137. CCA Study Notes: Dementia – Signs, Symptoms, Progression, and Reversible and Irreversible Forms

The Big Picture

Dementia is a term for illnesses that affect how the brain works. A person may have trouble remembering things, making decisions, communicating, or completing everyday activities.

Dementia is not a normal part of getting older. It usually develops slowly and becomes worse over time. Some conditions can cause similar problems that improve with treatment. Other forms of dementia cannot be reversed.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

1. What Is Dementia?

Dementia is a general term for a group of illnesses that cause a progressive loss of brain function.

Progressive means the loss becomes worse over time.

Dementia can affect several important abilities:

• Memory: Remembering information, people, and events.
• Thinking and learning: Understanding information and learning new things.
• Judgement and decision making: Making decisions and choosing what to do.
• Communication: Finding words, speaking, and following conversations.
• Behaviour and social functioning: How a person behaves and interacts with others.
• Everyday activities: Completing tasks that the person could previously manage.

Dementia is not one specific disease. Different illnesses can cause different forms of dementia.

Dementia and Normal Aging

Key fact: Dementia is not a normal part of aging.

Most older adults do not develop dementia.

Although dementia is more common after age 65, it can also affect people in their 40s and 50s.

2. Understanding Cognitive Function and Cognitive Impairment

Two important terms help explain what happens when dementia affects the brain.

Cognitive function means the brain’s ability to remember, think, reason, understand, make judgements, and guide behaviour.

Cognitive impairment is the loss of the ability to remember, think, reason, understand, or live independently.

A person with dementia experiences a decline in brain abilities that affects daily functioning.

Mild and Major Neurocognitive Disorders

After dementia is diagnosed, it is categorized as either a mild or major neurocognitive disorder.

A neurocognitive disorder involves a significant decline in abilities such as:

• Attention
• Everyday functioning
• Learning
• Memory
• Language
• Deliberate motor movement
• Social functioning

Deliberate motor movement means making purposeful movements.

The distinction between mild and major neurocognitive disorders depends on the extent of the person’s loss of cognitive and social functioning.

3. How Dementia Progresses

Dementia usually begins slowly and gradually becomes worse.

A person may first struggle with complicated activities. As the condition progresses, even simple everyday activities can become difficult.

Early Difficulties: Complex Tasks

Early difficulties may involve:

• Driving
• Managing money
• Planning meals
• Working

These activities may become difficult before the person has problems with basic personal care.

Later Difficulties: Simple Tasks

As dementia progresses, the person may struggle with activities that were once familiar and routine.

These include:

• Bathing
• Dressing
• Eating
• Using the toilet
• Walking

Over time, the person may lose the ability to perform everyday skills.

In irreversible dementia, the decline eventually interferes with all activities of daily living (ADLs).

4. Early Warning Signs of Dementia

Early warning signs involve changes in memory, thinking, communication, judgement, behaviour, and everyday activities.

Memory and Orientation Changes

A person may:

• Forget information that affects daily activities.
• Frequently misplace belongings.
• Put familiar objects in unusual places.
• Become lost in familiar surroundings.
• Forget how to use ordinary household items, such as a microwave.

Disorientation means mental confusion or difficulty remembering people, time, or places.

Disorientation can result from physical changes involving the brain, illness, or substance-related factors. It is also called confusion.

Changes in Communication

A person may:

• Repeat words or sentences.
• Struggle to find the correct word.
• Have trouble following conversations.

These difficulties can affect ordinary communication.

Changes in Judgement and Everyday Tasks

A person may make decisions that show impaired judgement.

For example, someone might go outside in snowy weather without shoes.

Previously familiar activities may also become difficult, including:

• Dressing
• Cooking
• Driving

Mood, Behaviour, and Interest Changes

Early dementia can involve changes in mood, personality, or social behaviour.

Possible changes include:

• Becoming unusually jealous without a clear reason.
• Becoming suspicious of others.
• Showing inappropriate social behaviour.
• Losing interest in favourite activities or hobbies.

For example, someone who previously enjoyed gardening may stop caring for their garden.

5. Signs That Dementia Is Progressing

As dementia becomes worse, difficulties may affect more parts of a person’s daily life.

The following changes can involve memory, language, orientation, practical skills, movement, and behaviour.

Memory Loss Becomes More Noticeable

A person may forget:

• Recent events
• Simple directions
• Conversations
• Appointments
• People’s names, including family members
• The names of ordinary objects, such as a clock or television
• Familiar words

Language and Communication Become More Difficult

A person may:

• Replace forgotten words with unusual words or names.
• Lose their train of thought.
• Have difficulty following conversations.
• Struggle with reading.
• Struggle with writing.
• Begin cursing or swearing.

A person who learned English as a second language may forget English and begin speaking only their first language.

Orientation to Places and Time Becomes Worse

A person may:

• Become lost in familiar surroundings.
• Forget where they are.
• Wander away from home.
• Be unable to find their way home.
• Have difficulty telling or understanding the time.
• Have difficulty telling or understanding dates.

These changes involve the person’s ability to recognize locations and understand time.

Managing Money Becomes Difficult

Dementia may interfere with financial activities.

A person may:

• Have trouble using debit cards.
• Struggle to write cheques.
• Be unable to balance a chequebook ⓘ.
• Give away large amounts of money.
• Have difficulty recognizing or understanding numbers.

These difficulties may become more noticeable as dementia progresses.

Familiar Household Activities Become Difficult

The person may no longer manage tasks that were once routine.

