What is Dementia?

Dementia is not a single disease; it’s an overall term — like heart disease — that covers a wide range of specific medical conditions, including Alzheimer’s disease. Disorders grouped under the general term “Dementia” are caused by abnormal brain changes. These changes trigger a decline in thinking skills, also known as cognitive abilities, severe enough to impair daily life and independent function. They also affect behaviour, feelings and relationships.

Regardless of which type of dementia is diagnosed and what part of the brain is affected, each person will experience dementia in their own unique way.

The symptoms of dementia can include:

Memory problems

People with dementia might have problems retaining new information. They might get lost in previously familiar places and may struggle with names. Relatives might notice the person seems increasingly forgetful, misplacing things regularly.

Cognitive ability, i.e. processing information

People with dementia may have a problem with their concentration level which can also impact on their short term memory. They may also have difficulty with time and place, for example, getting up in the middle of the night to go to work, even though they’re retired. There may be a difficulty when shopping with choosing the items and then selecting the right money to pay for them. For some people, the ability to reason and make decisions may also be affected. Some people with dementia may get a sense of restlessness and prefer to keep moving than sit still; others may be reluctant or lack the motivation to take part in activities they used to enjoy.

Communication

People with dementia may repeat themselves often or have difficulty finding the right words. Reading and writing might become challenging. They can lose interest in seeing others socially. Following and engaging in conversation can be difficult and tiring, and so a formerly outgoing person might become quieter and more introverted. Their self-confidence might also be affected.

Mood and behaviour

People with dementia might experience changes in personality, behaviour, mood, and have some elements of anxiety and depression due to the changes they are experiencing.

Many conditions are progressive, which means that the signs of dementia start out slowly and gradually get worse. If you or someone you know is experiencing memory difficulties or other changes in thinking skills, don't ignore them. See a doctor soon to determine the cause. Professional evaluation may detect a treatable condition. And even if symptoms suggest dementia, early diagnosis allows a person to get the maximum benefit from available treatments and provides an opportunity to volunteer for clinical trials or studies. It also provides time to plan for the future.

The brain is made up of nerve cells (neurones) that communicate with each other by sending messages. Dementia damages the nerve cells in the brain so messages can’t be sent from and to the brain effectively, which prevents the body from functioning normally.

Regardless of which type of dementia is diagnosed and what part of the brain is affected, each person will experience dementia in their own unique way..

Different types of dementia are associated with particular types of brain cell damage in particular regions of the brain. For example, in Alzheimer's disease, high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and to communicate with each other. The brain region called the hippocampus is the centre of learning and memory in the brain, and the brain cells in this region are often the first to be damaged. That's why memory loss is often one of the earliest symptoms of Alzheimer's.

While most changes in the brain that cause dementia are permanent and worsen over time, thinking and memory problems caused by the following conditions may improve when the condition is treated or addressed:

• Depression.

• Medication side effects.

• Excess use of alcohol.

• Thyroid problems.

• Vitamin deficiencies.

These are the most common types of Dementia:

Alzheimer’s disease

Alzheimer’s disease is the most common type of dementia in the UK. It is a physical condition caused by changes in the structure of the brain. This is due to a build-up of proteins, resulting in ‘plaques’ and ‘tangles’ which damage the brain cells’ ability to transmit messages and which eventually lead to deterioration in the brain cells. Signs of Alzheimer’s tend to develop gradually over time and can affect concentration, memory, communication and word finding and skills such as reading, writing, numeracy, planning and sense of direction.

Medication is available which may help to increase concentration and slow progression but it does not prevent or cure Alzheimer’s disease.

Vascular Dementia

Vascular Dementia is the second most common type of dementia. It is caused by problems in the blood supply to the brain cells, commonly due to strokes or a series of small strokes, known as Transient Ischaemic Attacks (TIAs), which cause areas of localised cell damage in the brain.

Changes in a person’s condition as a result of TIAs or a larger stroke are often sudden, before their condition plateaus. But the damage caused often means the person does not function in quite the same way as they did before. This is often referred to as a step wise progression.

