Dementia (Alzheimer’s Disease): Early Signs, Symptoms, and Prevention Strategies

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Causes and Types of Dementia

The causes of dementia can be broadly categorized into two main types⁽²⁾:

Neurodegenerative Causes of Dementia:

• Alzheimer’s Disease: Discovered in 1906 by German physician Alois Alzheimer, it is the most common form of dementia, accounting for over 60%. It primarily affects the hippocampus in the early stages, leading to symptoms of recent memory loss.
• Lewy Body Dementia: The third most common dementia, characterized by visual hallucinations, fluctuating attention, consciousness, and subsequent spontaneous Parkinsonism. Symptoms include stiffness, tremors, unsteady gait, and unexplained falls, with memory impairment not necessarily prominent in the early stages.
• Frontotemporal Dementia: Involving the frontal and temporal lobes, it manifests early with personality changes or language disorders and often exhibits irrational behavior. It is more common after the age of fifty.
• Dementia due to Parkinson’s or Huntington’s Disease, among others.

Vascular Causes of Dementia:
Accounting for approximately 10-15%, it is the second most common form of dementia and is associated with stroke or brain vascular damage. Cognitive function gradually declines within months after a stroke, and many cases have associated local neurological symptoms.

In addition to these two main categories, other diseases can indirectly lead to dementia, such as Acquired Immunodeficiency Syndrome (AIDS), head trauma, alcohol or substance abuse, chronic brain tumors, hypothyroidism, radiation therapy, carbon monoxide or heavy metal poisoning, syphilis, Kuru disease, or deficiencies in vitamin B12 or folic acid. The incidence of secondary dementia is relatively low, making it essential to identify the reversible causes or coexisting factors contributing to cognitive decline early on for appropriate treatment⁽²⁾.

 

Dementia vs. Forgetfulness

Memory decline is a natural part of aging, and the table below helps distinguish between normal age-related forgetfulness and cognitive impairment leading to dementia⁽³⁾:

	Normal Aging	Dementia
Activities of Daily Living	Independent	Requires Assistance
Awareness of the Condition	Conscious awareness of memory decline	May have early awareness, often lacks insight
Recall Ability	Can remember after a period or with reminders	Difficulty recalling even with reminders
Perception of Forgetfulness	Patients may be more concerned than family	Family more concerned than patients
Short-Term Memory	Less likely to forget in the short term	Easily forgets in the short term
Speech Coherence	Occasional word-finding difficulties	Speech interruptions or substitution of words
Sense of Direction	Less likely to get lost in familiar surroundings	May get lost even in familiar surroundings
Use of New Tools	Retains learning and operational ability	Gradual loss of learning and operational ability
Social Skills	No significant decline	Loss of interest in participation or inappropriate behavior
Cognitive Function Test	Normal	Abnormal

Risk Factors for Dementia

Age is the primary and most significant risk factor for all forms of dementia. For example, Alzheimer’s disease affects approximately 5-10% of the 65-year-old population, and in the 85-year-old population, the incidence of Alzheimer’s disease can be as high as 50%. Other non-modifiable risk factors include being female, ethnicity (Black, Hispanic), and genetic factors⁽³⁾.

However, there are also many modifiable risk factors⁽³⁾:

• Hypertension: The risk of Alzheimer’s disease is five times higher in untreated individuals with a systolic blood pressure >160 mmHg compared to those with normal blood pressure.
• High Blood Sugar
• Obesity: Individuals with obesity (BMI ≥30) in midlife have a threefold increase in the relative risk of developing Alzheimer’s disease, while overweight individuals (BMI 25-30) have a two-fold increase.
• Lack of Physical and Social Activity
• Imbalanced Nutrition

 

Symptoms of Dementia

Dementia is a slow, degenerative disease that progresses from mild symptoms in the early stage to moderate, severe, and end-stage symptoms. The duration of disease progression varies individually.

Based on the development of dementia, behavioral symptoms that may occur are divided into three stages⁽⁴⁾:

	Early Stage	Intermediate Stage	Late Stage
Severity	Mild symptoms often overlooked, delaying medical attention	Continued decline in daily living skills, difficulty handling life affairs	Almost entirely dependent on others for care
Forgetfulness	Often forgets item locations, spoken words, time; difficulty remembering recent events	Progressive memory decline, such as forgetting to eat or bathe Repetitive questioning Difficulty recognizing people, environment, time	Forgetting familiar people and things Forgetting important life events Not remembering one’s own identity
Misidentification	More likely in low light conditions	Unable to distinguish morning or evening, seasons Believing family members are impostors Thinking the current environment is not their home	Loss of reality perception, believing TV content is real Talking to oneself in the mirror or reflections
Emotions	Large fluctuations, may get angry due to not finding things	Sudden appearance of agitated behavior	Difficulty expressing emotions
Personality	Indecisive, suspicious, timid, isolated, irritable	More prone to anger, frequent conflicts with family or caregivers	More dependent, less expressive personality
Speech	Difficulty expressing thoughts Difficulty recalling what to say	Reduced speech, poor content, incoherent Gradual loss of reading and language abilities	Almost no speech or only repetitive fixed phrases Unable to engage with others
Getting Lost	May get lost in unfamiliar places	May get lost even in familiar places	Almost unable to go out independently
Sleep	Day-night reversal, nocturnal activities	May stay awake all night, daytime drowsiness	Disrupted daytime rhythm, longer daytime sleep
Movement	Reluctance to go out, loss of interest	Unable to reach the destination smoothly, even within the house	Difficulty walking, wheelchair assistance needed
Eating	May claim not to have eaten even after eating	Repetition of wanting to eat becomes more severe	May have difficulty swallowing
Hygiene	Inappropriate clothing choices	Assistance needed for toileting	Loss of bowel and bladder control

 

Preventing Dementia

As there is currently no effective medication to cure dementia, preventing it has become a major concern for everyone.