For example, they may:

• Leave an iron switched on.
• Forget to turn off stove burners.
• Leave food burning on the stove.
• Misplace items or store them in unusual locations.

These examples show how changes in memory and everyday functioning can affect familiar activities.

Apraxia: Losing the Ability to Perform Learned Movements

Apraxia is an impairment of the skilled motor system.

It means a person loses the ability to perform learned, purposeful movements.

This can interfere with familiar activities such as:

• Bathing
• Brushing teeth
• Other everyday personal-care activities

Key fact: Apraxia involves the loss of an ability to perform movements the person previously learned.

Changes in Behaviour, Mood, and Social Activity

Dementia progression may also involve changes in how a person acts or interacts with others.

A person may:

• Distrust others.
• Become more suspicious.
• Show stubborn behaviour.
• Withdraw from social activities.
• Become restless.
• Become fearful.
• Lose the desire to participate in activities.
• Sleep more than usual.

These changes are important observations. When reporting or documenting ⓘ them, describe what the client does rather than using judgemental labels.

6. Understanding Reversible and Irreversible Forms of Dementia

There are many forms and causes of dementia.

Some conditions can produce dementia-like symptoms that improve when the underlying cause is treated.

Other forms cause continuing brain decline that cannot be reversed.

What Does Reversible Mean?

Reversible means that a condition or its effects can improve or be corrected.

Some treatable conditions cause disorientation, delirium, or dementia-like changes.

Treatment may reverse these changes or slow their progression. Reversal is not guaranteed in every situation.

How Is Delirium Different?

Delirium is a temporary state of mental disorientation that can develop suddenly.

This differs from the usual pattern of dementia, which begins slowly and becomes progressively worse.

Some treatable conditions may cause delirium or disorientation rather than irreversible dementia.

7. Treatable or Potentially Reversible Causes

Several health conditions and exposures can cause changes in memory, thinking, or behaviour.

The effects depend on the particular cause.

Metabolic Problems

Several conditions can affect mental functioning.

Underactive thyroid gland

An underactive thyroid can cause disorientation or delirium.

These changes can be reversed when the thyroid condition is corrected.

Low blood sugar

Low blood sugar is called hypoglycemia.

If untreated, it can cause disorientation or dementia.

Abnormal sodium or calcium levels

Abnormal amounts of sodium or calcium in the body can cause changes in mental functioning.

Nutritional Deficiencies

A nutritional deficiency means the body does not have enough of a needed nutrient.

Low levels of certain vitamins can contribute to dementia-like mental impairment.

These include:

• Vitamin B₁
• Vitamin B₃
• Vitamin B₁₂

Brain Injuries

Some brain injuries cause bleeding inside the skull.

This bleeding can lead to a rapid appearance of dementia symptoms.

Safety: Without prompt attention and surgery to correct the bleeding, the client would most likely die or experience permanent changes in cognitive function.

Brain Tumours

A brain tumour may cause delirium or dementia.

The effects depend on:

• The tumour’s location
• The tumour’s size
• The tumour’s type

Treatment may involve surgery or chemotherapy.

Substance Abuse

Long-term alcohol abuse can cause dementia.

This form may or may not be reversible.

Regular cannabis use is also associated with changes in brain structure and functioning.

Infections

Certain infections can cause disorientation or delirium.

Examples include:

• UTI
• Infected wounds
• Tuberculosis

The confusion caused by these infections can be reversible when the infection is treated.

Important difference: Disorientation caused by an infection may be mistaken for irreversible dementia.

When this happens, an infection may go unreported because the mental changes are attributed to dementia.

Poisoning

Certain poisonous substances can cause changes in thinking and behaviour.

Possible causes include:

• Exposure to lead
• Exposure to other heavy metals
• Swallowing lead or other heavy metals
• Abuse of inhalants ⓘ

These changes may be mistaken for dementia.

8. Irreversible Forms of Dementia

Irreversible dementia means the continuing loss of brain function cannot be reversed.

Most forms of dementia are irreversible and have no prevention or cure.

As the condition progresses, the client’s brain function continues to decline.

Can Medication Help?

Some medications may delay the decline in brain functioning.

They have helped some clients, but their effectiveness depends on:

• The client’s individual situation
• The type of dementia

These medications do not mean that irreversible dementia has been cured.

How Irreversible Dementia Affects Daily Life

As irreversible dementia progresses, the client experiences increasing difficulties with everyday activities.

Eventually, all activities of daily living are affected.

Irreversible dementia will ultimately contribute to the client’s death.

9. Reporting and Documenting Dementia-Related Behaviours

Dementia has different causes and can affect clients in different ways.

For this reason, it is important to describe the behaviours the client shows.

When reporting or documenting observations:

• Describe the client’s actual behaviour.
• Use clear, factual wording.
• Avoid judgemental descriptions.
• Do not substitute a personal opinion for an observed behaviour.

For example, forgetting familiar names, wandering from home, or having difficulty with everyday tasks are specific behaviours that can be described.

Key fact: Report and document what the client does rather than making judgements about the client’s personality.

Common Mix-Ups

Wrong Idea	Better Idea
Dementia is a normal part of getting older.	Dementia is not normal aging. Most older adults do not have it.
Dementia and delirium always develop in the same way.	Dementia usually develops gradually. Delirium can appear suddenly and is temporary.
All dementia-like symptoms are permanent.	Some conditions cause mental changes that can improve or reverse with treatment.
All dementia can be cured with medication.	Most dementia is irreversible. Some medications may delay decline in certain clients.