Dementia

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What is dementia?

It is normal for your memory to be affected by natural parts of life, like stress, tiredness and illnesses. However, if you or a family member notice that you are becoming increasingly forgetful, and you are over the age of 65, it may be worth getting assessed for dementia.

Dementia is a medical term used to describe a group of symptoms that are related to an increasing amount of memory loss. These group of symptoms develop when the brain stops working as it normally should.

Dementia is extremely common, affecting a lot of people worldwide who are over the age of 65. The number of people living with dementia is increasing because people are living a lot longer than they used to.

There are many different causes of dementia, and several different types which can affect you in different ways.

Old father with dementia sitting on his bed holding hands and talking with his son

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What are the symptoms of dementia?

There is more to dementia than just memory loss; other things can often be symptoms of dementia too. For example:

  • Memory loss
  • Slowed thinking
  • Reduced mental sharpness
  • Trouble speaking
  • Trouble finding the words that you want to say
  • Using words incorrectly
  • Your judgement may be impaired
  • Low mood
  • Slower movement
  • Difficulty understanding or doing daily tasks and activities that were previously easy for you to do
  • Aggressive behaviour
  • Personality changes 
  • Disinhibited behaviour (for example acting in a more sexualised way that is not normal for you)

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What are the different types of dementia?

As mentioned above, dementia is an umbrella term that is used to describe a range of symptoms that include, but are not limited to, memory loss.

So far, four major groups of dementia have been identified:

  1. Alzheimer’s Disease
  2. Vascular Dementia
  3. Dementia with Lewy Bodies (DLB)
  4. Frontotemporal Dementia (FTD)

You can have more than one type of dementia at once, and this may be called ‘mixed dementia’.

Alzheimer’s disease is a disease that causes dementia. It is the most common type of dementia, causing about 60% of cases in older people. Although Alzheimer’s disease is not a normal part of ageing, the risk of developing it does increase as we get older. 

How does Alzheimer’s disease cause dementia?

As we grow older, it is normal for us to get a little bit slower with the things that we do. This is because naturally,  our brain shrinks as we get older. However, in Alzheimer’s disease, the changes in the brain are different to those seen in natural ageing. 

In Alzheimer’s disease, it is thought that two proteins, called amyloid and tau, cause damage to the brain. As these two proteins build-up, they cause more and more damage to brain cells, which causes the disease to get progressively more severe.

 

Wife comforting her husband with dementia.

 

Why is it sometimes difficult to diagnose Alzheimer’s disease?


Like most types of dementia, Alzheimer’s disease develops very slowly, usually over a number of years. This slow development can make it difficult to recognise the disease in its early stages, and often the first sign of memory problems are put down to normal ageing. 


Often early symptoms of Alzheimer’s disease can be mistaken for depression, as people often lose interest in things that they used to enjoy.

 

What are the early symptoms of Alzheimer’s disease?


Early symptoms of Alzheimer’s disease include:

 

  • Short term memory loss
  • Forgetting names and faces
  • Repeating yourself a lot
  • Losing things
  • Putting things in odd places
  • Forgetting the date or day
  • Having trouble finding the right words
  • Low mood
  • Anxiety
  • Becoming irritable easily

As Alzheimer’s disease develops, communicating with others can become difficult, and you will likely need help doing more activities like dressing, eating and using the toilet. It may be that you are unable to continue living in your own home, and may need to move in with a relative or to a care home to have more help with daily life.

Vascular Dementia is another type of dementia that develops when blood vessels in the brain are damaged. 

When the blood vessels in the brain are damaged, it affects how well the blood can flow to brain cells, and this, in turn, can cause memory problems. 

What causes vascular dementia?

Strokes & Mini-strokes

When someone has a stroke or a mini-stroke (which is called a TIA), the blood supply to a part of the brain is suddenly cut off. This sudden loss of blood supply can damage the blood vessels in the brain, which, in turn, can cause vascular dementia. 

If someone develops vascular dementia after a stroke, the symptoms of memory loss will often be quite obvious.

 

Doctor taking the blood pressure of a patient.

 

High blood pressure & cholesterol

Vascular dementia can also develop very slowly due to changes in very small blood vessels in the brain. These changes are normally caused by high blood pressure and high cholesterol. Most people are usually unaware if they have high blood pressure or cholesterol,  unless their doctor has told them that they have it.  

The damage caused by high blood pressure & cholesterol can cause very slow memory loss. 

 

Which parts of the brain can be affected by vascular dementia?

Unlike Alzheimer’s disease which usually affects the whole brain,  vascular dementia can sometimes affect only a specific part of the brain. This can therefore cause very specific symptoms to develop. 

For example, if an area in the back the brain called the cerebellum is damaged, it may cause problems with walking and balance. If the area at the front of the brain( the frontal lobe) is damaged, you may notice personality changes instead. 

As vascular dementia progresses over time, it can start to affect everyday life. This means that in time, someone with vascular dementia might need more help with dressing, eating and using the toilet.

