Dementia

As a diagnostic category, dementia is comprised of several symptoms of which the most notable is memory loss. Additional symptoms include impairment of judgment (including social appropriateness), abstract reasoning, sense of time, speech and communication, and physical coordination. Changes in emotional responses may also be seen (American Psychiatric Association 1994). Since dementia results from many different diseases, an individual's symptoms may progress at varying rates and in different ways. Additionally, losses in dementia can be uneven, with one ability (e.g., comprehension) being lost before another (e.g., reading) (Rabins et al. 1999).

In the early stages of dementia, it may be hard to distinguish "normal" behavior (such as forgetfulness) from pathological (or illness based) changes. Since a person rarely uses their full capacities for daily functioning, a person in the early stages of dementia may be able to compensate for some of their losses by developing a variety of coping strategies (Mace and Rabins 1999). While some of these strategies (e.g., leaving oneself notes) can be helpful for a while, others may lead to additional behavioral and psychological symptoms that can add to the person's confusion and pose significant challenges for their caregivers.

An example of this may be seen in regard to impairments in a person's emotional responses. Often such changes are characterized by a lack of emotional involvement. On the other hand, persons with dementia might also demonstrate heightened emotional responses. Such reactions, where a person may become excessively upset or combative over something they might have earlier perceived as trivial, are referred to as catastrophic reactions (Mace and Rabins 1999). Sometimes catastrophic reactions can be confused with obstinacy when they are really a response to too much stimulation. A person may cry or even strike out to cover up their confusion or frustration. Such reactions can be particularly trying for caregivers. Recognizing and removing the triggers for such outbursts (e.g., by removing an offending noise or breaking down a confusing task into simpler steps) may help to reduce their occurrence.

Another example of behavioral symptoms may be seen in the strategies used for communication. Two distinct communication challenges for persons with dementia are making themselves understood and understanding others. With regard to being understood, common communication issues include word substitution; incomplete or incoherent thoughts; making up information to fill in the gaps (confabulation); and frequent repetition of a response (perseveration). In regard to understanding others, it is important to note that reading and understanding are not the same skill. Thus, a person may be able to read words but not understand the content. Also, persons with dementia may only catch part of what is being said, and thus fill in (often inaccurately) the rest on their own. This can lead to confusion and frustration for all involved (Small, Geldart, and Gutman 2000).