Dementia: What it is, when you should become concerned, and how you can help others

A senior geriatric psychiatrist and neurophysician explains.

Dementia is a clinical syndrome caused by a range of diseases or injuries to the brain. Worldwide, 47.5 million people have dementia. Given the dramatic growth of the population of older people, the number of people living with dementia worldwide is expected to double every 20 years, going up to 135.5 million by 2050. According to a 2020 report published by the Alzheimer’s and Related Disorders Society of India, there are around 5 million people in India living with dementia.

Anant (name changed), an 80-year-old retired district judge, came to our institute with increasing forgetfulness for 18 months. He would misplace commonly used items such as keys, his mobile phone and pens. He would then keep searching for these items. He had also started to lose his way in and around his house. He would be frequently found in his neighbourhood trying to find his bearings. (His son then made him wear a GPS armband.) His social engagements had shrunk, as had his vocabulary. He also had wild mood swings and had become more irritable and aggressive over time.

After he became paranoid and started to think his family members were “out to get him”, they consulted me. The provisional diagnosis was Alzheimer’s disease with behavioural and psychological symptoms of dementia.

Clinical presentation

The most common cause of dementia is Alzheimer’s disease. It is implicated in up to 70% of dementia diagnoses. The tragic combination of symptoms in Alzheimer’s has a profound and resource-intensive impact on patients, family, friends, and carers.

Early symptoms include absent-mindedness, difficulty recalling names and words, difficulty retaining new information, disorientation in unfamiliar surroundings, and reduced social engagement. More atypical symptoms include impairment in recognising visually presented objects (visual agnosia) despite a normal visual field, acuity and colour vision. Some might also experience word-finding difficulties (anomic aphasia).

As the disease progresses, there is marked memory loss and loss of other cognitive skills, including a reduced vocabulary and less complex speech patterns. This may be accompanied by mood swings, apathy, a decline in social skills, and the emergence of psychotic phenomena. Advanced disease is characterised by monosyllabic speech, psychotic symptoms, behavioural disturbance, loss of bladder and bowel control, and reduced mobility.