Dementia with Lewy Bodies is the third most common type of dementia. Lewy bodies are the names of the proteins that clump together in the brain and in turn, damage the brain’s nerve cells. The damaged nerve cells then struggle to communicate with important parts of the brain, particularly those that control movement, memory and thinking.

What are the symptoms of dementia with Lewy Bodies?

There are some dementia symptoms that are more specific to dementia with Lewy bodies, for example:

 

  • Movement problems e.g. stiffness in the arms and legs
  • Trembling
  • Balance problems causing unsteadiness and frequent falls
  • Sleep problems  e.g. having vivid dreams
  • Unpredictable confusion that may change from day to day

How is dementia with Lewy bodies connected to Parkinson’s disease?


Dementia with Lewy bodies is closely related to Parkinson’s disease. This is because the Lewy bodies that cause nerve damage in dementia with Lewy bodies, also cause the movement problems in Parkinson’s disease. 


If dementia symptoms appear before or at the same time as any movement problems, then it is called Dementia with Lewy bodies. If however, someone has Parkinson’s disease for a year or more, and then goes onto develop memory problems, it is called Parkinson’s disease dementia (PDD).

Frontotemporal dementia (FTD) is much rarer than all the other types of dementia. It is caused by the build-up of proteins in the areas of the brain that control personality and behaviour, emotions and speech and language. Usually this build-up develops in the parts of the brain called the frontal and temporal lobes. 

 

Image showing the temporal and frontal lobes of the brain.

 

Who usually develops frontotemporal dementia?


Frontotemporal dementia most commonly affects people under the age of 65. It can also be called Pick’s disease, after the doctor who discovered the condition. 


Frontotemporal dementia is actually an umbrella term used to describe several different diseases including:

  • Behavioural variant frontotemporal dementia
  • Semantic dementia (whereby people struggle to understand language)
  • Progressive non-fluent aphasia (when people have problems speaking and writing)
  • Frontotemporal dementia in motor neurone disease (MND)

 

Which symptoms are seen in frontotemporal dementia?

There are some other symptoms that are seen more often in the types of frontotemporal dementia than in other types of dementia, for example:

  • Emotional changes - including a lack of understanding of other people's feelings
  • Inappropriate behaviour - such as  making inappropriate jokes or overly sexualised behaviour
  • Developing obsessions
  • Movement problems 

 

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Who usually gets dementia?

Dementia most commonly develops in people over the age of 65.

There are a few risk factors that have been identified that may increase your likelihood of developing dementia, for example:

  • Age (the older you are, the more likely you are to develop dementia)

  • Genetic factors (in some types of dementia, particularly, frontotemporal dementia, there is thought to be a genetic part contributing to getting the disease)

  • Untreated depression can increase your risk of developing dementia

Having high blood pressure and high cholesterol increases your risk of stroke, which can therefore increase your risk of developing Alzheimer’s Disease and Vascular Dementia.

How can you reduce your risk of developing dementia?

You can reduce your risk of developing dementia by:

  • Controlling your weight
  • Stopping smoking
  • Keeping your blood pressure under control
  • Eating a balanced diet
  • Exercising regularly 
  • Not drinking too much alcohol
Senior couple exercising in the gym with personal trainer

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What is early-onset dementia?

If you develop symptoms of dementia before the age of 65, this is known as early-onset dementia.

Early-onset dementia is likely to present itself in a slightly different way. For example:

  • Is it much more likely to be a more rare form of dementia
  • Memory loss is less likely to be one of the first symptoms
  • It  is more likely to cause problems with walking, balance or coordination
  • It is more likely to be passed on from parents to children/through families through genes

Can dementia kill you?

Dementia is a disease that affects people for many years, and worsens over time. Often, it is more likely to be something else that directly causes someone with dementia’s death.

Over time, people with dementia may become very frail due to poor eating, not moving around as much, and being unable to take care of themselves. At very late stages of the condition, their ability to swallow can also be affected.This makes people with dementia more likely to develop severe infections like pneumonia, that can eventually lead to their death.

They may also die due to issues like:

  • Dehydration from not being able to drink as much,
  • Malnutrition, from not being able to feed themselves
  • Dangerous falls due to coordination problems

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How can dementia affect quality of life?

Dementia can have a huge effect on someone’s life and can trigger a range of emotions. When you first receive a diagnosis, you may experience grief, shock, anger or fear. You may be terrified of what might happen to you if your disease gets worse, angry that it has happened to you, or maybe even feel relieved that a cause has been found for your symptoms.

Things to remember if you have been diagnosed with dementia

If you have been diagnosed with dementia it is important to remember:

The number 1

You are still you even though you now have a diagnosis of dementia

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Everyone experiences dementia differently

The number 3

Focusing on the things you can still do and enjoy will help you feel positive

The number 4

Try to stay socially active as this is good for your mental wellbeing

As dementia progresses, you may not be able to do things that you used to enjoy anymore, like going on walks, reading books or meeting friends. This can be very distressing and can contribute to a low mood/depression. Make sure you talk to your doctor and friends and family as much as possible to get all the help you need.

