Dementias are degenerative disorders that develop primarily in the nervous system and selectively damage particular areas of the brain. Some dementias, like Alzheimer’s disease, affect all areas of the brain simultaneously, while others, such as frontotemporal dementia, affect the parts of the brain involved in controlling one’s communications and emotions. Still others are caused by vascular disease, brain trauma, or chronic alcohol abuse (Korsakoff’s syndrome)

By 2030, 20% of U.S. population will be older than 65 years of age – about 50 million people. Dementia affects 1% to 6% of those older than 65, and between 10% and 20% of those older than 80 years of age. In the next 30 years, estimated 10-20 million seniors in U.S. will have mild to severe forms of dementia.

Seniors with history of moderate traumatic brain injury (TBI) have a 2-3 times greater risk of developing Alzheimer's disease – those with a severe TBI have a 4-5 times greater risk. Even healthy seniors are at risk for falls and head trauma, so any fall to the head, however minor, should be seen by a medical professional and documented.

Alzheimer’s disease accounts for 65% of all dementias. There is no direct diagnosis of Alzheimer’s – and while PET scans and other imaging techniques are being studied, none have yet been able to show the presence of Alzheimer’s disease.

Alzheimer’s onset often surprises families because vision, movement, and sensation remain untouched while a senior’s memories begin to slowly decrease. Recent memories are affected first, leading to “senior moments” that appear innocent because all other memories, including those from decades ago, remain intact. Eventually those remote memories begin to fade, and lastly the senior’s “crystallized” memories, such as family member’s names and faces, are compromised.

The Six Stages of Dementia

Family members, caregivers, and other health professionals should be aware of the six stages commonly seen in seniors with dementia:

Stage One: Very Mild

• Forgetting when one has placed familiar objects

• Forgetting names that one formerly knew

• No visible evidence of memory problem.

• No problems with employment or social interactions

Stage Two: Mild

• Getting lost when traveling to unfamiliar location

• Forgetting what one has just read

• Coworkers become aware of poor work performance

• Not remembering names when meeting new people

• Losing or misplacing things of value

• Memory or concentration problems seen only on clinical testing

• Beginnings of mild to moderate anxiety

• Denial begins to set in

Stage Three: Moderate

• Decreasing knowledge of current or recent events

• Losing memory of personal history

• Decreased ability to handle finances, travel alone, etc.

• Inability to perform complex tasks

• Withdrawal from challenging activities

• Flattening of affect (loss of facial expression of emotions)

• Denial becomes dominant defense mechanism

Stage Four: Moderately Severe

• Unable to function without assistance

• Unable to recall major relevant aspects of current life

• Unable to remember address, telephone numbers, names of close family members, names of schools attended

• Frequent disorientation to date, day, season, and current location

Stage Five: Severe

• Occasionally forgets name of spouse

• Largely unaware of all recent events or experiences

• Retaining some knowledge of life, but sketchy

• Difficulty counting backward and forward to 10

• Requires some assistance with activities of daily living (travel assistance, incontinence)

• Can recall own name and can distinguish familiar from unfamiliar persons

• Changes in personality and emotion

• Delusional behaviors, obsessive symptoms, anxiety

• Loss of purposeful behavior

Stage Six: Very Severe

• All verbal abilities are lost

• Complete incontinence

• Requires assistance in feeding

• Loss of basic psychomotor skills (e.g., ability to walk)

• Brain appears unable to tell the body what to do

If symptoms of early stages begin to show themselves, it would be in everyone’s best interest to have the senior tested at Raffle Brain Institute to determine (a) the presence of dementia or other cause (e.g., overmedication), (b) the type of dementia, and (c) the stage of dementia, so that caregivers can learn how to make accommodations and provide the best support for the seniors, so that the last chapter of their lives will be an easier one for them and their loved ones.