While memory loss is the best known symptom of dementia, it’s not the only symptom – and memory loss alone doesn’t mean you have dementia.
Learn more from a UVA specialist in dementia and other memory disorders.
Signs and Symptoms of Dementia
Featured Speaker:
Dr. Carol Manning
Dr. Carol Manning is a board-certified clinical neuropsychologist who directs UVA’s Memory and Aging Care Clinic and specializes in caring for patients with memory disorders such as dementia. Transcription:
Signs and Symptoms of Dementia
Melanie Cole (Host): While memory loss is the best known symptom of dementia, it’s not the only symptom, and memory loss alone does not mean that you have dementia. My guest is Dr. Carol Manning. She’s a board-certified clinical neuropsychologist who directs UVA’s Memory and Aging Care Clinic and specializes in caring for patients with memory disorders such as dementia. Welcome to the show, Dr. Manning. What is dementia?
Dr. Carol Manning (Guest): As you said, dementia is not just memory loss that occurs with normal aging. Dementia is an umbrella term for several disorders, and what dementia is, it describes what happens when there’s a decline from normal levels of ability—of when there are changes in memory, attention, concentration, abstract thinking—all kinds of cognition that we rely upon when there’s a decline that’s greater than what we would expect with normal aging. So dementia describes constellation of symptoms, but it doesn’t describe the exact disease process.
Melanie: So these most common symptoms, what would send up a red flag that would signal somebody really, something is going on here?
Dr. Manning: With, for example, normal aging and memory loss, we would anticipate that someone might forget where they parked their car in a parking lot. But if they forget what their car looks like, that would be a signal to me that there’s something wrong. With normal aging, what we might see is that people forget proper nouns. They forget names. That’s very normal. With dementia, people lose the ability to speak fluently altogether—so spontaneous speech decline. Losing your keys is normal, but putting things in highly unusual places and then suspecting that someone else took them, that would be something that would be out of the norm.
Melanie: So, suspecting that someone else took them. Is there a generalized paranoia? Do you start to look for these things if it’s happening in yourself or if it’s happening for your loved one and you start to notice these things?
Dr. Manning: That often occurs later on in dementia, and the paranoia is because people may not be aware of the fact that they put them there and there’s something called confabulation, where people make up things to fit with other things that they can’t put together. For example, they don’t have a memory that they put their keys somewhere unusual, and so they assume that someone took them. I can give you another example of a change that would concern me: someone who’s been making the same favorite dish for many, many years and suddenly gets in the kitchen and can’t remember how to do it. So things that are well-learned, that we’ve known for a long period of time and suddenly can’t do them anymore.
Melanie: What is the difference, Dr. Manning, between dementia and Alzheimer’s disease? Because these symptoms that you’re mentioning, right away, people are going to start to be very concerned that this is not an age-related dementia but something much more serious.
Dr. Manning: “Dementia” is a general term, and Alzheimer’s disease is a kind of dementia. Alzheimer’s disease happens to be the most common kind of dementia, but there are other dementias as well. There is dementia that’s associated with vascular change, vascular dementia. There is dementia that can occur with Parkinson’s disease—so for example, Parkinson’s disease dementia. The umbrella term is “dementia,” and Alzheimer’s disease is a kind of dementia. By far, it’s the most common kind.
Melanie: So then, what treatments are available? If somebody experiences these symptoms or you notice it in a loved one, and then you go to see a doctor such as yourself, what can you do about it?
Dr. Manning: Well, I think, first, it’s important, extremely important to get a diagnosis and to get an accurate diagnosis, because to assume that it’s Alzheimer’s disease or that it’s a dementia that we can’t treat is doing the person a disservice. There are some dementias and there are conditions that are treatable, and we definitely want to treat them. So if there’s a thyroid problem, or if there’s a vitamin deficiency, we want to treat it. If it’s depression, which can look like dementia, we definitely want to treat the depression. So it’s really important to go to a specialized memory disorders clinic to make sure that you get the right diagnosis. Then, once you have the diagnosis, we want to treat what’s treatable, and we want to also treat symptoms even if we can’t cure. So for example, currently, with Alzheimer’s disease, there’s a lot of research being done to actually try to cure it. At this moment, we can’t. But what we can do is to treat the symptoms, and we have medications that we can prescribe that slow the rate of decline. We also want to work with people on behavioral management because there are behavioral strategies that can be used to help minimize the effects of the dementia or the Alzheimer’s.
Melanie: Some of the medications that you mentioned, Dr. Manning, do they also help to slow the development of these symptoms?
