, alcoholism, vitamin B-12 deficiency, hypothyroidism, and brain disease can cause these. Once these symptoms are noted, the individual must undergo an examination by their primary care physician to determine if further testing needs to be done to assess the degree of memory impairment and accurate diagnosis.

Common Types of Dementia 

Alzheimer’s Disease  

Studies have shown that 60-80% of people with dementia have Alzheimer’s. The individual presents with symptoms such as memory loss and difficulty planning and performing routine tasks. The symptoms are mild at first but progressively worsen. Other symptoms noted may be confusion about person, place, and time, difficulty speaking and writing, losing things and inability to find them, poor judgment, and mood and personality changes  (4). 

Vascular Dementia  

Individuals with this type of dementia typically have had a stroke, and symptoms depend on which part of the brain is affected by the stroke. The first signs noted with vascular dementia normally are poor judgment or difficulty planning, organizing, and making decisions. Other reported symptoms are memory problems that disrupt the individual’s daily life, difficulty speaking and understanding speech, difficulty recognizing sights and sounds that used to be familiar, becoming confused or agitated  quickly, changes noted in mood and personality, and difficulty walking and having increased falls  (4) 

Dementia with Lewy Bodies (DLB) 

Lewy bodies consist of tiny, microscopic protein deposits in some individuals’ brains. The name is traced back to the scientist who discovered them. The protein deposits develop and form in the brain’s cortex, and the symptoms include difficulty thinking, making decisions, or paying attention. The individual also has problems with memory, experiences hallucinations, unusual sleepiness during the day, periods of “blanking out” or staring, difficulty with movement including slowness, and trouble walking. The individual may have dreams where out physically, which may include walking, talking, and kicking  (4)  Parkinson’s Disease Dementia. 

Studies have shown that individuals with nervous system disorders experience this type of dementia an estimated 50-80% of the time. Typically, the symptoms of dementia develop approximately ten years after a person is first diagnosed with Parkinson’s. Individuals with Parkinson’s Disease have the same symptoms as those with DLB, and both conditions exemplify signs of Lewy bodies in/their brains  (4).   

Frontotemporal Dementia (FTD)  

Individuals with this type of dementia have developed cell damage in areas of the brain that control judgment, planning, emotions, movement, and speech. These individuals may also experience behavior and personality changes, sudden lack of inhibition in social and personal situations, problems thinking the correct words when speaking, and movement problems such as shakiness, muscle spasms, and balance problems  (4). 

Huntington’s Disease 

A genetic defect causes this disease, typically passing from one family member to another. The individual may have the gene for this disease at birth, but the symptoms usually begin at 30-50. The individual typically struggles with thinking and reasoning, memory, judgment, organizing, planning, and concentrating  (4) 

Creutzfeldt-Jakob Disease  

In this type of dementia, a protein called prions causes normal proteins in the brain to begin developing into abnormal shapes. This disease is a rare condition that leads to dementia symptoms that occur suddenly and quickly become worse. The individual may experience memory and concentration problems, poor judgment, mood swings, confusion, sleep problems, depression, trouble walking, and twitching or jerking muscles  (4) 

Normal Pressure Hydrocephalus  

A buildup of fluid in the brain is noted in this type of dementia: difficulty walking and concentrating, which provides for difficulty walking, difficulty concentrating, and personality and behavior changes. Sometimes, the extra fluid can be drained from the brain into the abdomen through a long, thin tube called a shunt  (4) 

Wernicke-Korsakoff Syndrome 

A severe shortage of thiamin (vitamin B-1) is noted in this type of dementia with reported problems with memory and seems to be expected in long-term heavy drinkers. The most common symptom is problems with memory, but typically, one’s problem-solving and thinking skills are  unaffected 4)    

Due to certain other conditions that mimic dementia, many times, average age-related memory loss can be mistaken as a form of dementia. Also, certain medical conditions and vitamin deficiencies such as hypothyroidism, hydrocephalus, Vitamin B12 deficiency, infections, and specific prescription and over-the-counter medications can cause dementia-like symptoms. An assessment should be completed by an individual’s primary care physician or referral to a neurologist to rule out any underlying causes for these symptoms that may not be true dementia.    ​