Tips for coping with memory loss

Coping with memory loss can be really distressing, but there are some things that you and your caregiver can do to try and help. For example:

  • Try and stick to a routine
  • Keep a timetable somewhere that can be seen
  • Try and fill it with dementia-friendly activities like support group meetups 
  • Keep a list of emergency contacts somewhere that can be easily found
  • Use a pill organiser box to help you remember which medications to take at which times
  • Make your home as dementia friendly and as safe as you can by using safe flooring and labels and signs to help you get around
Old woman with her carer looking over pictures in an album

Which other conditions have similar symptoms to dementia?

There are some conditions that can have similar symptoms to dementia for example:

Low mood and depression in older people can often look like dementia. The low mood often causes someone to be forgetful, and can be mistaken for early dementia. It is important to see your doctor early so they can do a thorough examination and treat you appropriately. 



If the underlying depression is treated, the memory problems often disappear. Longstanding untreated depression can however, be a risk factor for developing dementia.

Delirium is confusion that comes on suddenly when someone is unwell. It is often seen  in the elderly when they become unwell after developing an infection such as a urinary infection. 

 

Delirium can come and go, and it is often worse at night time. It can get better quite quickly, but in some people, it can take a long time for them to go back to normal.

Delirium may be associated with dementia in that patients who suffer a delirium are more likely to develop dementia in the future. Also, patients who already have a diagnosis of dementia and are admitted to hospital for another reason (e.g. infection) are more likely to develop a delirium.

Disclaimer

The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.

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How do you treat dementia?

Unfortunately, dementia cannot be cured, but its progress can be slowed down with some medications and lifestyle changes.

Things you can do at home

There are some non-medical things that can be done to help with the behavioural and psychological symptoms of dementia. For example:

  • Getting involved with group activities involving social interaction with others may help ease some symptoms of dementia. 
  • Playing familiar music or films may help to calm you down if you are feeling distressed.
  • Using Aromatherapy can have a calming effect.
  • Dancing helps to keep you mobile and can also be something that was enjoyed at a younger age.
  • Animal-assisted therapy such as interacting with dogs for a short while can help calm you down.

Medications

Medication may beneficial for people with mild to moderate Alzheimer’s disease.

There are two main types of medication used to treat Alzheimer’s disease:

There are three cholinesterase inhibitors that can be used to treat mild to moderate Alzheimer’s disease:

  • Donepezil
  • Rivastigmine
  • Galantamine

A cholinesterase inhibitor works by increasing the amount of a brain chemical called acetylcholine, which helps messages to travel around the brain.

How can cholinesterase inhibitors help people with Alzheimer’s?

Cholinesterase inhibitors can help to reduce the symptoms of Alzheimer’s disease for a short time. They can help improve thinking, memory or performing day-to-day activities. Some find that their condition stabilises and doesn’t get any worse while they are taking this medication. Some people however,  may not notice any difference at all.

How do you take cholinesterase inhibitors and what are the side effects?

Donepezil and galantamine tend to be given as a tablet once a day. Rivastigmine is a patch, where the drug is absorbed through the skin. 

Some common side effects of cholinesterase inhibitors include:

  • Feeling sick
  • Diarrhoea
  • Trouble sleeping
  • Muscle cramps
  • Tiredness

These are usually temporary and will pass after a short time. Not everyone who takes cholinesterase inhibitors will experience these side effects.

Memantine is another medication used to treat people with severe Alzheimer’s disease, or those with moderate disease when a cholinesterase inhibitor isn’t suitable. It can also be used if you have Dementia with Lewy bodies.

How does memantine work?

Memantine helps increase a different chemical in the brain called glutamate to help the brain work more effectively. This increase in glutamate can sometimes help reduce the symptoms of Alzheimer’s for a while.

What are the side effects of memantine?

Some people taking memantine do not suffer from any side effects whilst others can experience:

  • Headaches
  • Dizziness
  • Drowsiness
  • Constipation

Is there a cure for dementia?

There is currently no medical cure for dementia. However, certain types of dementia can be slowed down using medications that can help improve someone’s quality of life. Research is constantly ongoing to find out more information about dementia, how it can be prevented, and how it may be treated.

How can you help someone with dementia?

Caring for someone with dementia can be really hard. It can have a big strain on your own mental wellbeing.

There are some things that you can do to help someone with dementia, that might make things easier for you too. For example:

  • Speak to your doctor about what help is available for them and you
  • Join a support group 
  • Avoid correcting them when they forget or get something wrong, this might cause them distress
  • Make their surroundings as safe as possible
  • Ask simple questions
  • Be patient
  • Reminisce about the past as it will help boost their mood
Old couple holding hands.

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Can you prevent dementia?

There is no proven way to prevent all the different types of dementia, but it is something that researchers are trying to find out. There is good evidence that leading a healthy lifestyle, not smoking, and controlling your blood pressure and your weight can help to prevent cardiovascular diseases, which are risk factors for Alzheimer’s and Vascular Dementia.

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