7 fasi della demenza: Tutto quello che c'è da sapere

As defined by The Centers for Disease Control and Prevention (CDC), dementia is ​"not a specific disease but is rather a general term for the impaired ability to remember, think, or make decisions that interfere with doing everyday activities.” There are a few different conditions that fall under this category, including Alzheimer’s disease.

While dementia is somewhat common (55 million people currently live with dementia worldwide, according to the World Health Organization), it’s not a normal part of aging. There isn’t currently a cure for types of dementia, and symptoms tend to worsen as the disease progresses. Dementia tends to occur in stages known as mild dementia, early-stage dementia, middle-stage dementia, late-stage dementia, and severe dementia.

There are a few different conditions that fall under the category of dementia—some more common than others.

Alzheimer’s Disease

Alzheimer’s disease is the most well-known and most common form of dementia and accounts for 60 to 80 percent of all dementia cases. It impacts memory, cognitive ability, and behavior.

Some symptoms of Alzheimer’s disease include:

• Difficoltà a ricordare nuove informazioni

• Perdita di memoria

• Perdita di memoria delle date o della posizione attuale

• Struggling to complete daily tasks

• Giudizio negativo

• Perdere gli oggetti o smarrirli ripetutamente

There is still much to learn about Alzheimer’s disease, but it is speculated that the cause has to do with unnatural protein buildup around brain cells.

Demenza a corpi di Lewy

La demenza a corpi di Lewy deriva da proteine che si raggruppano nella corteccia cerebrale. Sebbene la causa precisa sia sconosciuta, sappiamo che esiste un'associazione con la perdita di alcuni neuroni che producono importanti sostanze chimiche del cervello (una delle quali è legata alla memoria e all'apprendimento). La demenza a corpi di Lewy è un'altra forma comune di demenza.

I sintomi della demenza a corpi di Lewy comprendono:

• Allucinazioni visive

• Grave perdita del senno e declino cognitivo

• Difficoltà di equilibrio o di movimento

• Difficulty sleeping/​sleep disturbances

Demenza frontotemporale

Frontotemporal dementia (also referred to as frontotemporal disorders or FTD) results from damage to neurons in the frontal and temporal parts of the brain. The official cause is unknown, though genetics (those with a history of family members with FTD) accounts for 10–30% of cases.

I sintomi della FTD possono variare, ma possono includere:

• Problemi di pianificazione e risoluzione dei problemi

• Ripetizione costante delle stesse parole o azioni

• Difficoltà a parlare o a muoversi

• Cambiamenti comportamentali (disinteresse per le cose che si amavano un tempo, sbalzi d'umore, ecc.)

• Difficoltà a concentrarsi o a dare priorità ai compiti

Demenza vascolare

Vascular dementia occurs due to damage to blood vessels in the brain and results in changes to memory and behavior. There isn’t an official cause, though there have been some potential connections between those who have experienced strokes or who have cardiovascular disease.

I sintomi della demenza vascolare comprendono:

• Difficoltà a svolgere compiti che un tempo erano facili (pagare le bollette, ecc.).

• Perdita di memoria

• Spostamenti ripetuti di oggetti

• Difficoltà di lettura o scrittura

• Getting lost/​not knowing the current location

• Perdita di interesse per le persone o le attività

• Cambiamenti nella personalità o nel comportamento (sbalzi d'umore, rabbia, depressione, ansia, ecc.).

• Scarsa capacità di giudizio o incapacità di percepire situazioni pericolose

Parkinson’s Disease Dementia

Parkinson’s disease dementia is defined by the Alzheimer’s Association as ​"a decline in thinking and reasoning skills that develops in some people living with Parkinson’s at least a year after diagnosis.” Not all people who have Parkinson’s disease will have Parkinson’s dementia. The cause isn’t known, though brain changes resulting from Parkinson’s may play a role in its development.

Symptoms of Parkinson’s dementia may include:

• Allucinazioni visive

• Deliri (paranoia)

• Cambiamenti nella memoria e nella concentrazione

• Disturbi del sonno

• Cambiamenti nel comportamento (depressione, irritabilità, rabbia, ecc.)

• Muffled speech/​difficulty speaking

Fase 1: nessun declino cognitivo

In this stage, a person will likely not show any dementia symptoms. There is a possibility tests could reveal an issue.

