Key Takeaways
- Dementia is a group of symptoms affecting memory, thinking, and behavior—not a normal part of aging
- Alzheimer's disease is the most common type of dementia (60-80% of cases)
- Short-term memory is affected first; long-term memory is preserved longer
- Sundowning causes increased confusion in late afternoon and evening
- Always look for physical causes (pain, infection, hunger) of behavioral changes
Understanding Dementia
Dementia is not a single disease but a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily life. CNAs provide essential care for residents with dementia and must understand the condition to provide safe, compassionate care.
What Is Dementia?
Dementia is a general term for decline in mental ability that interferes with daily life. It is characterized by:
- Memory loss (especially recent events)
- Difficulty with thinking and reasoning
- Changes in personality and behavior
- Difficulty with language and communication
- Impaired judgment and decision-making
Important: Dementia is NOT a normal part of aging. While mild forgetfulness may occur with age, dementia involves significant decline that affects daily functioning.
Types of Dementia
| Type | Cause | Key Features |
|---|---|---|
| Alzheimer's Disease | Brain cell death, plaques, tangles | Most common (60-80%); gradual onset; memory loss first |
| Vascular Dementia | Reduced blood flow to brain (strokes) | Second most common; sudden onset; step-like decline |
| Lewy Body Dementia | Abnormal protein deposits | Visual hallucinations; movement problems; fluctuating alertness |
| Frontotemporal Dementia | Damage to frontal/temporal lobes | Personality and behavior changes; language problems |
| Mixed Dementia | Combination of types | Features of multiple dementias |
Alzheimer's Disease Stages
Alzheimer's disease progresses through predictable stages:
| Stage | Duration | Characteristics |
|---|---|---|
| Early (Mild) | 2-4 years | Memory lapses; word-finding difficulty; losing items; still independent |
| Middle (Moderate) | 2-10 years | Requires assistance with ADLs; confusion about time/place; behavior changes; wandering |
| Late (Severe) | 1-3 years | Requires total care; loss of speech; unable to recognize family; bedridden |
Memory and Cognitive Changes
Types of Memory Affected:
| Memory Type | Definition | In Dementia |
|---|---|---|
| Short-term | Recent events (minutes to hours) | Affected early and severely |
| Long-term | Past events (years ago) | Preserved longer; may recall childhood clearly |
| Procedural | How to do things (walking, eating) | Often preserved until late stages |
Other Cognitive Changes:
- Disorientation - Confusion about time, place, or person
- Agnosia - Inability to recognize objects or people
- Aphasia - Difficulty with language (speaking, understanding)
- Apraxia - Inability to perform purposeful movements despite physical ability
Behavioral Symptoms
Common behaviors in dementia include:
| Behavior | Description | Possible Causes |
|---|---|---|
| Wandering | Walking without purpose or destination | Restlessness, looking for something, past routine |
| Sundowning | Increased confusion/agitation in evening | Fatigue, reduced lighting, disrupted body clock |
| Repetition | Asking same question repeatedly | Memory loss, anxiety, seeking reassurance |
| Hoarding/Hiding | Collecting or hiding items | Feeling insecure, protecting belongings |
| Aggression | Verbal or physical outbursts | Frustration, fear, pain, overstimulation |
| Shadowing | Following caregiver constantly | Fear of being alone, insecurity |
| Catastrophic reactions | Sudden, intense emotional outbursts | Overwhelmed, overstimulated, frustrated |
Causes of Behavioral Changes
Always look for underlying causes before assuming behavior is "just dementia":
Physical Causes:
- Pain or discomfort
- Hunger or thirst
- Need to use bathroom
- Infection (especially UTI)
- Medication side effects
- Constipation
Environmental Causes:
- Overstimulation (noise, activity)
- Understimulation (boredom)
- Changes in routine
- Unfamiliar surroundings
- Poor lighting
Emotional Causes:
- Fear or anxiety
- Frustration
- Loneliness
- Feeling rushed or pressured
Which type of dementia is the most common?
What is "sundowning"?
Which type of memory is typically preserved longest in dementia?