What is dementia?

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Dementia, simply put, is a group of symptoms associated with a progressive loss of brain functioning. The word “dementia” comes from “de” (without) and “mentia” (mind).

Dementia is a syndrome, usually of a chronic or progressive nature, caused by a variety of brain illnesses that affect memory, thinking, behaviour and ability to perform everyday activities.
— Dementia: A Public Health Priority (WHO report.)

Dementia is a serious medical condition. It occurs because of diseases that affect the brain. Because the brain controls every function of our body, dementia patients start having problems in many tasks of daily life. Initial symptoms are mild, like memory loss, confusion, mood changes, problems finding the right words, needing some help with planning or work. But over time, they are unable to do normal tasks of daily living. They could have problems walking, talking, and swallowing food. In the final stage, they become fully dependent and may get pneumonia, infections, bedsores, multi-organ failure, and so on.

Often the family may notice initial changes but they think this is part of normal ageing or stress. Sometimes, especially when the persons with dementia are younger and show behavior changes, the symptoms may be mistaken as a psychiatric problem. Problems may be ignored as “stubbornness” or “bad character”.

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Examples of dementia symptoms

Persons with dementia may show some or most of the following symptoms described below. The number and intensity of symptoms increases as dementia progresses:

early dementia patient confused and misplaces watch in fridge
  • They forget important things, especially recent things.
  • They find it difficult to plan events or solve problems.
  • Normal, daily activities seem more difficult to do.
  • They wear wrong or unsuitable clothes, or become untidy.
  • They don’t know which day, month or year it is.
  • They are confused about their location or city.
  • They have problems understanding pictures or charts.
  • They have problems with numbers and simple arithmetic.
  • They use wrong words while speaking or writing.
  • They put things at very unsuitable places (like putting a file in the fridge).
  • They may start a task, but then cannot remember what they wanted to do, even after trying a lot.
  • They take big and unwise decisions about their savings and investments.
  • They no longer understand the value of money, and treat ten rupees and thousand rupees like the same thing.
  • They act in socially inappropriate ways, like taking off clothes or using abusive language.
  • They withdraw socially.
  • They get agitated for minor things or for no apparent reason at all.
  • They may start hitting persons or throwing things around.
  • They don’t seem to care about anything, not even about what close family members are feeling. They don’t seem interested in anything.
  • They seem suspicious about people for no apparent reason.
Words for dementia in India indicate childishness and weak brain

When we talk of what dementia is, it is also important to understand what it is not. Dementia is not mental retardation.  It is not delirium or amnesia. And it is not being crazy.

In India, we have some words in our languages for some of the symptoms of dementia when seen in the elderly. These words focus on the behavior. They do not indicate that the symptoms are the result of a medical condition. The figure here shows some of these words, and is based on a page of the 10/66 Dementia Research Group.

Some more links to understand dementia symptoms are available at the bottom of the page.

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The memory loss in dementia is different from normal memory problems that come with age

memory loss in dementia not same as normal memory loss

A lot of people think dementia is the same as “memory loss”.  They get worried every time they forget something. They think they have dementia. But not every misplaced key or forgotten date indicates dementia. Many of us forget things occasionally. Such simple memory problems are very different from the “memory loss” seen in dementia.

For example, consider your own name. Do you expect that, however old you become, you will forget your own name? Persons with dementia forget their names. They are not able to remember the names of family members. They may even forget they were married and have children.

A normal person may forget where she kept her key. Someone with dementia may feel puzzled when looking at a key because she cannot remember what a key is used for.

Many of us forget dates and years. So we may forget in which year we last visited Mumbai. That is normal memory loss. But someone with dementia may say they have never been to Mumbai, or even ask what Mumbai is.

dementia patient forgets name and covers up by pretending

In the early stages of dementia, persons often manage to hide their memory loss. Even if they seem confused, others think this is a “normal” loss. Families need to be more alert to notice problems.

As dementia progresses, however, the problem becomes more obvious.

Please note that if you have memory loss and feel it is odd or not normal, or are worried about it, you should consult a doctor anyway.

Links to more examples on dementia memory loss compared to normal memory loss have been given at the bottom of the page.

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Dementia is not the same as normal old age

Often, people ignore early symptoms of dementia, because they think these are part of normal old age. Both persons facing problems and their family members think this. Our normal language adds to this confusion, because old age and senility are talked of as if they are the same thing. Even some doctors use terms like “senile dementia” and “pre-senile dementia.”

But dementia is not just a faster case of ageing. Getting older affects our abilities, but the changes in dementia are different from those seen in normal ageing. Dementia symptoms are caused by distinct changes in the brain, such as damage to brain cells. Also, these symptoms are not seen only in older persons. Dementia also happens in younger persons (see below).

Some people think everyone who grows old will get dementia. This is not true. The chance of getting dementia is more as we grow older, but not every old person will get dementia. Dementia is not a part of normal ageing, and it is not inevitable.

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While older people are more likely to get dementia, people in their 30s, 40s, and 50s can also get dementia

People can get dementia at younger ages, too. Dementia diagnosed in someone less than 65 years old is called younger onset dementia. Other terms for this are young onset dementia and early onset dementia. Because people think of dementia as an old age disease, younger persons who experience the symptoms do not go to doctors. Doctors, too, may ignore the symptoms or ignore dementia diseases as a possible cause of the symptoms, They may give a wrong diagnosis, such as saying the person has a psychiatric disorder or is suffering from stress.

(Note that some papers mention the cut-off of younger onset as 60 years. But generally the cut-off for “younger onset dementia” is assumed to be 65 years old at time of diagnosis.)

The WHO report, Dementia, a Public Health Priority, discusses YOD (Younger Onset Dementia). It says: “While it was estimated that YOD accounts for only 2.2% of all people with dementia in the United Kingdom, the true proportion may be closer to 6–9%.” This is a fairly important proportion of the dementia population.

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Memory loss may not be an initial symptom in a person with dementia

There are many symptoms of dementia. Also, dementia may be caused by several diseases. Memory loss is a prominent feature in the initial stages of Alzheimer’s Disease, the main form of dementia. But memory loss is not always an initial symptom in dementia. For example, in fronto-temporal dementias (FTD), the typical initial symptoms are personality changes. These include things like disinhibition and loss of restraint, inability to use appropriate words and having a halting speech, problems in walking and balance, and so on. Persons suffering from FTD may not show any memory loss in the beginning.

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See Also…

This section contains some external links to references and resources related to the discussion on the page above.

Links for further reading on dementia symptoms:

More reading on memory problems in dementia, and how they are different from normal memory loss:

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Read on to know about the medical conditions that can cause the dementia symptoms.

Next: Diseases that cause dementia
Dementia Care Notes