What is dementia?
Dementia is not part of normal ageing. It is a progressive decline in one's memory and other thinking skills that interferes with the ability to perform one's usual activities such as driving, shopping, cooking, managing finances, holding a job etc. Dementia can affect memory, judgment, language, planning and behaviour. Knowing the "10 warning signs" of dementia helps in early identification. (See Table 1)
10 warning signs of dementia (Table 1)
1 | Memory loss that disrupts daily life A person with dementia may forget important dates or events and ask for the same information over and over again; increasingly needing to rely on memory aids. |
2 | Challenges in planning or solving problems A person with dementia may have trouble following a familiar recipe or keeping track of monthly bills. He or she may have difficulty concentrating and takes much longer to do things than it used to be. |
3 | Difficulty completing familiar tasks at home, at work or at leisure A person with dementia may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favourite game. |
4 | Confusion with time and place A person with dementia may have trouble finding his or her way to a familiar place or be confused about meal times such as asking for lunch at night. |
5 | New problems with words in speaking or writing A person with dementia may struggle with vocabulary, experiencing problems finding the right word or naming objects. He or she may have trouble following or joining a conversation and may stop in the middle of a conversation with no idea how to continue or may be repetitive. |
6 | Misplacing things A person with dementia may lose things and be unable to go back over his or her steps to find them again. Sometimes, he or she may accuse others of stealing. This may occur more frequently over time. |
7 | Poor judgment A person with dementia may exhibit poor judgment when dealing with money, giving large amount of money to strangers. He or she may pay less attention to grooming or hygiene. |
8 | Changes in personalities A person with dementia can become confused, suspicious, depressed, fearful or anxious. He or she may be easily upset at home, at work or with friends. |
9 | Withdrawal from work or social activities A person with dementia may become passive and sleep more than usual. He or she may lose interest in those activities which he or she once enjoyed. He or she may forget how to participate in a favourite hobby. |
10 | Changes in mood or behaviour A person with dementia can exhibit rapid mood swings with no apparent reasons or triggers. |
Adapted from Alzheimer's Disease Association, Singapore
Types of dementia
There are various types of dementia. Different types of dementia may have different symptoms and care needs. Therefore, it is important to learn more about the types of dementia. Table 2 provides an overview of the common types of dementia.
Common types of dementia (Table 2)
| Alzheimer's Disease (AD) The most common type of dementia. It has an insidious onset and is a progressive disease whereby symptoms gradually worsen over a number of years. AD is irreversible and slowly impairs memory and thinking skills and eventually even the ability to carry out the simplest tasks such as eating. Currently there is no cure for this disease but treatment can help manage symptoms of AD. |
| Vascular Dementia (VaD) A type of dementia that is caused by disease or injury to blood vessels in the brain, mostly strokes. The onset may be abrupt and symptoms depend on the location and size of the stroke. A person with vascular dementia may also show evidence of silent strokes on brain scan. While vascular dementia is not reversible, it is important to treat the risk factors. Controlling risk factors such as high blood pressure, diabetes mellitus, high cholesterol and smoking may slow progression and reduce stroke recurrence. |
| Lewy Body Dementia (LBD) A type of dementia which has the features of Parkinson's disease. These include slowness, tremor, rigid muscles, and vivid visual hallucinations. Other prominent symptoms include problems with attention, organisation, problem solving and planning. People with LBD have higher risks for falls in view of their increased rigidity, instability and slow gait. |
| Frontotemporal Dementia (FTD) A type of dementia that is characterised by marked personality changes and in some cases, language difficulties. Most people affected by FTD are younger, between 40-70 years of age. Due to the symptoms, FTD can be mistaken for Alzheimer's disease, Parkinson's disease or a psychiatric disorder like depression, obsessive-compulsive disorder or schizophrenia. There is no treatment or cure yet but medications and lifestyle changes can help to relieve the symptoms. |
Symptoms in dementia
Every person with dementia is unique, thus they do not all present with the same symptoms. There is a saying, "When you see a person with dementia, you have seen just one." The needs and manifestations vary from person to person although there are some symptoms common to most people with dementia.
Common symptoms in dementia (Table 3)
 MILD |  MODERATE |  ADVANCED |
Stages of dementia (Table 4)
In patients with mild disease, symptoms may be subtle. In moderate disease, symptoms are more apparent and patients with severe disease are typically incapacitated.
| MILD | MODERATE | ADVANCED | |
| MEMORY | • Difficulty with short-term memory • Poor attention span • Poor decision-making | • Difficulty with short and long term memory • Poor orientation to day, date and/or time • Begin to forget some friends and associates | • No apparent awareness of past or present |
| SPEECH & LANGUAGE | • Problems remembering the right word or name | • Problems with understanding • Difficulty in expressing self and making needs known | • Unable to engage in a meaningful conversation • Paucity of speech or incoherent speech. May express needs by yelling or calling out |
| BEHAVIOUR & MOOD | • May become socially withdrawn or have low mood | • More easily upset and frustrated • Appear to lack emotion | • Passive / withdrawn • Difficult to engage |
| PHYSICAL ABILITIES & SELF CARE | • Difficulty with planning and managing household affairs, such as cleaning and cooking • Problem with handling finances • Difficulty initiating activities • Getting lost in less familiar places | • Gets lost outdoors even in familiar places • Needs reminders & prompts often in daily tasks • Requires help in: • Dressing - selecting clothing - buttoning, zipping • Grooming: - lack of attention to fine details - needs reminders for shaving, hair combing • Bathing: - forgets to shower • Bladder & bowel: - difficulty locating the toilet - incontinent episodes | • Problems with balance and coordination resulting in gait instability and falls • Total dependence in:
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