About a decade ago, Ralph Carmona started forgetting things.
“My wife was the first to notice I was having problems with my memory,” says Carmona, 74, of Portland, Maine. “She would send me to the grocery store, and I would forget items I was supposed to get.”
Some forgetfulness as we age is normal, but Carmona’s condition kept progressing.
“At first I was in denial, but eventually, it was happening more and more to the point that I could no longer dismiss it,” he says. “I was also repeating myself in conversations.”
Carmona was diagnosed with mild cognitive impairment due to Alzheimer’s disease, a type of dementia.
“I admit, my reaction to the diagnosis was atypical: I wasn’t shocked. I wasn’t sad. More than anything, I was determined,” he says. “I wanted to learn more about Alzheimer’s and what I could do to fight it.”
A diagnosis of dementia can come with mixed emotions for both patients and caregivers: relief, sadness, shock and determination to maintain their quality of life.
“Often, it is scary, as it is a lot to process: How is this going to affect my life in the short run? What do I need to plan for the future?” says Steve Barlam, a social worker, certified care manager and president of the Aging Life Care Association.
Dementia has no cure, but there are treatments and lifestyle changes that can slow the progression of the disease and make it manageable for longer.
Let’s look at the different ways dementia can manifest and options for what patients and caregivers, along with their health care team, can do to manage it.
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What Is Dementia?
Dementia is a general term for a condition characterized by cognitive changes that are severe enough to interfere with a person’s ability to conduct their normal daily activities.
These changes in thinking, memory, language and problem-solving result when brain cells (called neurons) and their connections stop working well. Everyone loses some neurons as we age, but those with dementia lose many more.
Understanding dementia means separating the disease from normal changes in cognition that happen as we age. For example, a normal change would be not remembering the name of that actor you saw in a movie last week or the name of someone you met recently at a social event.
“Common aging-related cognitive changes, such as difficulty recalling a person’s name or finding a specific word during a conversation, can be bothersome or sometimes even embarrassing, but they generally do not have an impact on a person’s abilities to conduct their normal activities,” says Dr. Brendan Kelley, a neurologist at UT Southwestern Medical Center’s O’Donnell Brain Institute in Dallas. “Often, the word will come to the person’s mind a few minutes later.”
In contrast, more serious concerns should arise when a person doesn’t recognize a long-time family member or friend, or when they aren’t sure what day or time it is or where they are, Barlam says.
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Types of Dementia Diseases
Dementia is actually an umbrella term for several types of cognitive impairment. Although they cause similar symptoms, the various types of dementia come from different problems in the brain.
The common forms of dementia include:
— Alzheimer’s disease: This is the most common type of dementia in people older than age 60. It’s caused by accumulation of the proteins amyloid and tau in the brain, Kelley says.
— Lewy body dementia: This type is caused by abnormal deposits of the protein alpha-synuclein, which are called Lewy bodies and which often cause some unique symptoms, such as hallucinations and motor problems.
— Vascular dementia: Vascular dementia occurs when blood vessels in the brain are damaged, or the flow of blood and oxygen to the brain is interrupted.
— Frontotemporal dementia: This is a rare form that develops in people younger than 60, caused by buildup of the proteins tau and TDP-43.
— Mixed dementia: This occurs when multiple types of dementia are present.
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Dementia Symptoms and Stages
Cognitive decline in dementia is progressive, with more symptoms gradually appearing as the disease advances.
Although not everyone progresses at the same rate, dementia is generally divided into three main stages:
Early (“mild”) stage
Also called “mild,” the early stage is when signs of memory problems first appear in small ways — even though changes in the brain have been taking place for years.
“Mild changes may be overlooked or not attended to until they have reached a level where daily function is impacted,” Kelley says.
Some early memory problems that may warrant attention include:
— Difficulty remembering details from conversations
— Repeating yourself in conversion
— Repeating questions
— Difficulty keeping track of appointments
— Frequently misplacing personal effects
Middle stage
The middle is the longest stage, with the symptoms of dementia getting more pronounced, such as:
— Not being able to recall personal details, such as your phone number or the college you went to
— Mood swings and periods of being withdrawn
— Forgetting where you are or what day it is
— Behavior and personality changes
Late stage
During the most advanced stage, the ability to communicate becomes difficult.
