The signs of dementia – a syndrome whose term appeared at the beginning of the 19th century – are characterized by different disorders:
- memory ( these are early disorders);
- other higher functions: orientation, attention, judgment, reasoning;
- phasic (difficulties reading, speaking, reading, writing or repeating a sentence;
- praxis (inability to perform motor tasks despite intact motor skills);
- gnostic (lack of recognition of familiar objects despite intact sensory functions);
- executive functions (loss of sense of abstraction, planning, initiation and organization of tasks).
These cognitive disorders are generally accompanied by psychological and behavioral signs and symptoms (apathy, depression, agitation, aggressiveness, irritability, wandering, insomnia, delusions, etc.) that can affect activities of daily living.
The symptoms of dementia have two main characteristics:
- Symptoms appear in adulthood (mental retardation is not one of them).
- The symptoms are in most cases progressive and irreversible (confusions and depressive states of the elderly are not included).
Signs of cognitive impairment in dementia
| Cognitive disorders | Examples |
| Inability to learn recent information and events | • The subject involuntarily makes the same purchase several times during the day. • The subject repeats the same question. |
| Loss of orientation (especially temporal) | • The subject wanders for several hours in his neighborhood and no longer knows how to get home. • He cannot name today’s date. |
| Difficulties performing an abstract task | • The subject becomes distraught in front of a tax form because he has difficulty performing simple calculations or recognizing numbers. • Subject cannot plan a subway trip requiring one or more connections. |
| Difficulties finding words | • The subject compensates for the omission of words by using other words such as “trick, thing, contraption”. • The subject uses phonemic verbal paraphasias (says lion instead of violin). • The subject uses sentences that are difficult to understand. |
| Misplaced objects | Subject puts dirty clothes in a closet and does not remember where they have been stored. |
| Difficulties understanding symbols | Subject no longer recognizes a road sign. |
| Forgetting old facts | The subject forgets the name of a famous person, a birthday. |
| Poor or impaired judgment | The subject dresses warmly on a very hot summer day, or goes shopping in a dressing gown |
| Difficulty performing familiar tasks | • The subject has difficulty using household appliances. • Subject has difficulty preparing a meal. He forgets to serve it or to have prepared it. |
Is memory the only one affected in dementia?
No, these cognitive disorders are accompanied by changes in mood, behavior and a loss of initiative.
Here are some signs of behavioral dementia:
- Asocial behavior
For example: the subject is apathetic, sits idle, remains indifferent, has little interest in others, cuts off all contact with friends, abandons leisure activities. - Sadness
- emotional lability
- Irascibility or even verbal and physical aggression
- Suspicion
- Fearful behaviors
- Social disinhibition
- Appearance of excessive familiarity
- Noisy behaviors
- Euphoria, boundless energy
- Episodes of depression and anxiety (the subject becomes aware of his cognitive disorders)
- Insomnia
- Paranoia
- Hallucinations visual, auditory (rare)
- Slower movement speed
Signs of dementia that affect daily life
- Difficulty driving
- Wandering
- Forgetting to serve a dish cooked in the oven
- Negligence (housework, toilets, etc.) or carelessness
- Difficulties managing expenses
- Professional errors
- Difficulties making purchases
Why does the subject or his entourage ask to be consulted?
At an early stage, it is usually for memory disorders (appearing gradually) that the subject or most often a member of his or her entourage asks to be consulted (in 75% of cases, memory disorders presage dementia of the Alzheimer type ). Studies have shown that, in 30% to 50% of cases, the cognitive deficit is ignored by the person concerned.
Rarer are dementias of the Alzheimer type beginning with behavioral disorders. In the case of disorders that are already visible and seem to be getting worse, the request comes from the family and medical environment. It is then a question of behavioral disorders whose appearance or aggravation provoke a crisis in the family care.
What are the different stages during the consultation?
Whether or not the doctor makes a diagnosis following:
- An anamnesis which is a series of information provided by the subject (eg medical history) and confirmed if necessary by those around him. The doctor assesses the subject’s functional abilities (eg ability to carry out physical activities of daily living).
- Basic exams.
- A clinical physical examination which assesses in particular the mental faculties of the patient, in particular with the mini-mental state examination, which is the test used.
If a diagnosis of dementia is made, the next step is to determine the underlying cause.
The causes may be reversible (depression, delirium, ‘toxic’ side effects of medication, infections, etc.) or irreversible (Alzheimer’s type dementia, vascular dementia, frontotemporal dementia, Lewy body dementia, dementia associated with Parkinson’s disease, etc.).
Alzheimer’s disease is the most common cause of dementia (about 60% of dementia cases).
In summary
Cognitive disorders + emotional and behavioral disorders + disturbances in daily activities:
=> suspected dementia.
=> medical visit.
=> if dementia, search for the reversible or irreversible cause.