What To Do If You Notice A Sudden Worsening Of Dementia

According to Alzheimer’s Disease International (ADI), someone develops dementia approximately every three seconds. As of 2020, the ADI estimates that 55 million people are living with dementia worldwide. Many families monitor their loved one’s condition closely, particularly if they notice their symptoms are becoming more severe, as this could be a sign of rapidly progressive dementia (RPD) or delirium. A sudden worsening of dementia symptoms can indicate the need to contact a person’s care team. In many cases, loved ones of those with dementia, as well as those living with the condition, may find it helpful to speak to a therapist about how to effectively cope with the situation.

How does dementia progress?

The way dementia progresses can vary depending on its type. For example, the Alzheimer’s Association lists the three primary stages of Alzheimer’s as early, middle, and late. In medical contexts, these may also be referred to as mild, moderate, and severe levels of dementia. 

• Early-stage Alzheimer’s (Mild): Alzheimer’s disease can begin subtly, with symptoms sometimes going unnoticed by the individual experiencing them and their loved ones. A person may struggle to remember specific words or recall the names of acquaintances and familiar objects. It may also be difficult for an individual with mild Alzheimer’s to remember information they have recently learned or perform tasks they had no trouble previously completing. Additionally, those with mild Alzheimer’s may have problems with organization and planning. This, in combination with other symptoms, may make it difficult to function in social or work settings. 
• Middle-stage Alzheimer’s (Moderate): As Alzheimer’s progresses into its middle stage, an individual may experience a significant increase in symptoms. For example, an individual may start to become confused during conversations, become irritable or angry more frequently, or begin to struggle with self-care. Individuals experiencing moderate Alzheimer’s may find it difficult to remember personal information, such as their address, telephone number, or important events in their past. As symptoms worsen, a person may struggle with sleep disturbances, forget their current location or what day it is, and find it challenging to control their bowels and bladder. 
• Late-stage Alzheimer’s (Severe): In the final stages of Alzheimer’s, an individual may not be able to communicate, react to their environment, or control their movements. At this point, a person will likely require constant care, as they will typically be unable to complete tasks on their own. Individuals experiencing late-stage Alzheimer’s may not have the ability to walk, sit, or swallow, and they may become more vulnerable to infection. Even though these individuals may not be able to discuss their symptoms with others, they could benefit from interaction and a comfortable environment, as these factors may improve their overall well-being.

While some individuals experiencing dementia may follow a standard progression through these phases, this is not always the case. In some situations, dementia symptoms may suddenly increase in severity. 

What causes a sudden worsening of dementia? 

Even if an individual is responding to treatments, certain events or conditions may precipitate a sudden worsening of dementia symptoms. Two examples of these conditions are rapidly progressive dementia and delirium. 

Rapidly progressive dementia

When a person experiences rapidly progressive dementia (RPD), their symptoms may worsen at a fast pace. This type of dementia may quickly become more severe in as little as a few weeks or months, although in some cases, RPD may occur over several years. How quickly RPD progresses may depend on its underlying cause, which can vary. Some potential RPD causes include those listed below: 

In some cases, treating the underlying cause may stop or reverse the progression of RPD. However, in some situations, the progression of symptoms may be irreversible. 

Delirium

Delirium is a condition that may involve disorientation, confusion, difficulty communicating, memory challenges, behavior changes, and mood swings. These symptoms may be confused with those of dementia, potentially making it difficult for medical professionals to determine what is happening to a patient. In addition to dementia, there are a variety of risk factors that may increase a person’s chance of developing delirium, such as the following: 

• Hospitalization
• Lack of proper nutrition or hydration
• Infection
• Taking medications with significant mental side effects
• Metabolic disease

The onset of delirium can cause dementia symptoms to worsen rapidly. If the underlying cause of dementia is identifiable and treatable, it may be possible to reverse this progression. 

What to do if dementia symptoms worsen

To determine whether dementia symptoms are worsening, it can be important to look for certain signs. These signs may vary depending on their underlying cause. In many cases, an individual presents with the same symptoms as they had before, but with increasing severity. In other situations, new symptoms may occur. It may be helpful to keep track of which symptoms an individual is experiencing. This may make it easier to determine whether there have been any recent significant changes. 

How is dementia treated?

A variety of treatments may help those experiencing dementia. The UK National Health Service (NHS) lists several medications that may be beneficial for those with dementia, all of which must be prescribed by a licensed medical professional:

• Acetylcholinesterase inhibitors: Acetylcholinesterase inhibitors generally work by slowing the process of breaking down the neurotransmitter acetylcholine. By doing so, they may facilitate communication between nerve cells. 
• Memantine: Memantine is often prescribed to individuals with more severe forms of dementia, such as late-stage cases of Alzheimer’s disease or dementia with Lewy bodies. Memantine usually works by blocking the excessive production of glutamate, a chemical that carries messages between nerve cells in the brain. In some cases, memantine may be prescribed for those who cannot take acetylcholinesterase inhibitors, and it may induce side effects like dizziness, constipation, and headaches. 

The NHS also recommends several types of therapy or non-medication treatments, such as reminiscence and life story work, cognitive rehabilitation, and cognitive stimulation therapy. 

• Reminiscence therapy: Reminiscence therapy often works by stimulating an individual with visuals, sounds, or smells that may remind them of pleasant memories. For example, a therapist may play a person's favorite song, show them recordings of family events, or present them with a meal they enjoyed during their childhood. Research suggests that reminiscence therapy may have positive effects on a variety of outcomes, including quality of life, mood, communication, and cognition. 
• Cognitive rehabilitation therapy: Cognitive rehabilitation therapy may improve cognitive function in those with earlier stages of dementia. Sessions may focus on a variety of subjects, such as memory, attention span, and problem-solving skills. For those with dementia, it may be beneficial to try a form of cognitive rehabilitation therapy known as compensatory treatment. These treatments may help individuals learn how to live with their condition and work around the difficulties they are experiencing instead of trying to “fix” them. 
• Cognitive stimulation therapy: Cognitive stimulation therapy typically aims to address the social isolation common in those with dementia by offering stimulating group activities in which they can participate. CST sessions may be guided by a variety of professionals, including occupational therapists, speech-language pathologists, registered nurses, and social workers. Research suggests that CST may significantly improve cognitive functioning and quality of life while impacting language skills, such as overall comprehension, naming, and word-finding. 

Are you taking care of a loved one with dementia?

Get support from an online therapist

While therapy may benefit individuals living with dementia and their caretakers, in-person therapy may not be convenient or accessible to everyone. For some, finding the time to search for a specialist or schedule an appointment may be challenging. Others may struggle to find reliable transportation or prefer to use other types of communication, such as phone calls, video conferences, and online chat. In these situations, it may be beneficial to explore alternatives, such as online therapy.

Although more research on the efficacy of online therapy specifically for dementia may be needed, existing studies suggest that for many individuals, online therapy can be just as effective as in-person therapy. One 2022 study involving 931 patients and 12 separate trials looked to compare the efficacy of these types of therapy. Researchers found that there were no significant differences between therapy delivered online and in-person in a variety of categories, including symptom severity, working alliance, overall improvement, function, and client satisfaction.