Dementia Is a Syndrome of Brain Dysfunction Symptoms
A concise guide to understanding what dementia is, why it occurs, its causes, and practical interaction tips for each of the 10 common dementia symptoms — based on ALZI and RUKUN Dementia Support standards.
Caregiver and senior resident interacting at RUKUN Senior Living dementia care facility
Dementia Is a Syndrome of Brain Dysfunction Symptoms
Limited knowledge and misunderstanding about dementia are among the primary reasons why a negative stigma has formed around people with dementia.
When we first notice that something has "changed" in the behaviour or habits of a family member, we may not think too much of it at first. A quiet voice in the mind says, "maybe Mum is just tired today, so she's a little moody," or "Dad must have been in a rush, so he forgot where he put his wallet." But over time, these behavioural changes may begin to happen more frequently — until at some point they become a "new normal." When we come to recognise this reality, there is a possibility that our family member has already begun to experience the concerning condition of dementia.
This guide aims to provide a concise overview for the general public so they can understand what dementia means, some of its common symptoms, and tips for interacting with a person with dementia.
What Is Dementia?
Dementia is a syndrome — that is, a collection of interrelated symptoms that occur together. In the case of dementia, the symptoms that arise are caused by brain dysfunction that affects a person's cognitive functioning. With dementia, the ability to think, remember, and reason begins to diminish. Limitations in capability and changes in behaviour also begin to emerge in ways that interfere with the daily life and activities of the person with dementia.
Cognitive functions include memory, language ability, visual perception, problem-solving, self-regulation, and the ability to focus and pay attention. Some people with dementia cannot control their emotions, and their personality may change.
Dementia is a spectrum condition, generally defined across seven stages. Stage one represents a point at which problems are not yet detectable, while stage seven is when the person with dementia must depend entirely on others for assistance with the basic activities of daily life — such as personal care, dressing, eating, drinking, and others.
Why Does Dementia Occur?
Dementia occurs when healthy neurons (nerve cells) in the brain stop functioning, lose their connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience a far greater degree of neuronal loss than the general population. It is important to emphasise that the onset of dementia is not a normal part of the ageing process. Many people live into their 90s and beyond without any signs of dementia. Indeed, one type of dementia — caused by disruption to the frontotemporal region of the brain — is more common in middle-aged individuals than in older people.
What Causes Dementia?
Dementia can be caused by several things, depending on the type of brain and neurological changes that occur. The most common disease causing dementia is Alzheimer's disease, which accounts for 50–75% of all dementia cases. Alzheimer's is a disease that attacks the brain directly through the formation of abnormal protein deposits throughout the brain, causing healthy neurons to stop functioning, lose their connections with other neurons, and ultimately die.
Beyond Alzheimer's, a range of other factors can also lead to brain dysfunction — including other brain diseases such as Lewy Body disease and frontotemporal dementia, as well as vascular dementia — a condition caused by disruption to blood flow to the brain. This disruption can result from several conditions, including heart disease, high blood pressure, diabetes, and high cholesterol. Beyond disease, brain dysfunction can also arise from other causes such as poisoning, hereditary factors, or psychological pressures such as depression.
The human brain is an extraordinarily complex organ that performs critically important functions. Dysfunction in the brain therefore has a significant impact on a person's capabilities, behaviour, and personality. Each part of the brain has its own function, and the problems that arise in a person with dementia can therefore vary depending on which region of the brain is affected. For example, the Frontal Lobe controls important cognitive functions such as emotional regulation, reasoning, personality, and decision-making. The Occipital Lobe, by contrast, is responsible for visual processing through the eyes — interpreting colour, light, and movement.
Although there are several possible causes of dementia, and because no medical cure is yet available, all types of dementia share the following four characteristics:
- At least two regions of the brain are affected, one of which includes memory function.
- It is chronic — persisting for an extended duration or with continuously recurring symptoms.
- It is progressive — the condition worsens gradually over time.
- It is terminal — the condition of dementia will ultimately end with the death of the person living with it.
Common Dementia Symptoms and Tips for Responding to Each
Based on the standard guidelines from Alzheimer's Indonesia (ALZI.or.id) regarding the 10 common dementia symptoms, the following are interaction tips corresponding to each symptom of a Person with Dementia (PWD):
Symptom: Memory Impairment
Including frequently forgetting recent events or appointments, asking or telling the same thing repeatedly, or forgetting where something was placed.
Interaction Tips
Answer questions and carry on conversations with patience. Even if a question or topic is raised repeatedly, respond as though each time is the very first time it has been raised. Proactively bring up other questions that may prompt other memories or recollections the person still has.
Symptom: Difficulty Concentrating
Including difficulty with everyday tasks or using the telephone, inability to perform simple calculations, or taking noticeably longer than usual to complete something.
Interaction Tips
Speak clearly and without rushing to ensure your words can be understood. Let them know you are there to help, and sincerely provide support and assistance according to their needs.
Symptom: Difficulty with Familiar Activities
Often finding it difficult to plan or complete daily tasks, confusion about how to drive, or difficulty managing finances.
Interaction Tips
Help plan their daily activities with patience and calm. Provide guidance and assistance for activities they can still perform safely on their own.
Symptom: Disorientation
Confused about location or time (day/date/hour), unsure of where they are or how they got there, unable to find their way home.
Interaction Tips
The primary priority is to validate their emotional feelings. If they are anxious, acknowledge their concern while gently attempting to explain the actual situation. However, do not force reality upon them. For example, if at night they insist it is actually morning, accept their perspective while redirecting their attention to another topic.