This is often a time when loved ones can start the planning process with the person on how to proceed as the disease progresses.

Stadio 2: Declino cognitivo minimo

During the early stages of dementia, a person may only experience slight changes in behavior but will still be able to maintain independence.

Alcuni segnali includono:

• Difficulty finding the right words to use
• Difficoltà a fare progetti
• Piccoli problemi di memoria, come lo smarrimento di oggetti familiari

Fase 3: deterioramento cognitivo lieve

At this stage, it may become more apparent that the person has small changes in their reasoning/​thinking abilities. This is also the stage that loved ones may begin to notice issues.

Alcuni segnali includono:

• Not remembering plans made
• Fasi iniziali della perdita di memoria
• Struggling to keep track of dates or recent events/​conversations
• Maggiori difficoltà a rispettare gli appuntamenti, a gestire il denaro o i farmaci
• Leggera difficoltà di concentrazione

Stadio 4: Declino cognitivo moderato

Questa fase può introdurre cambiamenti più evidenti nelle capacità di ragionamento e di pensiero. Ricordano ancora la maggior parte del loro passato, ma possono avere più difficoltà con le situazioni quotidiane.

Alcuni segnali includono:

• Dimenticare dove sono gli oggetti più comuni, come il telefono o gli occhiali.
• Problemi con le attività di routine, come il bucato, la spesa o la cucina.
• Dimenticare gli eventi recenti
• Difficoltà di concentrazione
• Problemi di guida
• Disagio nello stare da soli in posti nuovi
• Struggling to complete or follow through with tasks

Stadio 5: Declino cognitivo moderatamente grave

This stage will show signs of more distinct memory loss and may notice a moderately severe decline in physical abilities.

Alcuni segnali includono:

• Not remembering certain family members’ names
• Not knowing the time or date
• Non sapere dove si trovano, il loro numero di telefono o indirizzo, ecc.
• Possono verificarsi cambiamenti di personalità o sbalzi d'umore più evidenti.
• Necessità di aiuto per svolgere funzioni come mangiare o andare in bagno

Stadio 6: Declino cognitivo grave

This stage will include severe memory loss, such as forgetting a spouse’s name or not recognizing them. This stage will require constant care, either from a family member or a healthcare provider.

Alcuni segnali includono:

• Incapacità di svolgere compiti come lavarsi, andare in bagno o mangiare senza assistenza.
• Forgetting major events from the past
• Cambiamenti di personalità e di comportamento
• Deliri e compulsioni
• Difficoltà a parlare o comunicare
• Può verificarsi una perdita di controllo della vescica

Stadio 7: Declino cognitivo molto grave

In questa fase, definita anche demenza tardiva, è probabile che la persona non comunichi o non risponda molto.

Oltre agli stadi precedenti, alcuni segnali includono:

• Perdita delle capacità motorie
• Incapacità di parlare o comunicare
• Unable to walk, may require a wheelchair
• Richiede assistenza per la maggior parte delle attività

Dementia is often labeled a ​"progressive disease” meaning that symptoms will continue to develop and worsen with time. However, the specific timeline of how quickly dementia progresses will depend on a few factors, including:

• Tipo di demenza: certain types of dementia, such as Alzheimer’s disease, tend to progress slower than others.

• Età: contrary to popular belief, an older adult diagnosed with dementia will likely have a slower development of symptoms than a younger (under 65) adult.

• Altre condizioni mediche: if a person has other medical conditions, such as heart disease, it could increase the progression of dementia symptoms.

A person diagnosed with dementia will likely live for years with the condition. The length of time a person lives with dementia depends on factors such as age, other health conditions, and the type of dementia. The general life expectancy for certain types of dementia is as follows:

• Alzheimer’s disease: 8–10 years (though some have reported living 15–20 years)

• Demenza a corpi di Lewy: about 6 years

• Demenza vascolare: about 5 years

• Demenza frontotemporale: about 6–8 years

Given that noticeable dementia symptoms typically do not appear until a few stages in, it can be difficult to determine when to see a healthcare provider. Some indicators may include:

• If the person has a family history of dementia: despite not having noticeable symptoms, a person may choose to see a healthcare provider if there is a family history. Tests may be able to pick up on early stages and can allow some time to prepare and discuss how to approach later stages as dementia progresses.