Treatment and Interventions for Nurses and Caregivers 

Pharmacological Interventions 

Even though there is no cure for dementia or any disease-modifying agents that can fully combat Alzheimer’s disease and related dementias, there are some medications that can assist with slowing down the progression of cognitive loss. These medications are classified as anti-dementia drugs and can only be prescribed by a medical doctor. Medications prescribed are given based on the type of dementia characterized by the individual. It is important to note that the individual may experience side effects as with any medication, and the medications used for dementia are typically expensive (4). Non-pharmacological Interventions 

Various therapies are used to support those diagnosed with dementia, assisting the nurses and/or helping the nurses and/or the nurses and family caregivers caring for these individuals. Not all therapies work for each individual experiencing dementia, and it is essential to work together as a team with both medical providers and family members to provide and offer the best-individualized solution. The types of non-pharmacological interventions are as follows (4):  

Cognitive Stimulation Therapy (CST) 

Cognitive Stimulation Therapy is used for those individuals with mild to moderate dementia, and the individual is invited to partake in therapeutic sessions with a trained practitioner who specializes in skills explicitly related to individuals with dementia. A session consists of themed activities designed to stimulate and engage individuals with dementia. Some themes may include money, current affairs, food, and clothing. The sessions are typically held twice a week, beginning with 14 sessions followed by 24 maintenance sessions. The critical aspects focused on are person-centeredness, involvement, respect, inclusion, fun, choices, the use of reminiscence, and strengthening relationships (4). 

Reminiscence Therapy 

Reminiscence therapy allows a person with dementia to tap into long-term memory and experience pleasurable memories. This type of therapy has been considered one of the most popular and can be enjoyed by individuals with dementia, health service professionals, and relatives. The treatment can be completed in several formats: special, unique life story, work, simple general reminiscence, and specific special reminiscence (4).   

Validation Therapy 

Validation therapy attempts to use a practitioner to communicate with the person with dementia by showing empathy for their feelings and assisting the individual. Validation therapy aims to validate the individual’s emotions by acknowledging one’s feelings, and the aim is to make the person with dementia as happy as possible, even though there may be misconceptions and misinterpretations. It is essential to keep in mind that if a demented individual is experiencing delusions or false beliefs, which can cause added distress, validation therapy is not the best source of therapy (4).   

Reality Orientation 

This therapy therapy helps individuals with dementia by reminding them about the present. Self-identity is reinforced, and recognition of one’s surrounding environment is also emphasized. The different forms used with reality orientation are calendars, reminder boards, and cueing,  typically in groups or individually. It is essential to be mindful that the individual may have difficulty remembering current or recent events due to their cognitive impairment (4).    

Physical Exercise 

Exercising has been shown to benefit people with and without cognitive impairment and is highly beneficial to those who once led a very active life. It is important to encourage individuals with dementia to participate in some form of physical activity and to make adaptations as needed once dementia progresses. In formulating exercise programs for these individuals, attention should be given to the individual’s abilities, preferences, interests, and safety needs. Physical activity has also been recognized for its effects on reducing depressive symptoms and behavioral disturbances such as aggression and agitation (4).  

Multisensory stimulation: Snoezelen rooms 

Multisensory stimulation is increasingly being used in long-term residential care settings to help individuals with dementia who may be agitated or restless. A Snoezelen room incorporates multiple sources of stimulation, such as light, watercolor, fiber optics, contrasting textures, quiet music, and soft furnishings. All these features are meant to help relax the individual with dementia and enhance communication between the individual and their caregiver (4). 

Aromatherapy 

Aromatherapy is often used with individuals with dementia. Smells, massage, and bathing can stimulate pleasurable emotions in these individuals. Two of the most used essential oils are lavender and a particular balm. Aromatherapy has been proven in many trials to decrease agitation among individuals with dementia (4).  

Health systems are working to improve in this area and to assist caregivers caring for those with dementia. There needs to be more clarity between the need for treatment, the active provisions for treatment, and educating families regarding the available treatments. Many families seem to feel the burden is too significant to care for their loved ones with dementia independently. Due to this reason,  both physical and emotional support must be offered. Often, families need to be made aware of the resources available for this population of individuals, and they need assistance and education to evaluate the available options. All these factors should encourage the importance of increased support, health, and awareness among this vulnerable population.    