Similar to what was mentioned earlier, there are numerous risk factors for dementia that we can strive to change in order to prevent or delay its onset.

Exercise
Regular physical activity benefits brain health. Large-scale studies indicate that individuals who engage in frequent exercise have a relatively lower incidence of cognitive impairment, vascular dementia, and Alzheimer’s disease⁽⁵⁾. Moreover, with increased exercise intensity and frequency, there is a better preventive effect⁽⁶⁾. Exercise also has positive effects on risk factors such as hypertension, high blood sugar, and high cholesterol, contributing to the prevention of vascular dementia. The World Health Organization provides exercise recommendations for individuals aged 65 and above, including:

• At least 150 minutes of moderate aerobic exercise per week or 75 minutes of vigorous aerobic exercise⁽¹⁾.
• Aerobic exercise for at least 10 minutes per session.
• Strength training at least two days per week.

Diet
The Mediterranean diet is beneficial for maintaining cognitive function. Integrated analysis studies show that individuals who adhere to the Mediterranean diet over the long term have a lower risk of mild cognitive impairment and Alzheimer’s disease⁽⁷⁾. Additionally, adopting the Mediterranean diet is associated with better memory and overall cognitive abilities in healthy individuals⁽⁸⁾. WHO’s dietary recommendations include⁽¹⁾:

• Increased consumption of fruits, vegetables, legumes, nuts, and whole grains.
• Daily intake of at least 400 grams (about five servings) of fruits and vegetables.
• Limited daily calorie intake, with refined sugars constituting no more than 10% of total calories, approximately equivalent to 50 grams of sugar.
• Limited daily calorie intake, with fats constituting no more than 30% of total calories, with a preference for unsaturated fats such as those found in fish, avocados, nuts, and plant oils.
• Daily salt intake below 5 grams.

Supplementation
Scientific evidence supports the benefits of certain nutrients for dementia:

• Omega-3 Fatty Acids – Fish rich in long-chain polyunsaturated fatty acids has preventive or therapeutic effects on cognitive decline. A meta-analysis of clinical trials conducted over 8 years found that long-term use of DHA, EPA, or a combination of both in fish oil supplements showed about 70% of trials exhibiting positive effects on cognitive functions such as working memory, executive function, recent memory, and language⁽⁹⁾.
• Folate – Folate is essential for the development of the central nervous system. Inadequate folate during early pregnancy may lead to congenital neural defects. In adults, folate deficiency is associated with elevated homocysteine levels in the blood, which is linked to arterial diseases, dementia, Alzheimer’s disease, and cognitive decline⁽¹⁰⁾. The recommended daily intake of folate for adults is approximately 400 micrograms (μg).
• Vitamin B12 – Deficiency can cause anemia and nerve damage. Adequate supplementation of vitamin B12 helps lower homocysteine levels and may slow down the decline in cognitive abilities in Alzheimer’s or dementia patients⁽¹¹⁾. The recommended daily intake of vitamin B12 for healthy adults is around 2.4 micrograms.
• Phosphatidylcholine – Studies suggest that the memory and cognitive decline in dementia patients are closely related to a decrease in nerve cells secreting acetylcholine. Phosphatidylcholine, a major dietary source of choline, may help slow down the progression of dementia⁽¹²⁾.

 

Caring for Dementia Patients⁽²⁾

Dementia patients may become indifferent, reticent, excessively defensive, or overly dependent in an attempt to conceal memory loss, thinking, and language difficulties. These behaviors can be exhausting and difficult for caregivers to understand, leading to emotional reactions. When interacting and communicating with dementia patients, here are some suggested approaches to try:

• Do not treat the patient like a child. Inquire about their needs and involve them in decision-making to a certain extent.
• Sincerely understand and accept the true meaning or emotions the patient is trying to convey.
• Show empathy by imagining how it would feel to have dementia symptoms one day and what concerns would arise.
• Use a gentle and calm tone, employ concise and clear instructions, and observe the patient’s gestures, facial expressions, and emotional responses, which can often facilitate effective communication.

 

Government and Medical Resources for Family Support⁽²⁾

Caregivers of dementia patients can make good use of the caregiving service resources established by the Ministry of Health and Welfare, including:

• Family Caregiver Service Hotline 0800-50-7272 (“You’re really good”)
• Dementia Care Hotline 0800-474-580 (“I’ll help you when you have dementia”)
• Long-term Care Hotline 02-412-8080

In addition, the Ministry of Health and Welfare provides the following services for dementia patients:

• Daycare service units
• Dementia community service points
• Institutional accommodation services with a dedicated area for dementia
• Group homes specifically providing services for dementia elders
• Rui Zhi Social Welfare Foundation

For more information, you can call the aforementioned phone service hotlines or check the Taiwan Alzheimer’s Disease Association’s resource website: http://www.tada2002.org.tw/About/About/3

 

Whether in the role of a patient or caregiver, dementia is a frustrating and disheartening disease. As society ages, aging bodies and cognitive decline will become increasingly prevalent. By gaining a deeper understanding of dementia and implementing preventive measures, we can delay its onset. For caregivers, both the government and various organizations offer abundant social resources for assistance. You are not alone; proactively seek advice and explore organizations and resources related to dementia. There are people who will share their experiences and help shoulder the burdens of caregivers.