Dementia: Symptoms, Complaints, Signs

Note: For the diagnosis of dementias, international guidelines and diagnostic criteria provide for a two-step approach:

  1. As thorough as possible elicitation, description, and confirmation of the dementia syndrome.
  2. Specification of the dementia etiology (cause of dementia).

The following symptoms and complaints may indicate dementia:

Possible early warning signs:

  • Deterioration of memory and short-term memory.
    • Failure to remember events that occurred in the short past.
    • Things you need every day (e.g., keys, wallet) get misplaced and can’t be found again.
    • Appointments, arrangements and phone numbers are forgotten.
  • Impairment of concentration and thought processes
    • Concentration is worse than before.
    • Decisions and deliberation are more difficult.
    • Situations that require quick and prudent action are no longer overlooked and it is reacted too slowly and incorrectly.
    • Reading, writing and arithmetic disorders.
    • Asking the same questions over and over again.
    • Everyday things can no longer be called.
    • Problems with familiar courses of action, such as tying shoes.
    • Several requests can no longer be done simultaneously (“multitasking” no longer possible).
  • Orientation disorders
    • Things that you need every day are put or misplaced in unusual places (ashtray in the refrigerator).
    • Orientation problems in strange places or at home at night.
    • Wearing inappropriate clothing (eg, winter coat in summer).
    • Disturbance of the sleep-wake rhythm (tired during the day and can not sleep at night).
  • Speech disorders
    • Spontaneous speech and language impoverished; active participation in conversations decreases.
    • It becomes increasingly difficult to follow conversations, television and radio broadcasts.
    • Increasingly word-finding disorders occur; the affected person can no longer name things in everyday life.
  • Behavioral abnormalities and psychological changes (“behavioral and psychological symptoms of dementia“, BPSD).
    • Abandonment of usual activities, hobbies
    • Withdrawal from the usual social environment
    • Believes he has been stolen from and unfoundedly accuses others of theft.
    • Affective symptoms (negative changes in mood state; depression, anxiety).
    • Hyperactivity (including agitation, aggression, disinhibition, irritability).
    • Psychotic symptoms (hallucinations (delusions), delusions).
    • Apathy (listlessness) – Studies using validated definitions of apathy showed that the relative risk of developing dementia was 1.81 (95% confidence interval: 1.32-2.50).

Leading symptoms

  • Limitation of memory performance
  • Speech disorders
  • Calculation disorders
  • Deficits in judgment and problem solving
  • Reduced critical faculties
  • Aggressiveness

Associated symptoms

  • Hallucinations
  • Sleep disturbances
  • Mood swings
  • Anxiety

For a diagnosis of dementia-related syndrome, symptoms must have persisted for at least six months (WHO ICD-10 criteria for dementia syndrome; aspect missing from ICD-10 German Modification, version 2018).

Types of dementia and their symptoms

Alzheimer-type dementia (DAT) (50-70-(80)%).

Symptoms and complaints

  • Begins unnoticed and then develops steadily over a period of many years (= continuum disease)
  • Memory impairment (here already the subjectively perceived memory deterioration / memory impairment).
  • Orientation disorders
  • Perseverations – linguistic pathological persistence with the same ideas, with the same thought content.
  • Aphasia (central language disorder after largely completed language development) – leading symptom: word-finding disorders (difficulty naming objects and the like).
  • Further see below Alzheimer’s disease / symptoms – complaints

Vascular dementia (VD; 15-25-(35) %).

Symptoms and complaints

  • Impairment of everyday activities such as attention, orientation, language, judgment, visuoconstruction (ability to recognize and reproduce complex shapes or patterns (in addition to letters, numbers and words, symbols, etc.)), ability to act and abstract, motor control, and praxia ( purposeful, purposive action).

Frontotemporal dementia (FTD; synonyms: Pick’s disease; Pick’s disease; about 10%).

