When Memories Fade: Understanding and Supporting Dementia

Dementia is far more than just 'forgetfulness in old age.' The term (Latin de mens – 'away from the mind') refers to a disease that arises from damage in the brain. Depending on which areas are affected, different symptoms can occur. These range from impairments in memory and learning to problems with orientation, attention, and judgment to disturbances in planning actions (executive functions). Language, motor skills, and the ability for social interaction and empathy (social cognition) can also be significantly impaired.

Currently, around 1.8 million people in Germany are directly affected by a demential disease – a number that could rise to 2.7 million by 2050, according to estimates. World Alzheimer's Day, held every September, highlights the great societal importance of this disease. It is all the more important to be informed about causes, forms, and symptoms and to know ways in which affected individuals and their families can be supported.

Dementia = Alzheimer? What types of dementia are there?

Not every dementia is synonymous with Alzheimer's. Different causes lead to different forms. Basically, a distinction is made between primary and secondary dementias.

• Primary dementias account for about 90% of all cases. They are primarily based on neurodegenerative processes or vascular damage. Examples include Alzheimer's, frontotemporal dementia, and Parkinson's dementia. Primary dementias are, according to current knowledge, incurable.
• Secondary dementias arise as a result of other diseases or conditions, such as metabolic disorders, vitamin deficiencies, or chronic poisoning. Since the underlying disease may be treatable, there is a possibility of the symptoms regressing with early diagnosis.

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Alzheimer's dementia

Alzheimer's disease, first described by Alois Alzheimer in 1906, is the most common form of dementia, accounting for about 60–65%. The cerebral cortex and hippocampus, which control central functions such as thinking, memory, language, and orientation, are primarily affected.

Young dementia

Even though the risk of developing dementia increases with age, younger people can also be affected. In Germany, according to the German Alzheimer Society (as of December 2021), about 103,000 people between the ages of 40 and 65 are affected.

The special challenge: Those affected are often still working, have children or parents in need of care, and therefore require different support services than older patients.

The most common causes of a young form of dementia are Alzheimer's and frontotemporal dementia. In rare cases, Alzheimer's is genetically determined. If one parent has one of the known genetic mutations, the risk of the child developing the disease is 50%. A genetic test can provide clarity.

Signs of dementia

Dementia is often equated with forgetfulness in public perception. However, the picture of the disease is much more complex. In addition to memory gaps, changes in personality, behavior, and social relationships can also occur. For those affected, these symptoms are often associated with shame, as they realize that everyday skills are diminishing and familiar routines are becoming difficult. The signs are also often distressing for relatives, as they see a loved one lose independence and sometimes even their personality.

Typical signs of dementia include:

• Memory disorders, such as forgetting recently said things or appointments.
• Difficulty following conversations, especially when multiple people are speaking or there are distractions.
• Problems with orientation in time and space, such as confusion about the day of the week or uncertainty in familiar places.
• Social withdrawal, both from professional and personal contacts.
• Problems keeping track of things, such as finances, medication, or more complex tasks.
• Changes in mood and behavior, ranging from irritability to anxiety to apathy.
• Limitations in spatial perception, making it harder for those affected to judge distances or obstacles.
• Frequently misplacing items, sometimes accompanied by suspicions that others have taken them.
• Declining judgment, such as in financial decisions or everyday risks.
• Difficulties in everyday life, even with activities that were once taken for granted, such as cooking, shopping, or operating devices.

These signs usually appear gradually and intensify over time. Especially in the early stages, they are not always clear, which can lead to those affected concealing or downplaying their difficulties—out of insecurity, but also out of fear of stigmatization. Relatives, in turn, face the challenge of showing patience and understanding while also initiating early medical clarification to receive appropriate support and relief.

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Therapeutic measures for dementia

Despite increasingly promising approaches, a cure for dementia is not yet possible. The primary goal of any therapy is therefore to maintain the independence of those affected for as long as possible and to improve the quality of life for patients and relatives.

In general, a distinction is made between drug-based and non-drug-based measures:

1. Drug-based therapies: Antidementia drugs can stabilize brain performance and alleviate symptoms. Additionally, antidepressants or antipsychotics can be used to treat lack of drive, behavioral abnormalities, or perception disorders.
2. Non-drug-based therapies: This includes psychotherapeutic and physiotherapeutic procedures as well as creative approaches such as art or music therapy. These methods help to promote quality of life and well-being. In practice, various measures are often combined and individually adapted to the form of dementia and the stage of the disease.

Preventing dementia - is it possible?

Even if dementia cannot be safely prevented, there are factors that can lower the risk or positively influence the course of the disease:

• Regular physical activity promotes blood circulation in the brain and has a positive effect on memory and concentration.
• Mental activities such as reading, learning, puzzling, or making music strengthen cognitive reserves.
• A healthy diet, especially a Mediterranean diet with plenty of vegetables, fruits, fish, olive oil, and nuts, has a protective effect on the heart and brain.
• Social contacts and active participation in social life reduce the risk of loneliness and support mental health.
• Avoiding risk factors such as high blood pressure, diabetes, smoking, or excessive alcohol consumption reduces the likelihood of vascular dementia.
• Good sleep is important for brain recovery and memory processing.

Prevention not only means reducing the risk of illness but also building resources that can positively influence the course in case of a diagnosis.

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Contact points and resources

At the first signs, the family doctor's practice should be visited to carry out basic diagnostics and consider possible pre-existing conditions or family risk factors.

In addition, the German Alzheimer Society provides comprehensive information, checklists, tips, and self-help offers. Regional Alzheimer societies also represent important local contact points.

Those who want to get involved will find numerous opportunities, such as companionship services in everyday life or through the Dementia Partner initiative, which offers training in dealing with affected individuals—both locally and online.

According to forecasts, up to 2.7 million people in Germany could be affected by dementia by 2050. Since the disease is often not immediately recognizable, it is all the more important for both relatives and outsiders to inform themselves and learn a respectful, understanding approach to those affected. Only in this way can an environment be created that provides support for people with dementia and their families and sustainably enhances their quality of life.