Dementia Symptoms

We've talked about the various types of dementia and what treatments are available.   We've talked about a definition of dementia and of intellectual disabilities.  We've talked about how dementia is diagnosed.  We've started cataloguing Lyn's changes.  We've not yet discussed the various symptoms of dementia.  Some of them have come out in the various posts to date.  However, it may help to have the symptoms listed out for us.

The Mayo Clinic comes through for us with a concise list of the symptoms.  It includes the following:

• Memory loss
• Difficulty communicating
• Inability to learn or remember new information
• Difficulty with planning and organizing
• Difficulty with coordination and motor functions
• Personality changes
• Inability to reason
• Inappropriate behavior
• Paranoia
• Agitation
• Hallucinations

This list is based off of a population of patients who do not have intellectual disabilities.  While helpful, Lyn does have intellectual disabilities and we should factor that into the equation.

In September 2007, the Journal of Intellectual Disability Research published a study titled "Symptoms of dementia among adults with Down's syndrome: a qualitative study" by S. Deb, M. Hare and L. Prior.  In it, they point out that dementia may be difficult to diagnose because of "the different clinical manifestation of dementia amount people with intellectual disabilities."  Their study points out that the existing intellectual disability makes some of the initial cognitive diagnostic tools used in diagnosis invalid.  For example, if the patient is unable to complete simple math equations to begin with, then how can a test which asks the patient to complete simple math equations be effective?

As a result of the cognitive impairment, it may not be as obvious that a patient is unable to learn or remember new information as it is in a patient who is not cognitively impaired.  If the patient already had difficulty communicating, then a decline in communication skills may also go overlooked in the early stages.  They point out that some of these changes may, in fact, only be noticed by the individuals who are caring for the patient in question.  However, the study does point out that other changes, such as those to the patient's personality, moods, and sleep patterns may be noticed earlier than in patients without an intellectual disability.

The study lists as symptoms several types of memory impairment, confusion, problems with instructions, slowness, speech and language problems, sleep problems, loss of skills and several more.  Of particular interest to me are the symptoms they list which we already see in Lyn:

• Procedural memory impairment - Lyn now requires direction on steps necessary to complete some routine tasks such as taking out the trash.  She also no longer knows what button to push to turn the car radio to her favorite station or which button(s) to push on the tv remote.
• Episodic memory impairment - Lyn is no longer able to tell you what she did or ate yesterday consistently and cannot tell you what she did last week.
• Spatial memory impairment - Lyn does not always remember where something is located.  This is particularly noticed outside of her home environment.  For example, Lyn didn't know where to look for an item when I said "on the coffee table in the living room" when last she visited my home.  We had to say "Turn around.  Do you see the table?  It is on the table."
• Other memory impairment - Lyn forgets what she wants to tell you.
• Confusion - Lyn gets confused when she is not 100% sure of where she is.  She's been confused with the onset of her period.
• Problems with Instructions - Lyn now struggles with multiple instructions given together.  She does much better if you give her one step to complete before she goes to the next.
• Slowness - Lyn is moving more slowly. 
• Speech and Language problems - Aside from forgetting what she wants to say, she is now repeating questions.  She trails off mid-sentence.  
• Sleep problems - Her sleep patterns have changed pretty significantly.  While the study indicates a lack of sleep or a flip to sleeping during the day, Lyn's sleeping more, much more.
• Loss of skills - Lyn needs significant prompting to complete tasks which were previously routine such as taking out the trash or tending to certain personal hygiene needs.
• Balance problems - Lyn is shuffling more in her walking.  She needs assistance to step up or down even one step such as at a curb.  
• Lack of confidence - Lyn used to be pretty fearless.  There is a timidity and a questioning of herself that was not there previously.  
• Emotional problems - Lyn bursts into tears easily and has emotional outbursts which seem to come with little or no warning.
• Covering up - One of the symptoms that stood out to me was this one.  They mention that some of the patients tried to cover up for their loss of memories.  I see this with Lyn.  However, Lyn is currently trying to cover up her loss of skill and procedural memory.  For example, if she doesn't remember how to turn on the tv or change the radio station and you're not right there ready to do it for her, she'll say "I don't really want to watch tv" or "This station is OK."  It may seem like a change of mind to most people.  Not with Lyn.  If Lyn wants to watch Cops, she's not going to suddenly decide to not watch tv.

Lyn does not have Down's.  This study may not be 100% applicable.  However, I do find it illustrative of much of what we're seeing with my sister.