Symptoms and complaints

  • Progressive dementia with onset in middle age (40-60 years of age).
  • Characterized by early, slowly progressive personality change and loss of social skills.
  • Disease is followed by impairment of intellect, memory and language functions with apathy, euphoria and occasionally extrapyramidal phenomena.
  • Complete disinhibition and inconsistency.
  • Dementia usually progresses far more rapidly in FTD than in Alzheimer’s-type dementia.

Dementia in primary Parkinson’s disease dementia (PDD) (<10%)Symptoms and complaints.

  • Dementia that develops during the course of Parkinson’s disease.
  • Impairment of attention (spontaneous/focused).
  • Decreased spontaneity
  • Loss of motivation and interest
  • Hallucinations and delusions

Lewy body type dementia (LBD) (0.5-15-(30)%).

Symptoms and complaints

  • Central feature of LKD is dementia associated with functional limitations in daily life.
  • Memory function is relatively well preserved at the onset of the disease.
  • Attention deficits, impairment of executive and visuoperceptive functions are common
  • Behavioral disturbances during sleep (talking, screaming).
  • Neuroleptic hypersensitivity

Note: This form often occurs with Parkinson’s disease.

Differentiation of dementia from mild cognitive impairment ( MCI)

  • The demarcation of dementia from mild cognitive impairment (“MCI”) is defined by the impairment of everyday functions by the cognitive or behavioral impairment. The assessment of impairment of daily living is a clinical assessment based on the individual patient constellation and on information provided by the patient and an informant.

Further notes

  • In one study, 578 people older than 90 years who did not yet have dementia underwent neuropsychiatric and neurologic examinations every six months: subjects who were
    • Performed poorly on the standing test were more likely to have dementia (HR = 1.9-2.5; p = 0.02)
    • Were slow on the four-meter walk test were equally likely to have increased dementia risk (HR = 1.1-1.8; p = 0.04)
  • Based on data from more than 2,000 subjects in the Framingham Offspring Study at a mean age of 62 years, increased dementia or Alzheimer’s risk was indicated by: one standard deviation reduction in gait speed
    • Dementia risk by + 76
    • Alzheimer’s dementia by + 68 %

    Handshake strength:

    • <10th percentile (for women ≤ 15 kg, for men ≤ 30 kg) → increase in dementia or Alzheimer’s disease risk by a factor of 2.2-3.2
  • Age-related hearing loss (ARHL):
    • Cognitive impairment (global perception, executive functions, episodic memory, word memory and spatial-visual perception, processing speed) and age-related hearing loss (ARHL, age-related hearing loss) were significantly associated; odds ratios were 2.0 and 1.22 (cross-sectional and cohort studies, respectively); similar was generally true for dementia (OR 2.42 and 1.28, respectively)

Differentiation in the elderly patient between dementia and depression

  • If an elderly patient refers to cognitive deficits by itself, it is often not dementia but depression.
  • Dementia patients tend to trivialize cognitive deficits more than depressives. Dementia patients try to pass over deficits or to conceal them.

Warning signs (red flags)

  • Anamnestic information:
    • Alcohol dependence
    • Depression
    • Traumatic brain injury (TBI)
  • Pronounced language problems before the age of 60 → think of: semantic dementia in Pick’s disease (synonyms: frontotemporal dementia (FTD), formerly also Pick’s disease); neurodegenerative disease usually occurring before the age of 60 in the frontal or temporal lobe of the brain with the consequence of increasing personality decline.
  • Rapid onset dementia (within 3-6 months) → think of:
    • Chemical toxins
    • Autoimmune encephalitides (especially anti-NMDA receptor encephalitis in young patients/ disease affecting almost exclusively girls and women, presenting a neuropsychiatric spectrum of symptoms (behavioral abnormality, psychosis, seizures, movement disorder); anti-GAD encephalitis)
  • Onset with psychiatric symptoms such as behavioral changes, impulsivity and indifference + later cognitive decline → think: frontotemporal dementia (FTD).