Managing Mild Dementia: Strategies for Caregivers and Health Concerns - Neurology

Dr. Hong Weibin reply Neurology

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Hello: In addition to pharmacological treatment for dementia, there are non-pharmacological interventions, including occupational therapy, cognitive training, reminiscence therapy, art therapy, and social activities, among others.
You can contact the dementia care centers or long-term care service management centers in your mother's city or county to inquire about relevant service providers.
The progression of dementia varies, with different rates of advancement for different types.
For example, in the early stage of Alzheimer's disease, patients can usually live independently with assistance; some may still drive, work, and participate in social activities, but they often experience memory lapses, such as forgetting familiar words or the locations of everyday items, typically lasting around 2 years.
In the moderate stage, which usually lasts about 4 years, symptoms become more pronounced, and patients may exhibit language difficulties, feelings of frustration or anger, and may act unexpectedly, such as refusing to bathe.
They may struggle to express thoughts and perform daily tasks without help.
In the late stage of dementia, which generally lasts about 7 years, patients are unable to respond appropriately to their environment, experience severe language and movement difficulties, and completely lose their ability to live independently, requiring full care from others.
However, the duration of each stage is only a reference and can vary individually; proper care can help delay progression.
The various stages of dementia can be referenced using the Global Deterioration Scale for assessment of primary degenerative dementia (GDS) [1], as shown in the table below.
Symptoms of shortness of breath are mostly related to heart or lung issues; if these conditions have been ruled out, psychological factors must also be considered.
Dementia patients often experience accompanying symptoms of depression or anxiety, which may manifest as shortness of breath.
It is advisable to seek evaluation and referral from a neurologist or psychiatrist.

GDS Clinical characteristics Yrs[2]
1 No cognitive decline No subjective complaints of memory deficit.
No memory deficit evident on clinical interview.
2 Very mild cognitive decline.
Subjective complaints of memory deficit, most frequently in the following areas: (a) forgetting where one has placed familiar objects; (b) forgetting names one formerly knew well.
No objective evidence of memory deficit on clinical interview.
No objective deficits in employment or social situations.
Appropriate concern with respect to symptomatology.
1-5
3 Mild cognitive decline.
Earliest clear-cut deficits.
Manifestations in more than one of the following areas: (a) patient may have gotten lost when traveling to an unfamiliar location; (b) coworkers become aware of patient's relatively poor performance; (c) word and name finding deficit becomes evident to intimates; (d) patient may read a passage or a book and retain relatively little material; (e) patient may demonstrate decreased facility in remembering names upon introduction to new people; (f) patient may have lost or misplaced an object of value; (g) concentration deficit may be evident on clinical testing.
Objective evidence of memory deficit obtained only with an intensive interview.
Decreased performance in demanding employment and social settings.
Denial begins to become manifest in patient.
Mild to moderate anxiety accompanies symptoms.
7-4
4 Moderate cognitive decline.
Mild dementia.
Clear-cut deficit on careful clinical interview.
Deficit manifest in following areas: (a) decreased knowledge of current and recent events; (b) may exhibit some deficit in memory of one's personal history; (c) concentration deficit elicited on serial subtractions; (d) decreased ability to travel, handle finances, etc.
Frequently no deficit in following areas: (a) orientation to time and place; (b) recognition of familiar persons and faces; (c) ability to travel to familiar locations.
Inability to perform complex tasks.
Denial is dominant defense mechanism.
Flattening of affect and withdrawal from challenging situations frequently occur.
2-5
5 Moderately severe cognitive decline.
Moderate dementia.
Patient can no longer survive without some assistance.
Patient is unable during interview to recall a major relevant aspect of their current lives, e.g., an address or telephone number of many years, the names of close family members (such as grandchildren), the name of the high school or college from which they graduated.
Frequently some disorientation to time (date, day of week, season, etc.) or to place.
An educated person may have difficulty counting back from 40 by 4s or from 20 by 2s.
Persons at this stage retain knowledge of many major facts regarding themselves and others.
They invariably know their own names and generally know their spouses' and children's names.
They require no assistance with toileting and eating, but may have some difficulty choosing the proper clothing to wear.
1.5-6
6 Severe cognitive decline.
Moderately severe dementia.
May occasionally forget the name of the spouse upon whom they are entirely dependent for survival.
Will be largely unaware of all recent events and experiences in their lives.
Retain some knowledge of their past lives but this is very sketchy.
Generally unaware of their surroundings, the year, the season, etc.
May have difficulty counting from 10, both backward and, sometimes, forward.
Will require some assistance with activities of daily living, e.g., may become incontinent, will require travel assistance but occasionally will be able to travel to familiar locations.
Diurnal rhythm frequently disturbed.
Almost always recall their own name.
Frequently continue to be able to distinguish familiar from unfamiliar persons in their environment.
Personality and emotional changes occur.
These are quite variable and include: (a) delusional behavior, e.g., patients may accuse their spouse of being an impostor, may talk to imaginary figures in the environment, or to their own reflection in the mirror; (b) obsessive symptoms, e.g., person may continually repeat simple cleaning activities; (c) anxiety symptoms, agitation, and even previously nonexistent violent behavior may occur; (d) cognitive abulia, i.e., loss of willpower because an individual cannot carry a thought long enough to determine a purposeful course of action.
2.5-7
7 Very severe cognitive decline.
Severe dementia.
All verbal abilities are lost over the course of this stage.
Frequently there is no speech at all - only unintelligible utterances and rare emergence of seemingly forgotten words and phrases.
Incontinent of urine, requires assistance with toileting and feeding.
Basic psychomotor skills, e.g., ability to walk, are lost with the progression of this stage.
The brain appears to no longer be able to tell the body what to do.
Generalized rigidity and developmental neurologic reflexes are frequently present.
7
Ref: [1] Reisberg B, Ferris SH, de Leon MJ, Crook T.
The Global Deterioration Scale for assessment of primary degenerative dementia.
Am J Psychiatry.
1982 Sep;139(9):1136-9.
doi: 10.1176/ajp.139.9.1136.
PMID: 7114305.
[2] Yrs*: 7 clinical stages of Alzheimer’s Brochure.
Fisher center for Alzheimer’s research foundation.

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Reply Date: 2022/05/03