Symptom: Difficulty with Visuospatial Understanding
Difficulty reading, judging distance, or distinguishing colours; failing to recognise their own reflection; walking into walls or glass doors; difficulty pouring water accurately into a glass.
Interaction Tips
Prepare and adapt their living environment to accommodate their reduced capabilities. For example, use sufficiently contrasting colours to mark changes in floor level, or install physical barriers in areas of the home that pose a safety risk. Provide daily assistance and support as needed.
Symptom: Communication Difficulties
Difficulty speaking and finding the right words; frequently stopping mid-sentence and becoming unsure how to continue.
Interaction Tips
Follow the flow of the conversation and pay close attention to their emotional behaviour in order to understand the meaning they are trying to convey. Reflect back what you have understood to show that you have followed what they said. Speak clearly and without rushing.
Symptom: Misplacing Objects
For example, storing house keys in the refrigerator, then becoming suspicious that someone has stolen or hidden the item.
Interaction Tips
People who are beginning to forget can be helped by providing clear visual cues to guide their daily behaviour. For example, labelling the place where keys should be kept with a sign reading "Store keys here." A tidy and well-organised living environment will also help, making it easier to see and locate things.
Symptom: Poor Judgement and Decision-Making
Unable to choose appropriate clothing; difficulty determining what they want; not caring for themselves adequately.
Interaction Tips
In this situation, a good relational bond between the PWD and their companion — whether a family member or a professional caregiver — is critically important. Wholehearted sincerity and compassion in assisting them with personal care, dressing, and other decisions must always be practised in the best interest of the person being cared for.
Symptom: Withdrawal from Social Life
Lacking motivation or initiative for activities or hobbies they previously enjoyed; no longer interested in spending time with friends.
Interaction Tips
Understand that this symptom can arise for several reasons — including embarrassment at having forgotten how to do something, or feeling insecure or afraid because they no longer recognise the people around them. We must therefore actively invite them to do things — anything at all — from simple activities like chatting and folding laundry, to singing, doing arts and crafts together, and playing a variety of games.
Symptom: Changes in Behaviour and Personality
Dramatic emotional changes; becoming confused, suspicious, or depressed; becoming fearful or excessively dependent on family; easily frustrated and despairing in daily situations.
Interaction Tips
The progression of the disease within the brain of a person with dementia will inevitably alter their personality. They may seem to become a different person — someone we no longer recognise. Accept this reality with an open heart and mind, and care for them as they are in the present moment. Every interaction is a new moment for a person with dementia; the concepts of yesterday and tomorrow no longer apply. Everything we do with them is a new experience, and we must approach it with a positive spirit.
Core Principles for Interacting with a Person with Dementia
Whatever behaviour, intensity, or stage of dementia is being faced, the following core principles should guide every interaction:
- Behaviour is generally beyond the control of their rational mind. Redirecting — not prohibiting — is more effective. Identify root causes and consider contributing circumstances.
- Enter their world and serve with patience. Empathy is the primary key. Apply the Validation Method: sincerely align your conversations with the reality as perceived by the PWD.
- Your emotional state affects theirs. A kind and understanding approach builds calm and trust; shouting or harsh treatment will not.
- Prioritise their needs above your own. Flexibility in timing — for meals, bathing, and daily routines — prevents conflict and creates peace.
- Preserve their dignity at all times. Treat the PWD with the respect due to any adult. Their emotional capacity endures long after their cognitive capacity declines.
Deepening our understanding of dementia is essential to being able to interact with people with dementia effectively. In doing so, we hope the negative stigma around the behaviour of people with dementia will diminish — replaced by greater awareness and the capacity to interact with and care for them optimally.
About RUKUN Dementia Support Solution
RUKUN Senior Living offers a range of residential facilities and specialised services for seniors with dementia, as a solution for senior families.
www.rukunseniorliving.com/dementia-support
Email: info@rukunseniorliving.com
Phone: 021 8795 1525
Dementia is a syndrome — a collection of interrelated symptoms — caused by brain dysfunction that affects a person's cognitive functioning. With dementia, the ability to think, remember, and reason begins to decline, accompanied by changes in behaviour and personality that interfere with daily life and activities.
All types of dementia share four characteristics: (1) at least two regions of the brain are affected, one of which includes memory function; (2) it is chronic — persisting for a long duration or with continuously recurring symptoms; (3) it is progressive — the condition worsens over time; and (4) it is terminal — the condition of dementia will ultimately end with the death of the person living with it.
Beyond Alzheimer's disease (which causes 50–75% of cases), dementia can also be caused by: Lewy Body disease, frontotemporal dementia, vascular dementia (caused by disrupted blood flow to the brain — linked to heart disease, high blood pressure, diabetes, or high cholesterol), as well as other factors such as poisoning, hereditary conditions, or psychological pressures such as depression.
No. Although dementia is more common in older adults, it is not a normal part of the ageing process. Many people live into their 90s without any signs of dementia. In fact, one type of dementia — involving disruption to the frontotemporal region of the brain — more commonly occurs in middle-aged individuals than in older people.
The Frontal Lobe controls important cognitive functions including emotional regulation, reasoning, personality, and decision-making. Dysfunction in this area can cause personality changes, uncontrolled emotions, and difficulty making decisions. The Occipital Lobe is responsible for visual interpretation — colour, light, and movement. Dysfunction here can cause visuospatial difficulties such as failing to recognise one's own reflection in a mirror or walking into objects in the environment.