Language – Comprehension and Expression

The way a person takes in information, how they process the information, the rate in which they process information and then how they respond to it changes. This can include difficulty finding the right words (word-finding difficulties), using incorrect words, repeating phrases, or struggling to understand what others are saying.

Memory and Orientation

A person might not remember yesterday but vividly recall something from decades ago. They may not remember the steps for doing something but can carry out tasks that are more habitual in nature. Individuals may become confused about the time of day, date, year, or their current location, even in familiar environments. They may believe they need to go “home” when they are already there.

Emotional Regulation and Reactions

Brain change can heighten sensitivity or dull filters. A person may struggle to recognize what is socially appropriate behavior and what is not. They may use language that had not routinely part of their vocabulary, such as curse words when they are frustrated.

Sensory Processing

Sights, sounds, and textures might feel overwhelming, distorted or very uncomfortable. A person may show a tendency toward seeking soothing sensory input by rubbing or feeling things with their hands. Nutritional intake can be challenging with an increased desire for sweet and salty. Improperly fitted hearing aids and glasses can be more irritating than helpful.

Decision-Making, Judgment and Planning

Changes in decision making, judgment and planning are the result of changes in the prefrontal cortex. This is the “command” center for executive functioning skills. These are the skills that help us to stay safe and anticipate consequences of our actions and generate solutions.

Fluctuations in Clarity and Confusion

Brain change doesn’t follow a straight path. There are times when confusion is high and times when a person appears crystal clear in their thinking skills. Sometimes we see patterns – “Mom wakes up in the morning and seems a little disoriented but as the day goes on she gets better. We almost wonder if she has dementia at all. Then by late afternoon, there is no doubt. She is a mess!” There are several possible explanations for these fluctuations but do note that they happen, and it may look different from one person to another.

Changes in Physical Ability

Early in dementia we see gross motor and fine motor coordination are pretty well preserved. It does however depend on the type of dementia and certainly other forms. As dementia progresses, we will see gross motor skills preserved longer and the loss of fine motor skills sooner. Think of gross motor as getting up from a chair, walking, dancing, running, reaching, bending, grasping. Fine motor skills look like tool use, writing, manipulating things with our fingers. In addition to the gross and fine motor changes, we also see changes in balance and energy levels.

Way Finding

While memory is often cited as the first noticed symptom of dementia, so is way finding. The most common report starts to get lost, when traveling a route that has been very familiar.