What is Dementia?

According to the World Health Organization, dementia affects 50 million people worldwide with 10 million new cases diagnosed every year.

The Alzheimer’s Society estimates that approximately 850,000 people in the UK have dementia, one in 14 people over 65 will develop dementia, and one in six people over 80 will be affected by the condition.

Due to an accelerated population ageing, this is projected to rise to 1.6 million people in the UK living with dementia in 2040.

With such large numbers of people affected most of us will, at some point, need to know more about dementia.

Here's a summary of the key information to help you support and care for a loved one living with dementia.

WHAT IS DEMENTIA?

Dementia is a collective term that encompasses a wide range of progressive neurological disorders. Dementia prevents the neurones (nerve cells) in the brain from sending messages to each other, which causes an ongoing decline in brain function.

Scientists have identified more than 200 subtypes of dementia, including Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia and mixed dementia.

Dementia can affect any person, regardless of age. However, it is more commonly diagnosed in people who are 65 years or older. When a person develops dementia before they’re 65, it is known as young onset dementia.

Problems associated with dementia include gradual memory loss, reduced thinking speed, impaired judgement, and difficulties carrying out regular tasks.

 

WHAT CAUSES DEMENTIA?

Dementia is usually caused when brain cells in the cerebral cortex begin to die. The cerebral cortex is the area of the brain that controls thought, action, memory, and personality.

When those brain cells die, it damages the person’s cognitive function, i.e. their ability to process thought, maintain focus and comprehend ideas.

some causes of dementia are treatable, most are progressive, degenerative and irreversible. In other words, the sufferer’s brain function will decline gradually and grow steadily worse over time. 

The treatable causes of dementia include head injuries, brain tumours, infections (like meningitis and HIV/AIDS), metabolic disorders (diseases that affect the body’s organs), and nutritional deficiencies.

WHAT ARE THE DIFFERENT TYPES OF DEMENTIA?

Some of the most common types of dementia are:

Alzheimer’s Disease

Alzheimer’s disease contributes to 60-70% of dementia diagnoses. It is caused by abnormal protein deposits in the brain which attack and destroy the cells associated with memory and mental function.

These deposits, called beta amyloids, are caused by an imbalance in the brain’s ability to produce and clear short chains of amino acids called peptides. Because the build-up of beta amyloids is extremely slow, it can take up to 20 years before Alzheimer’s disease begins to show.

Symptoms of Alzheimer’s disease include lack of concentration, memory loss, problems with communication, and difficulties with reading, writing, numeracy and planning.

Although there isn’t presently a way to prevent Alzheimer’s disease, the two known risk factors are advancing age and family history.

Around 5% of people above 65 years of age, 20% of people above 80 years of age, and 30% of people above 90 years of age suffer from Alzheimer’s disease.

People who have a parent or sibling affected by the disease are approximately two to three times more likely to develop the condition, and if more than one close relative has Alzheimer’s disease the risk is even greater.

Vascular Dementia

Vascular dementia accounts for roughly 20% of dementia cases. It is caused by fatty deposits, dead cells, and other debris that partially or completely restrict blood flow through the arteries.

This condition is known as atherosclerosis, and it can cause multiple strokes or interruptions of blood flow which cause localised cell damage in the brain.

This localised damage is called Transient Ischaemic Attacks (TIAs) and interruption of blood flow to the brain is called an infarction, which is why this is sometimes referred to as multi-infarct dementia.

Vascular dementia is commonly associated with conditions like high blood pressure, high cholesterol, heart disease and diabetes. If those conditions are treated, vascular dementia can be slowed down. Sadly any loss of function is irrecoverable.

Frontotemporal Dementia

Frontotemporal dementia is a progressive condition that usually affects people aged between 45 to 65.

The symptoms of frontotemporal dementia worsen gradually over time, and most commonly affect the brain’s frontal lobe (which controls personality, problem solving, decision making, empathy, motivation, and social planning) and temporal lobe (which controls speech, comprehension, language ability and memory formation).

Dementia that primarily impacts the front lobe is called frontal dementia, behavioural variant frontotemporal dementia, or Pick’s disease.

Dementia that primarily affects the temporal lobe is called semantic dementia or primary progressive aphasia. The early signs of frontotemporal dementias can be easily misdiagnosed, which is why the condition often remains unrecognised for as much as four to five years.

Dementia with Lewy bodies

Dementia with Lewy bodies is a progressive condition. It affects movement and motor control, which means that the sufferer is more likely to lose balance and fall, experience tremors that appear similar to Parkinson’s disease, and have difficulty swallowing.

They can also experience intense dreams or nightmares and visual and/or auditory hallucinations.

Although dementia with Lewy bodies doesn’t affect the memory as much as other dementias, sufferers may also experience regular periods of confusion.

 

WHAT ARE THE SYMPTOMS OF DEMENTIA?

Communication problems: including difficulty with reading and writing and finding the right words. Sufferers can also find taking part in conversations tiring.

Changes in personality and behaviour: including anxiety, depression, and unexpected mood swings. Sufferers can lose empathy and exhibit lack of interest in social activities.

Memory problems: difficulty remembering familiar names and places or retaining fresh information. Sufferers may frequently misplace items and seem increasingly forgetful.

Cognitive difficulties: including loss of concentration, and problems understanding time and place (i.e. thinking they have to get up for work in the middle of the night (even if they’re no longer working) or losing the ability to make simple decisions (i.e. when going shopping, or needing to take the bus into town.)

HOW DO YOU GET A DIAGNOSIS OF DEMENTIA?

If dementia is diagnosed early enough, it is possible to slow its effects down. An early diagnosis will also ensure dementia patients receive the correct treatment and support.

