Clinical manifestations of cognitive impairment

The initial phase of the disease can last about two years and it usually shows failures in recent memory, lack of interest, depressed mood, changes in personality, mild episodes of disorientation and lack of adaptation to new situations. In this phase it is difficult to diagnose dementia, since in many cases these symptoms are attributed to the expected effect of aging. In this phase, difficulties begin to appear in carrying out the instrumental activities of daily life (handling money, cooking, using public transportation, etc.).

The intermediate phase can develop for 3-5 years. The memory loss is more important and affects not only recent memory but also remote memory. Language, writing, reading and calculating disorders appear, common actions and activities are unlearned (apraxias) and previously familiar people, places and objects are forgotten (agnosias). The patient shows difficulty with grooming, dressing, or eating. Psychotic symptoms may appear (aberrant thoughts, fantasies, hallucinations). In this phase, the patient has difficulties in maintaining social relationships and is unable to hold a discussion about a problem. The loss of the ability to carry out the basic activities of daily life begins.

In the terminal phase (severe dementia) the patient is unable to walk, becomes immobilized, urinary and fecal incontinence appears and cannot perform any activity of daily life, with high dependence for each and every one of these activities. The language becomes unintelligible or mute. Dysphagia can occur and there are risks of choking, pneumonia, dehydration, malnutrition, and pressure ulcers. Patients can remain in bed and often die of pneumonia or other intercurrent infection.

Depending on the type of dementia, the clinic will have a more abrupt or progressive onset and areas of language, motor skills (praxis), memory or behavior control will be affected earlier.

There are some symptoms that can lead to suspect the presence of initial dementia and for which it is advisable to consult a family doctor or neurologist. These are:

• Memory losses that affect normal life, such as appointments, names, phone numbers, repeating the same questions, forgetting the bills you have paid.
• Difficulties in performing common tasks: forgetting the ingredients of meals, handling money and bank accounts, use of the telephone, control of medications, use of normal means of transport.
• Language problems: difficulty remembering the name of some things, substituting some words for others, inventing nonsense words.
• Disorientation in time and place: forgetting dates, getting lost in familiar streets or places, having trouble driving.
• Poor judgment: abnormal behaviors, inappropriate clothing, for example going outside in winter without a coat.
• Abstract thinking problems: forgetting the meaning of money, problems interpreting similarities or sayings.
• Losing important things or putting them in the wrong places: keys in the fridge, changing money around (and blaming third parties).
• Frequent and unexpected changes in mood and behavior: sadness, aggressiveness, inappropriate social behavior, easy crying or laughing at inappropriate times.
• Recent personality changes, suspicion, fear.
• Loss of initiative in work and daily life with passivity and need for constant stimulation. It is difficult for you to give your opinion, make decisions, organize activities or face new situations. He wears the same clothes every day. Interest in previous hobbies diminishes.