Common symptoms of dementia and age-related issues

When designing environments that support people living with dementia, it is important to understand the key symptoms so that design responds to the needs and preferences of people with dementia, their family members, and carers.

Dementia is an umbrella term to describe a group of disorders caused by several diseases and conditions, with Alzheimer’s disease and Vascular Dementia being the most common. When outlining the symptoms of dementia in terms of the built environment, the following broad classification can be useful:

• Cognitive impairment: indicated by problems with memory (amnesia), speech or understanding of language (aphasia), a failure to carry out physical tasks despite having intact motor function (apraxia), and failure to recognise objects or people despite having knowledge of their characteristics (agnosia).
• Reactive behaviour, formerly described as Behavioural and Psychological Symptoms of Dementia (BPSD): cognitive impairment may be accompanied by symptoms such as depression, delusions, hallucinations (visual and auditory) – and behaviours such as wandering, incessant walking or agitation. These are thought to represent responses to altered perception of environments and interactions, or reaction to unarticulated stress, pain, disorientation, or other discomforts.
• Dysfunction in activities of daily living (ADL): In the early stages of dementia these can include difficulties with more complex tasks such as shopping, driving or handling money. In the later stages more basic tasks are affected such as dressing, eating and bathing.

Moreover, depending on the type and stage of dementia, or the way it affects a specific individual, a person living with dementia may also experience:

• Gait disorders impacting on mobility and stability while walking.
• Muscular strength loss and associated functional decline.
• Visual and perception issues related to visuospatial and visuoperceptual defects.

Given that increasing age is one of the strongest risk factors for dementia, it is also important to consider other age-related changes that might affect a person such as:

• Physical frailty.
• General mobility difficulties leading to increased risks of falls.
• Partial and severe sight loss.
• Hearing loss.
• Circadian rhythm difficulties resulting in sleep disturbance or disruption.

These symptoms are exacerbated by dementia as a person living with dementia may fail to comprehend, or compensate for these difficulties.