Frontotemporal Dementia

Frontotemporal Dementia is a progressive condition which means that the symptoms worsen over time. This tends to affect people aged 45 to 65 years and males and females in equal measure. The areas of the brain most affected are the:

• frontal lobes which are important for personality, social functioning, decision making, problem solving, insight, empathy, motivation and planning. Dementia that predominantly affects the frontal lobes can be called frontal dementia, behavioural variant frontotemporal dementia or Pick’s disease

• temporal lobes which are important for speech, word finding, comprehension and language ability. The hippocampus (important for memory formation) is also located in the temporal lobe. Dementia that predominantly affects the temporal lobes can be called semantic dementia or primary progressive aphasia

Often frontotemporal dementias are not recognised and diagnosed until the person has had signs and symptoms for four to five years as the early signs are often missed or misattributed by the person, their family and health professionals.

Dementia with Lewy bodies

Dementia with Lewy bodies is a progressive condition which means that the symptoms worsen over time. It affects movement and motor control. A person with Dementia with Lewy bodies might:

• be prone to falls

• have tremors (similar to Parkinson’s disease)

• have trouble swallowing

• shuffle when they walk

• experience disrupted sleep patterns due to intense dreams/ nightmares

• have visual and auditory hallucinations due to the nerve

• cell damage

Memory is often less affected than with other types of Dementia, but a person might experience sudden bouts of confusion which can change on an hourly basis.

If someone is showing symptoms associated with Dementia it is important to visit a GP as soon as possible. Some conditions might look like dementia as they affect a person’s memory, concentration or behaviour but are treatable if addressed quickly. These include: infections, thyroid problems, delirium, confusion, vascular problems related to circulatory issues, vitamin B12 deficiency, sleep apnoea, stress, anxiety and depression.

To establish if Dementia is present, a GP will take a medical and family history of the person and will screen them for mental health and cognitive issues by: asking questions, testing concentration, assessing short term memory, identifying mood and behaviour changes.

The GP may then request blood tests, an MRI or CT scan to examine the structure of the brain. If other physical health conditions are suspected they may also request blood tests and X-rays to check for any conditions that may mimic Dementia.

Once the GP has ruled out potentially treatable causes of the changes observed, they may also refer the person to a memory service/clinic, or to a specialist for further investigation and assessment.

If a diagnosis of Dementia is given, the GP should then ensure that the person with the diagnosis and their family are made aware of any specialist advice and support services in their area, as well as referring them for further assessments and interventions that may help. This support can come from a range of organisations, including health and social care professionals and the voluntary sector.

Treatment of Dementia depends on its cause. In the case of most progressive dementias, including Alzheimer's disease, there is no cure and no treatment that slows or stops its progression. But there are drug treatments that may temporarily improve symptoms. The same medications used to treat Alzheimer's are among the drugs sometimes prescribed to help with symptoms of other types of dementias. Non-drug therapies can also alleviate some symptoms of dementia.

Ultimately, the path to effective new treatments for Dementia is through increased research funding and increased participation in clinical studies. Right now, volunteers are urgently needed to participate in clinical studies and trials about Alzheimer's and other dementias.

About 10% of young onset dementias can be due to genetic mutations such as some forms of frontotemporal dementia, Huntington’s disease and rare varieties of Alzheimer’s disease.

However, in older age most cases of dementia are not thought to be inherited and recent research suggests that you can delay or prevent dementia by making some changes to your lifestyle. Everything that keeps your heart healthy can also keep your brain healthy. So, eat a balanced healthy diet, keep weight within recommended levels, keep hydrated, don’t smoke, avoid drinking too much alcohol, have regular check-ups with your GP and keep your cholesterol and blood pressure under control. If you have been diagnosed with type two diabetes you will need to follow any advice you have been given to manage this effectively and ensure that your blood sugar levels remain under control.

Stay physically active and mentally stimulated with different activities so that you use different parts of the brain. For example, walking, gardening, singing, art, music, reading, and other hobbies and interests are thought to help prevent or delay the onset of dementia.

There is no compelling research that says doing puzzles will improve brain health, however, learning another language is helpful because different parts of the brain are stimulated and this can enhance cognitive function.