For that reason, it’s important to speak to the GP as soon as possible.

Even if dementia isn’t the cause, conditions like vascular problems, infections, anxiety, depression and sleep apnoea can mimic the symptoms of dementia and should still be treated as quickly as possible. Side effects to medication can create dementia-like symptoms too.

The GP will generally take a medical and family history of the person and test their mental health and cognitive functions by asking questions, checking concentration and short-term memory, and looking for changes in mood and behaviour.

They’ll probably also ask how the person manages day-to-day activities like personal care, cooking and shopping.

Depending on the outcome of that conversation, they may then request blood tests, an MRI or CT scan, or a chest X-ray to rule out other conditions. They might also refer the person to a specialist for further assessment.

If possible, the person being investigated should take someone they trust with them.

Their relative or friend may be able to describe any changes they’ve noticed in the patient’s personality or physical condition, and help them remember what was said and agreed after the appointment.

It’s important to remember that dementia can often be difficult to diagnose. If the GP isn’t sure, they’ll most likely refer the patient to a specialist, such as a neurologist, a psychiatrist, or a geriatrician.

These specialists will be expert in diagnosing, advising, and caring for people with dementia, and their families.

What happens if dementia is diagnosed?

The GP or specialist should explain what type of dementia you have or what the next steps will involve. They will give you details about the symptoms and how the dementia might develop, discuss appropriate treatments, and give you advice about care and support services.

Once you’ve received your diagnosis, your GP should continue monitoring your condition. They may also prescribe drugs to help with your condition.

WHAT ARE THE WARNING SIGNS TO LOOK OUT FOR?

It’s easy to misinterpret the warning signs of dementia. Many suspected dementia symptoms, like changes with memory, may just be natural conditions caused by ageing.

Symptoms like loss of concentration or lack of interest in social activities could also be due to illnesses like anxiety or depression.

Also, memory loss caused by mild cognitive impairment (MCI) is relatively common and need not necessarily lead to dementia, although people with MCI do have an increased risk of developing a dementia condition.

Warning signs of dementia can include:

• Frequently forgetting important dates, like birthdays and appointments.
• Forgetting the names of family members and friends.
• Repeatedly asking the same questions.
• Struggling with language and vocabulary.
• Confusion, and getting lost in familiar places.
• Difficulty concentrating, grasping new information, or following conversations.
• Behavioural changes, like becoming upset or angry over matters that normally wouldn’t bother them.
• Losing track of time and forgetting what they are doing.
• Organisational difficulties, like writing a shopping list, paying a bill, or cooking a recipe.
• Inability to complete day-to-day tasks, like travelling to work.
• Vision problems, such as difficulty focusing or judging colour and distance.
• Misplacing objects and being unable to find them or remember when they were last seen.
• Demonstrating increasingly poor judgement, such as making out-of-character decisions.
• Not participating in activities or hobbies they used to enjoy and being less interested in social or family activities.

None of these signs necessarily signal dementia, but if any of them are familiar to you or someone you know it’s advisable to visit your GP for a diagnosis.

IS DEMENTIA PREVENTABLE?

Most cases of dementia which are diagnosed in older age are not hereditary.

According to research, many of them can be delayed or prevented by undertaking a healthier lifestyle.

This includes eating a balanced diet, drinking plenty of water, not smoking, limiting alcohol, and keeping control of cholesterol, blood pressure, and blood sugar levels.

Staying physically active and regularly using different parts of your brain can also help stave off dementia, too.

Working out at the gym, walking, gardening, reading, mind games such as Rubix Cubes, playing an instrument or learning a new language are all beneficial.

WHAT ARE THE RISK FACTORS FOR DEMENTIA?

Unfortunately, ageing is one of the biggest risk factors and ageing is unavoidable. However, just because you’re getting older doesn’t mean you’ll develop a dementia condition.

Genetic mutations are a rarer risk factor, and account for 10% of young onset dementias (dementias that are diagnosed before age 65.) These include certain varieties of Alzheimer’s disease, frontotemporal dementia, and Huntington’s disease.

According to research, other factors like untreated depression, social isolation, hearing loss or leading a sedentary lifestyle can also be dementia risk factors.

Diet: Avoid saturated fat, salt and sugar. Eat a healthy, balanced diet that includes plenty of fibre. Keep your weight within healthy limits.

Exercise: Physical exercise doesn’t only reduce the dementia risk factor, it also promotes cognitive abilities. Two and a half hours of moderate-intensity aerobic activity each week is the recommended guideline, as well as strengthening and stretching exercises like yoga, pilates, or even gardening. Try and move around as much as possible, for example taking the stairs instead of the elevator.

Alcohol: Excessive alcohol can damage your nervous system, and increase the risk of heart disease, stroke, and some cancers. The recommended advice is to drink no more than 14 units a week for men and women, spread over three or more days.

Smoking: Smoking narrows the arteries (which raises blood pressure and limits blood flow to the brain) and increases risk of cancer as well as cardiovascular disease.

Depression: Depression, anxiety and low mood can all affect social activity and prevent us from engaging in mentally stimulating activities. For that reason, research suggests that untreated depression can increase the risk of developing a dementia condition.

CAN DEMENTIA BE CURED?

There isn’t currently a cure for dementia, but advances in scientific areas like stem cell research and immunotherapy are all contributing to a better understanding of the condition.

Existing drugs for illnesses like type 2 diabetes, rheumatoid arthritis and high blood pressure are also being investigated, with hopes they can be repurposed to assist people living with dementia.

Because dementia is composed of so many different conditions, it’s unlikely that a one-size-fits-all ‘magic bullet’ will ever be available. However, the results of several clinical trials have been encouraging.

 

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