“Over time, a person will gradually need help with more daily activities, and eventually, they will likely depend on others for help with fixing meals, hygiene and dressing,” Kelley says.
Symptoms at this stage include:
— Being unaware of what’s happening around you
— Being unable to carry on a conversation, but still may speak some words
— Become unable to control body movements, including walking, sitting and swallowing
Dementia Diagnosis and Treatment
If you or a loved one is concerned about memory or cognitive changes, your doctor can give you a quick cognitive screening test in the office to test your memory and record your symptoms.
Based on the results, the doctor may order these further assessments:
— Blood tests
— Brain scans, most commonly computed tomographic (CT) scans and magnetic resonance imaging (MRI) scans
— Functional brain scans, including functional MRI (fMRI) and positron emission tomography (PET)
— Spinal fluid tests
More detailed memory testing may also be conducted to better understand the degree and pattern of the patient’s cognitive change and to rule out other conditions — infection, nutrition imbalance, dehydration, anxiety, stress and depression — that may cause cognitive changes and mimic dementia.
Medical Treatments
Once there’s a diagnosis, treatment can begin, but not everyone will respond the same way. “Dementia affects people differently — what works with one person may not work with another,” Barlam says.
Dementia medications work in different ways:
— Medications that slow the progress of the disease. Approved by the Food and Drug Administration in 2024, the anti-amyloid immunotherapy drugs donanemab (brand name Kisunla) and lecanemab (brand name Liqembi) are given intravenously to reduce amyloid accumulation in the brain.
— Medications that aid memory and reduce cognitive symptoms. These medications don’t treat the underlying disease, but focus on reducing symptoms. They include:
— Cholinesterase inhibitors, which prevent a chemical messenger important in learning and memory called acetylcholine from breaking down. Brand names include Aricept, Exelon and Razadyne.
— Glutamate regulators, which control another chemical messenger called glutamate. The brand name is Namenda.
— Additional treatment for related conditions. For example, depending on your case, your doctor may give you sleep aids if you have insomnia or medication for depression.
Lifestyle Changes
Lifestyle modifications have some limited scientific backing for improving the symptoms and progression of dementia. A small 2024 randomized trial showed that lifestyle interventions in early-stage Alzheimer’s patients slowed progression of the disease, giving hope for the future.
Lifestyle modifications that may slow dementia include:
— Exercise, such as running, weightlifting and yoga
— Healthy eating, such as the MIND diet, which was specifically designed to improve brain health and lower the risk of mental decline
— Socialization, including dementia support groups
On the other hand, unhealthy lifestyles and conditions like diabetes, smoking and high blood pressure are linked with an increased risk of dementia.
“The effects of many chronic conditions accumulate as we age,” Kelley says.
Ralph Carmona credits his healthy lifestyle for helping to stave off the progression of his disease.
“I believe my commitment to exercise, healthy eating and staying socially active has helped slow — if not stop — the progression of my cognitive decline,” he says.
He follows a diet of vegetables, fruits, whole grains and lean proteins, and started swimming and running marathons.
“This April 21, I will be the only qualified runner among the 30,000 participants in the Boston Marathon who has been diagnosed with Alzheimer’s,” he says.
Caring for Someone With Dementia
Emotionally, caregiving for a loved one with dementia can be taxing.
Emily F. and her sister have been watching their mother’s dementia progress over the years. At first she struggled to learn the rules of a new board game, sent text messages that didn’t make sense and made Facebook comments unrelated to the posts. She also seemed withdrawn and uninterested in family members’ birthdays, new jobs and achievements.
While her mother’s dementia diagnosis at first brought a sense of peace — to have words for what she was experiencing, it’s now a great source of stress for Emily and her sister.
“Her dementia has reached the point where, nine times out of 10, the words she says simply don’t make sense or the meaning is impossible to discern,” Emily F. says of her mother. “The person I knew isn’t really there anymore, and I miss her so much.”
Although it’s hard to see her mother in this condition, Emily still finds bittersweet moments in the time they spend together.
