An initiative of the Massachusetts Councils on Aging

What is Dementia?

What is Dementia?

Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. These functions include memory, language skills, visual perception, problem-solving, self-management, and the ability to focus and pay attention. Some people with dementia cannot control their emotions, and their personalities may change. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend entirely on others for necessary activities of living.

Signs and symptoms of dementia result when once-healthy neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss. While dementia is more common as people age (up to half of all people age 85 or older may have some form of dementia), it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia.

Alzheimer’s Association- What is Dementia

Mayo Clinic- Dementia Overview

Teepa Snow- 10 Early Signs of Dementia Video

Types of Dementia

One type of dementia, frontotemporal disorders, is more common in middle-aged than older adults. The causes of dementia can vary, depending on the types of brain changes that may be taking place. Alzheimer’s disease is the most common cause of dementia in older adults. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia—a combination of two or more types of dementia. For example, some people have both Alzheimer’s disease and vascular dementia. (Source: National Institute on Aging)

Alzheimer’s Association- Types of Dementia

National Institute on Aging

University of Texas Health Center: What are the Types of Dementia (Video)

Communication Techniques

People with dementia experience changes in cognition, which often affects the ability to understand or express verbal information.  Compromised short-term memory may lead to repetitive statements or questions. Because of these factors, engaging with someone who has dementia can be unfamiliar, intimidating, or frustrating.  

Be patient.  Accommodate the individual and be mindful that you are speaking to an adult deserving of respect.  Allow time for a person to respond. Take deep breaths. Remember that the struggle to communicate is also challenging for the person with dementia.  

Simplify your language.  People with dementia may be able to process limited new information at any time.  By bombarding them with several questions or directions, they can feel overwhelmed and frustrated.  Use yes/no questions; give directions one step at a time. Depending on their current abilities, adjust how you speak to them.  

Avoid arguing.  Confusion is common for someone with dementia.  A person with cognitive challenges may be analyzing information in a context that makes sense for them in their current reality, that may differ from the truth.  To correct or argue with them about their beliefs can be disorienting for them and may heighten feelings of anxiety. Converse with them, inquiring about their current experience. 

Identify principal language and cultural identity.  As dementia progresses, a person might revert to using their first language.  If possible, communicate with them in their primary language and support their cultural and personal identity.

Don’t take it personally.  Dementia physically affects the brain resulting in changes to a person’s behaviors or understanding of reality, but people with dementia are doing the best they can.  

Ultimately, know that the person you are speaking to is an adult who is experiencing a debilitating condition that affects many areas of their life.  More information on communication techniques is addressed in the resources below.

Alzheimer’s Association- Communication Brochure (PDF Download)

Alzheimer’s Family Services Center- Communication Page (PDF Download)

Daily Caring- Non-verbal Dementia Communication Techniques

Learning to Speak “Alzheimer’s” Presentation (PDF Download)

Teepa Snow- How Dementia Affects Language Skills

Erratic Behaviors and Dementia

People with dementia can sometimes experience a change in personality or behavior.  While these behaviors can appear out-of-character, it is important to note that individuals with dementia often cannot control these transformations in part because of neurological decline or a reaction to a medication. 

Unusual behaviors are often in response to internal or external stimuli and can be considered a means of communication.  Think about a time where you have yelled in pain after stubbing a toe. This scream was in response to experienced physical pain and conveyed that you might be injured.  For a person with dementia who cannot verbally describe discomfort, aggressive behavior might be a subconscious way of communicating that they are in pain, for example.  

Strategies, including preventative measures or employing de-escalation techniques, are examples of non-pharmacologic methods of addressing dementia-related behaviors.  No method is 100% successful. While a person with dementia should always be treated with sympathy, patience, and dignity, compassionate care does not always mitigate unpredictable behaviors.  When the safety of the individual or those around them in in jeopardy, alternative care options or a modification in medication may be necessary. 

If you are experiencing an emergency, call 911.  Inform emergency personnel if someone with dementia or any cognitive impairment is involved in the situation.

Some dementia-related behaviors include: agitation or aggression, anxiety, delusions, paranoia, wandering, and sleep disturbances.  Learn more about why these behaviors may present and how to respond to respond to unpredictable behaviors by examining some of the provided material found below.

ACT on Alzheimer’s- General Non-pharmacologic Strategies for Managing Behavioral Symptoms (PDF Download)

ACT on Alzheimer’s- Potential Non-pharmacologic Strategies (PDF Download)

Alzheimer’s Association- Behaviors- How to Respond When Dementia Causes Unpredictable Behaviors (PDF Download)

Alzheimer’s Association- Dementia-Related Behaviors (PDF Download)

Teepa Snow- Ten Ways to De-Escalate a Crisis

UCLA Health- Aggressive Behavior in People with Dementia

Additional Resources

To listen to a first-hand account about living with dementia, explore “The Forgetting: Inside the Mind of Alzheimer’s,” a podcast co-hosted by esteemed experts, David Shenk and Greg O’Brien.  In 2009 O’Brien was diagnosed with Alzheimer’s disease and through this podcast, describes his daily experiences living with the disease.

Visit our Youtube Channel for playlists that further explore dementia and the importance of dementia-friendly communities in supporting the independence of people with dementia.

The Alzheimer’s Association
24/7 Helpline: 800.272.3900 (toll-free)
https://www.alz.org/help-support/resources/helpline

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
1-800-438-4380 (toll-free)
https://www.nia.nih.gov/health/alzheimers

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