Not one tool is recognized as the best overall assessment tool to determine if a complete dementia evaluation is needed. There are several different ones, but the two that are consistently used are the General Practitioner Assessment of Cognition (GPCOG), a screening tool for cognitive impairment designed to be used in primary care settings. The Mini-Cog assessment tool consists of a three-minute recall test assessing memory and a scored-clock drawing test. The results are evaluated by a healthcare provider, who then determines if a full diagnostic assessment is needed (4).      

It is necessary to assess individuals with dementia for anger and aggressiveness that can stem from overstimulation or boredom. Feelings of being overwhelmed, bored, or lonely can all trigger rage or aggression. Also, once one factors into the scenario that the individual is experiencing confusion, one realizes that they are likely not even fully aware of what they are doing and their actions.

The most significant concern during an episode such as this is maintaining the individual’s and others’ safety. If the individual is approachable, it is essential to talk calmly and non-judgmentally to them during a period such as this to de-escalate and hopefully turn from being angry and aggressive. During episodes such as these, allowing others to assist and help is essential if they are present and available. It sometimes takes two or three individuals to calm someone in this state of mind due to dementia.   

The most significant barriers include reluctance to seek help, fear of loss of independence, or concerns about how others will perceive dementia. Other barriers include the lack of skills to recognize the possible signs and symptoms of dementia, as it can sometimes be challenging to differentiate from normal cognitive aging. Dementia is a diagnosis that requires precise and detailed assessments over several consultations that typically span over several months. To 

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Working with someone with characteristics of dementia and average age-related memory loss can be challenging, and it is essential to be able to clearly distinguish between the two to obtain the needed and crucial treatments necessary.   

Assessment is crucial in determining whether dementia is present or if the signs and symptoms indicate average age-related memory loss. It is also the first step in obtaining the required treatment for the individual and offering services and support to family members or caregivers.    

Individuals with dementia may feel that they are no longer in control and may not trust their judgment. They may also experience the effects of stigmas and social isolation, such as not being treated the same by certain people due to their diagnosis. All these issues can harm the individual’s self-esteem.  

Moving Forward:  The Future of Individuals with Dementia 

With increased awareness among this vulnerable population and the number of individuals diagnosed with dementia, the future for those caring for these individuals proves that advanced care and education needs, which have been a recent focal point, have proven successful. The information below details some highlights for the seemingly optimistic future (3):   

• A recent study from 1988 – 2015 has shown a 13 percent decrease per decade in the incidence of dementia in the United States and Europe 
• If trends continue, there could be 15 million fewer people living with dementia in high-income countries by 2040 
• Change is likely linked to increased health education and a better understanding of modifiable risk factors like diet and exercise. 
• Experts stress the need for doctors, healthcare members, individuals, family members, and caregivers to develop healthy habits to lower one’s risk of developing dementia 

Small and significant actions can be taken as a client care health advocate for positive results. First, volunteer or assist in a facility that offers services to these individuals, educate yourself and your immediate circle on dementia, serve as a mentor, and receive the necessary education and training to pursue legislative advocacy. Throughout the entire process of advocacy, these elements need to remain – confidentiality, purpose, equality, diversity, empowerment, and, most importantly, treating the individual with dementia with empathy, compassion, and respect.    

The care and treatment for those with dementia and the ones caring for these individuals certainly can improve if healthcare workers, family members, and caregivers are trained and educated on the symptoms, treatment options, and available resources to assist those caring for these individuals.   

Education is the key to becoming more aware of proper care and treatment options for individuals with dementia. Increased knowledge and expertise in this area and serving as an advocate for these individuals by listening and representing the individual’s views must be in place for this population to receive the necessary and adequate care they each deserve. Questions can be asked on the individual’s behalf to ascertain that essential treatment options and support services are offered. It is also imperative to use a holistic approach with both the individual with dementia and the health care member(s), caregiver(s), and family members to maintain open communication, empathy, and compassion while developing the best plan of action for the individual.   

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