She lives far from her parents but is able to provide caregiving duties, such as reviewing notes from doctor’s appointments, arranging home care and researching memory care facilities. Learn more about these facilities for seniors with U.S. News’s Best Memory Care ratings.
Early caregiver duties like these may also include:
— Making and taking your loved one to doctor’s appointments
— Taking notes and asking the doctor questions
— Making sure the patient follows the doctor’s recommendations
— Looking for appropriate clinical trials for new treatments
— Making dementia support and care plans that create a daily routine for your loved one
Later, caregiver tasks may progress to:
— Hiring in-home care or arranging for your loved one to move to a dementia care center
— Arranging home delivered meals
— Finding social day care programs
— Getting an ID bracelet in case the person with dementia gets lost
— Putting alarms on doors to alert the family if their loved one attempts to leave the house
Caregivers can hire an aging life care professional or geriatric care manager to take on many of these duties.
Communicating With a Person With Dementia
Caregivers may find themselves having to deal with their loved one’s increasingly difficult behavior. As a result, deescalation and distraction are the best courses of action.
“If someone with dementia is becoming increasingly agitated, it is important not to enter into an argument trying to prove to the person they’re mistaken,” Barlam says. Therapeutic lying can help a great deal here.
The goal is to deescalate the situation and help the person return to a calmer state. Distraction with certain types of activities allows the person to engage in a different way, such as suggesting to go on a walk together or have ice cream.
In general, when communicating with a loved one with dementia, Barlam says caregivers should:
— Use eye-to-eye level contact instead of standing over the person. This evens the playing field, and helps them feel more in control.
— Pay attention to your non-verbal cues. Don’t cross your arms, and a smile on your face helps.
— Talk calmly, and don’t snap or yell. The tone of voice is critical.
— Keep language simple or not overly complicated, which can add to their confusion.
— Don’t talk too quickly. Instead, slow down and pace yourself as you speak.
Living With Dementia
Dealing with changes in your own brain can be frustrating as well.
“At the beginning it tends to be about processing the diagnosis, figuring out how that will change the lives of everyone involved,” Barlam says.
He suggests that while you’re still in the early stage you should get your financial and legal affairs in order and select a durable power of attorney for finance and health care, who will take over decision-making when you can no longer manage. A geriatric care manager can help with these arrangements as well.
In addition, maintain your quality of life as best you can by doing the following:
— Eating a healthy diet. Eating a mostly plant-based diet and reducing your consumption of unhealthy fats may help protect your brain from further damage. In addition, eat foods with nutrients that improve brain health, such as the omega-3 fatty acids in salmon.
— Getting regular physical activity. Regular physical activity may help by increasing blood flow and oxygen to the brain, and strengthening the body can lessen the risk of falls. Exercise also reduces stress and can improve depression, which are both linked with dementia.
— Maintaining social Interaction. In addition to spending time with family and friends (either in person, phone or video chat), find social activities you enjoy. Carmona connected with others on the same health journey through his state’s Alzheimer’s Association chapter.
— Getting good sleep. Your brain needs sleep to function at its best. Stay active during the day so you’re tired at night, monitor your caffeine intake and do a calming activity — like reading or meditation — at the end of the day.
— Stimulating your brain. Although the scientific jury is out on whether brain games can actually slow the progress of dementia, they can help you stay engaged and learning, whether online, solo or in person, such as chess with a friend or a senior center group gathering to play mahjong. Barlam suggests these brain games websites and apps:
— Lumosity
— CogniFit
— Peak
Planning for what’s to come isn’t easy, but you can use the time you have now to live fully.
“I am living proof there is life after a diagnosis,” Carmona says.
“While a dementia diagnosis can be devastating, it also provides an opportunity to reset your priorities so you can live the best life possible,” he adds, “whether it is taking steps to slow progression or spending more time doing things you love to do.”
More from U.S. News
What Type of Doctor Treats Dementia and Cognitive Decline?
Rapidly Progressive Dementia: Reasons for a Sudden Worsening of Dementia Symptoms
A Patient’s Guide to Dementia originally appeared on usnews.com
Update 02/26/25: This story was published at an earlier date and has been updated with new information.