• If a person starts experiencing consistent forgetfulness or personality changes: while early symptoms may be difficult to distinguish from typical aging, a person may want to see a healthcare provider if they experience forgetfulness more than usual, or if family members begin to sense a noticeable difference in their behavior or cognitive skills.

• If a primary care provider (PCP) suggests seeing a specialist: typically, seeing a primary care provider is the first step in behavioral changes. However, if your PCP recommends consulting a specialist, such as a neurologist or a geriatrician, this is the next step to determining a dementia diagnosis.

There isn’t an official test to diagnose dementia, especially since ​"dementia” is a broad term that groups a variety of different diseases. Some tests can be run to help determine if dementia is present such as:

• Test cognitivi: a PCP may test memory, cognitive skills, language skills, and other aspects to determine the stage of a person’s dementia (if present).

• Scansioni cerebrali: scans such as a CT or MRI (that can determine evidence of stroke or bleeding in the brain) or a PET scan (which can determine if certain proteins have been deposited in the brain) can potentially help diagnose dementia.

• Laboratory tests: some blood tests may be able to indicate if symptoms are a result of another issue, such as low vitamin deficiency or issues with the thyroid gland. This can determine whether to continue with a dementia diagnosis.

Nota: Specifically relating to Alzheimer’s disease, certain biomarkers exist to give a more accurate diagnosis.

There currently isn’t a cure for dementia, so treatment often focuses on managing dementia symptoms which can vary from patient to patient as the causes of dementia depend on the type of dementia one has.

Farmaci

Alcuni farmaci spesso utilizzati per trattare i sintomi includono:

• Inibitori della colinesterasi: such as donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) work to help improve memory and judgment by boosting levels of a chemical messenger in the brain.

• Memantina (Namenda): questo farmaco agisce sulla regolazione dell'attività del glutammato, un altro messaggero chimico del cervello che favorisce la memoria e l'apprendimento.

• Altri farmaci: possono essere prescritti altri farmaci per combattere altri sintomi, tra cui depressione, ansia, disturbi del sonno e altri.

Terapie

Many dementia symptoms may be approached with therapies that don’t include medication, such as:

• Terapia occupazionale: An occupational therapist can teach coping behaviors and offer advice on how to make the home a safer place. This can help prevent accidents as well as prepare as dementia progression continues.

• Modificare e semplificare l'ambiente: options here may include reducing clutter or hiding unsafe objects in a person with dementia’s home. This can help prevent accidents as well as allow the person to focus better without becoming too distracted. Monitoring systems can also be advised, as they can alert if the person with dementia wanders.

• Semplificare i compiti: This will likely include breaking down basic tasks to make them easier, as well as creating a consistent routine to reduce confusion for the person with dementia.

Once a person is diagnosed with dementia, it’s important to determine what type of care is needed and can be provided.

Prendere decisioni mediche

Due to the impact on memory loss and reasoning skills, especially for a person diagnosed with moderate to late-stage dementia, a caregiver needs to be able to make informed medical decisions on the person’s behalf. Some things to keep in mind include:

• Setting up a dementia/end-of-life plan: if dementia is caught early on, or if there is a family history of dementia, putting together a document or plan laying out the person’s wishes can be an invaluable asset down the line.

• Includere la qualità della vita nel processo decisionale: while dementia has no cure, certain medications and treatments may delay or relieve symptoms for a period of time. Weighing the pros and cons of these treatments and how they will benefit/​affect the person is worth considering.

• Considerando tutti gli aspetti: it’s important to assess all benefits, side-effects, and risks associated with end-of-life dementia care. It may be more important to prioritize a person’s comfort over extending their life span, depending on the circumstances.

Come i caregiver possono fornire supporto

Trying to determine the best way to care for a loved one with dementia, especially in stages with severe memory loss, can seem difficult. Some ways a caregiver can provide support include:

• Engaging a person’s senses: while this may vary from person to person, it can be calming and beneficial to target the senses with familiar comforts, such as playing music they’ve enjoyed, calming scents, or giving a massage (if they are comfortable with being touched) can all be great ways to bring comfort.

• Essere presenti: for some, just having a person present can be comforting and reassuring.

• Ottenere raccomandazioni dall'assistenza in hospice: whether or not you ever choose to use hospice care, speaking with workers can provide suggestions on how best to care for a late-stage dementia patient.