Hello everyone! Today, we want to talk to you a little bit about the changes observed in people with dementia. When the person is diagnosed with dementia, we have so many questions in our minds. We have mixed feelings. feelings of anger, sadness, hopelessness, worry ... What will happen next? What is waiting for us? How will I cope with the changes? Will I be enough? Will my father not be able to go out alone? Will my mother with dementia recognize me? Will s/he be able to recognize her/his grandchildren? Someone with dementia doesn't remember you but you still know her/him. Will s/he be different from the person I used to know? Yes, there will be some changes. They will gradually lose their ability, we will see more changes in the person's behaviour and find this difficult to manage. How many times do I have to tell him/her not to spill it? Is s/he doing this on purpose? Is s/he trying to get my attention? She accused my wife of stealing her pots last day. I felt embarrassed. Why does s/he make me angry on purpose? No, s/he is not doing it on purpose. Behavior and personality often change because dementia causes these kind of changes. When we have realized that person is not doing this on purpose, our anger will decrease in time. Let's talk about behavior changes. If we understand the condition and what to expect, we will have a better understanding, we will feel less overwhelmed and feel like we have the power to manage it better. In addition to cognitive deterioration, a person living with dementia can experience behavioral changes and neuropsychiatric disorders. Dementia also affects functional ability of the patient. The way dementia may affect personality and behaviour can be very different between individuals. It is important to focus on the things the patient can still do and adhering to lifelong routines. Learning how the disease progresses and the changes it will bring can help you manage the situations better. What AreThe Cognitive Changes in Alzheimer Disease? Alzheimer's disease typically affects short-term memory area. The patient or a close relative may complain about challenges, concerns on repeating questions, phrases or stories in the same conversation, losing items as a result of their memory loss, forgetting appointments, forgetting to switch the oven,gas hobs, ovens off. The person living with dementia may have difficulty with visual and spatial abilities, disorientation. getting lost when driving or walking in familiar areas, losing their ability to recognize familiar places and getting lost. Patients with dementia demonstrate word-finding problems (anomia). Primary progressive aphasia may cause difficulty in understanding speech. Their vocabulary begins to narrow. Lopogenic progressive aphasia and Progressive non-fluent aphasia may cause difficulty finding the right words and poor grammar respectively. Primary progressive aphasia may experience word-finding problems may be expressed as 'forgetfulness' by a close relative. Agnosia (in greek gnosis- "not knowing") refers to a neurological condition in which a patient is unable to recognize and identify objects, persons. The patient tends to lose mental flexibility, adaptability, focus, and tenacity because of executive cognitive function disorder. The person may have difficulty in grasping the abstract meanings of metaphors, planning his/her behavior, reasoning about individual and social problems, and creating appropriate solutions to the problems s/he encounters in daily life. Social-cognitive deficits considerably overlap in behavioral changes The behavioral changes that await us in dementia are Loss of spontaneity, disorders in impulse control (hypersexuality, hyperphagia) can be counted. The patient exhibits fewer and fewer instances of spontaneity. He does not show initiative, does not demand anything spontaneously, does not speak when not directed towards him. Nothing that happens around him seems to interest him. Disinhibition manifests itself primarily in relaxed behavior, unusual sociability, playfulness, childishness incompatible with social position, which is called socially inappropriate behavior; relatives often refer to these changes as an embarrassment for the family.Hypersexuality can be seen in violence ranging from sexually suggestive words and behaviors to inappropriate sexual demands outside of the social norms that the patient has acquired until that time. Hyperphagia begins as a change in the patient's usual taste in the mouth, becoming greedy and especially fond of sweets, and it can reach such severity that even inedible objects such as tea bags and own feces can be stuffed into the mouth. Psychotic symptoms occur in the form of thought and perception disorders.Thought disorders, particularly those of theft ("caregiver steals my money"), infidelity ("my wife is cheating on me with someone else"), and abandonment ("you're going to throw me in a hospice"), thoughts ("this isn't my home, let's go home"), and Capgras delusions ( tells a person he knows that he is an imitation of his place). Perception disorders, on the other hand, are often in the form of visual hallucinations, as they can be in all sensory modalities.These include illusions in which environmental stimuli are misinterpreted, hallucinations such as a sense of presence in space, or very mild perceptual disturbances such as vivid dreams; It ranges from seeing objects, people and animals to more severe cases of hallucinations. As perception disorders become more severe, insight is lost and while they are limited to the night, they gradually begin to appear during the day.Depression is particularly common among mood disorders. MCI and/or early AD may be accompanied by depressive states and anxiety, ranging from reactive dysphoria/dysthymia to major depression, especially awareness of disability. Anxiety may appear as restlessness, constant change of place and place, and boredom very quickly; A special variant is anxiety, which is heightened by upcoming appointments.Phobias may show variations specific to the patient, especially in the form of the fear of being out of sight of the spouse and therefore the fear of not leaving the spouse or being alone. Agitation, including physical or verbal violence, aimless wandering-stepping, repetitive movements such as opening-closing cabinets, folding and unfolding the sheets, aimless-repetitive movements such as collecting and stacking in inappropriate places are among the behavioral problems that can be observed. As observable behavioral disorders become more severe, they tend to spread to the day, while they are initially limited to the night. This is called the "sunset phenomenon". What are the major changes in functionality? A person with dementia usually requires help with more complex tasks, such as managing bills and finances. People with dementia can continue with day-to-day finances, such as paying for shopping, but they may have difficulty with more complex decisions. For example, the person may find it difficult to learn a new washing machine/dishwasher, TV remote control. A person living with dementia find it hard to maintain a household and self-care or hygiene (dressing, washing, eating, toilet, etc.). A dementia patient may refuse to bathe, they may shout, throw away or hit themselves so as not to take a bathe or they may poop or pee on the floor. Considering that especially patients in the early period may have a tendency to deny, the relatives of the patients should be carefully questioned in this respect if possible (if necessary). There are differences between AD and FTD in terms of major changes in functionality. In AD, independence outside the home is impaired earliest and self-care last, whereas in FTD, on the contrary, self-care is impaired initially, while independence outside the home is retained for a long time. Considering forgetfulness as a natural part of aging sometimes delays the period from the onset of symptoms to the diagnosis of dementia and it cannot stop or reverse the disease. It is highly important to recognise dementia symptoms early. Diagnosis, treatment, and modified life style can help improve the quality of life of caregivers and persons with dementia. What happens to caregivers, what is waiting for us? Caregivers may have concerns about caregiving problems. If we understand the condition and know what to expect, we will have a better understanding, we will feel less overwhelmed and feel like we have the power to manage it better. We hope that the chapter has been useful to you, and also hoping that these tips can help you cope and get the support you need. If you are interested in obtaining more information, you can consult our project website at: http://demcare.hcilab.es/ . Until the next episode!