Dr. Manning: What they do is, yes, they slow the rate of decline. And there’s research looking at these drugs, and what they do is slow the rate of decline for about three years. And what they can do is slow the rate of decline such that people may not have to go into facilities, memory disorders, memory units, or nursing homes. It can prolong placement because of the slow in the rate of decline. While they don’t cure, they can be really helpful to patients and the care groups.
Melanie: Explain a little bit about some of the therapies that you mentioned. If you’re giving a behavioral therapy, modifying tasks, or the environment around this person, what’s involved in that?
Dr. Manning: Well, it’s involved when you’re with professionals who can help understand what the behavior is and what’s causing it. There’s a behavior that’s common in Alzheimer’s disease called sun downing, and that is that people with Alzheimer’s disease will often become more agitated or upset late afternoon or late evening. So it’s working with the caregiver and the patient to try to understand what is provoking the person to become more upset at that time of day. For some people, it’s that there’s too much activity. We want to minimize what’s going on around that person and put them in a calmer environment. So turn down the lights and get soothing music or soothing activity. For other people, it can be that there’s not enough stimulation and they have too much energy and they get agitated. We, in large part, work with caregivers to try to strategize to make things easier for both the patient and for the caregiver. This is a disease that affects entire families. And because Alzheimer’s disease is a progressive condition, it’s always changing. It requires ongoing current treatment and working with patients and families to cope with the changes as they occur.
Melanie: Dr. Manning, why should patients come to UVA for treatment of dementia?
Dr. Manning: I think they should come because we have a multidisciplinary clinic with people who are board certified and trained in behavioral neurology and neuropsychology. We have an entire multidisciplinary team involved—social work, neuropsychology, neurology, geriatric psychiatry. We have a nurse practitioner. We also have clinical trials which enable us to give our patients medications that aren’t available elsewhere but are really promising in terms of treating the disease. We have a full family approach, not just for the patient, but we look at the patient and the needs of the entire family and try to help them not just with the diagnosis but with ongoing care as the disease progresses.
Melanie: Dr. Manning, please, in the last minute, give us your very best advice for people who are starting to experience some of those symptoms of dementia, or for if you see it in your loved ones. Give us your best advice for things at home.
Dr. Manning: My best advice is go ahead and go to a memory disorders clinic and get a diagnosis so that you can make plans and understand what’s going on. Sometimes it’s not dementia, and you want to know that. And sometimes, unfortunately, it is, and you want to be prepared. People often try to avoid it and deny it and said, “I don’t want this person to know that they have dementia.” Our experience is that people know that there’s something wrong, and it’s actually a release to get a good diagnosis and to get good care and to be able to plan for the future.
Melanie: So important and such great information. You’re listening to UVA Health Systems Radio. And for more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening, and have a great day.
Signs and Symptoms of Dementia
Melanie Cole (Host): While memory loss is the best known symptom of dementia, it’s not the only symptom, and memory loss alone does not mean that you have dementia. My guest is Dr. Carol Manning. She’s a board-certified clinical neuropsychologist who directs UVA’s Memory and Aging Care Clinic and specializes in caring for patients with memory disorders such as dementia. Welcome to the show, Dr. Manning. What is dementia?
Dr. Carol Manning (Guest): As you said, dementia is not just memory loss that occurs with normal aging. Dementia is an umbrella term for several disorders, and what dementia is, it describes what happens when there’s a decline from normal levels of ability—of when there are changes in memory, attention, concentration, abstract thinking—all kinds of cognition that we rely upon when there’s a decline that’s greater than what we would expect with normal aging. So dementia describes constellation of symptoms, but it doesn’t describe the exact disease process.
Melanie: So these most common symptoms, what would send up a red flag that would signal somebody really, something is going on here?
Dr. Manning: With, for example, normal aging and memory loss, we would anticipate that someone might forget where they parked their car in a parking lot. But if they forget what their car looks like, that would be a signal to me that there’s something wrong. With normal aging, what we might see is that people forget proper nouns. They forget names. That’s very normal. With dementia, people lose the ability to speak fluently altogether—so spontaneous speech decline. Losing your keys is normal, but putting things in highly unusual places and then suspecting that someone else took them, that would be something that would be out of the norm.
Melanie: So, suspecting that someone else took them. Is there a generalized paranoia? Do you start to look for these things if it’s happening in yourself or if it’s happening for your loved one and you start to notice these things?
Dr. Manning: That often occurs later on in dementia, and the paranoia is because people may not be aware of the fact that they put them there and there’s something called confabulation, where people make up things to fit with other things that they can’t put together. For example, they don’t have a memory that they put their keys somewhere unusual, and so they assume that someone took them. I can give you another example of a change that would concern me: someone who’s been making the same favorite dish for many, many years and suddenly gets in the kitchen and can’t remember how to do it. So things that are well-learned, that we’ve known for a long period of time and suddenly can’t do them anymore.
Melanie: What is the difference, Dr. Manning, between dementia and Alzheimer’s disease? Because these symptoms that you’re mentioning, right away, people are going to start to be very concerned that this is not an age-related dementia but something much more serious.
Dr. Manning: “Dementia” is a general term, and Alzheimer’s disease is a kind of dementia. Alzheimer’s disease happens to be the most common kind of dementia, but there are other dementias as well. There is dementia that’s associated with vascular change, vascular dementia. There is dementia that can occur with Parkinson’s disease—so for example, Parkinson’s disease dementia. The umbrella term is “dementia,” and Alzheimer’s disease is a kind of dementia. By far, it’s the most common kind.
Melanie: So then, what treatments are available? If somebody experiences these symptoms or you notice it in a loved one, and then you go to see a doctor such as yourself, what can you do about it?
Dr. Manning: Well, I think, first, it’s important, extremely important to get a diagnosis and to get an accurate diagnosis, because to assume that it’s Alzheimer’s disease or that it’s a dementia that we can’t treat is doing the person a disservice. There are some dementias and there are conditions that are treatable, and we definitely want to treat them. So if there’s a thyroid problem, or if there’s a vitamin deficiency, we want to treat it. If it’s depression, which can look like dementia, we definitely want to treat the depression. So it’s really important to go to a specialized memory disorders clinic to make sure that you get the right diagnosis. Then, once you have the diagnosis, we want to treat what’s treatable, and we want to also treat symptoms even if we can’t cure. So for example, currently, with Alzheimer’s disease, there’s a lot of research being done to actually try to cure it. At this moment, we can’t. But what we can do is to treat the symptoms, and we have medications that we can prescribe that slow the rate of decline. We also want to work with people on behavioral management because there are behavioral strategies that can be used to help minimize the effects of the dementia or the Alzheimer’s.
Melanie: Some of the medications that you mentioned, Dr. Manning, do they also help to slow the development of these symptoms?
Dr. Manning: What they do is, yes, they slow the rate of decline. And there’s research looking at these drugs, and what they do is slow the rate of decline for about three years. And what they can do is slow the rate of decline such that people may not have to go into facilities, memory disorders, memory units, or nursing homes. It can prolong placement because of the slow in the rate of decline. While they don’t cure, they can be really helpful to patients and the care groups.
Melanie: Explain a little bit about some of the therapies that you mentioned. If you’re giving a behavioral therapy, modifying tasks, or the environment around this person, what’s involved in that?
Dr. Manning: Well, it’s involved when you’re with professionals who can help understand what the behavior is and what’s causing it. There’s a behavior that’s common in Alzheimer’s disease called sun downing, and that is that people with Alzheimer’s disease will often become more agitated or upset late afternoon or late evening. So it’s working with the caregiver and the patient to try to understand what is provoking the person to become more upset at that time of day. For some people, it’s that there’s too much activity. We want to minimize what’s going on around that person and put them in a calmer environment. So turn down the lights and get soothing music or soothing activity. For other people, it can be that there’s not enough stimulation and they have too much energy and they get agitated. We, in large part, work with caregivers to try to strategize to make things easier for both the patient and for the caregiver. This is a disease that affects entire families. And because Alzheimer’s disease is a progressive condition, it’s always changing. It requires ongoing current treatment and working with patients and families to cope with the changes as they occur.
Melanie: Dr. Manning, why should patients come to UVA for treatment of dementia?
Dr. Manning: I think they should come because we have a multidisciplinary clinic with people who are board certified and trained in behavioral neurology and neuropsychology. We have an entire multidisciplinary team involved—social work, neuropsychology, neurology, geriatric psychiatry. We have a nurse practitioner. We also have clinical trials which enable us to give our patients medications that aren’t available elsewhere but are really promising in terms of treating the disease. We have a full family approach, not just for the patient, but we look at the patient and the needs of the entire family and try to help them not just with the diagnosis but with ongoing care as the disease progresses.
Melanie: Dr. Manning, please, in the last minute, give us your very best advice for people who are starting to experience some of those symptoms of dementia, or for if you see it in your loved ones. Give us your best advice for things at home.
Dr. Manning: My best advice is go ahead and go to a memory disorders clinic and get a diagnosis so that you can make plans and understand what’s going on. Sometimes it’s not dementia, and you want to know that. And sometimes, unfortunately, it is, and you want to be prepared. People often try to avoid it and deny it and said, “I don’t want this person to know that they have dementia.” Our experience is that people know that there’s something wrong, and it’s actually a release to get a good diagnosis and to get good care and to be able to plan for the future.
Melanie: So important and such great information. You’re listening to UVA Health Systems Radio. And for more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening, and have a great day.