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Description

Dementia may be caused by a number of illnesses that affect the brain. Dementia typically leads to memory loss, inability to do everyday things, difficulty in communication, confusion, frustration, as well as personality and behaviour changes. People with dementia may also develop behavioural and psychological symptoms such as depression, aggression and wandering.

There are about 700,000 people in the UK with dementia and this is expected to double in the next 30 years. It's more likely to affect people over 65 - this is called late-onset dementia. Dementia occurring before this age is called early-onset.

Types of dementia

There are many different types of dementia and include the following.

• Alzheimer's disease is the most common type of dementia. Alzheimer's disease changes the brain's structure, which leads to the death of nerve cells. This disrupts the brain's usual activity. People with Alzheimer's disease also have a shortage of chemicals involved with the transmission of messages within the brain.


• Vascular dementia is another common form of dementia and is triggered by blockages to the blood vessels (vascular system) in the brain. Not enough blood and oxygen reach the nerve cells so they die. Areas of brain tissue that have died in this way are called infarcts, so vascular dementia is also called multi-infarct dementia. It may be easier to think of vascular dementia as a series of strokes that result from other health problems such as high blood pressure.


• Mixed dementia is when you have more than one type of dementia at the same time. A common combination is Alzheimer's disease and vascular dementia.


• Dementia with Lewy bodies (DLB) is a type of dementia caused by Lewy bodies, which are made from an abnormal build-up of a particular protein in the brain.

Dementia can also occur in the final stages of other conditions, such as Parkinson's disease, AIDS and Creutzfeld-Jakob disease.

Symptoms of dementia

If you have dementia, you may have some or all of the following symptoms.

• You may have memory loss, particularly of recent events. This may not be severe at first but is likely to become progressively worse.


• You may have problems finding the right words for what you want to say.


• You may feel increasingly disorientated, such as not recognising familiar streets and becoming confused about the time of day. This could cause you to get up in the middle of the night wanting to go out.


• You may have poor judgement, for example dressing inappropriately for the weather or being unaware of dangerous situations.


• You may become withdrawn, prone to fits of temper, or feel anxious and depressed.


• You may have trouble thinking clearly and doing practical tasks that you used to do easily.

Dementia affects everyone differently. Your symptoms may stay the same for some time or if you have vascular dementia, they may occur as a series of episodes with a succession of 'stepwise' deteriorations and occasionally some improvement after a period of getting worse.

People who have dementia can often have good quality of life for a number of years. However, the symptoms generally get progressively more severe with time. As your dementia worsens, you may find it increasingly difficult to look after yourself. It's important to get support from social services, your GP, family and friends.

Causes of dementia

The underlying causes of the various illnesses that result in dementia aren't well understood at present. However, they all result in structural and chemical changes in the brain leading to the death of brain tissue.

There are certain conditions that may make you more likely to get dementia. These include the following.

• You're more likely to develop late-onset dementia as you get older.


• You're more likely to develop vascular dementia if you have high blood pressure, irregular heart rhythms or have had a stroke.


• Your risk of dementia may be affected if someone else in your family has it. However, more research is needed to better understand this link.


• People with learning disabilities are at particular risk.

Diagnosis of dementia

If you think you may be developing dementia, visit your GP. It's very important to seek help early so you can get the support you need.

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may do blood and urine tests to rule out the possibility of other conditions that could cause symptoms similar to dementia.

You may also have a memory test - one that is often used to help find out if you have dementia is the 'mini mental state examination (MMSE)'. In this test, your GP will ask you some questions and test your attention and ability to remember words. How you score in this test indicates how serious your condition is, for example:

• an MMSE score of 20 to 24 indicates mild dementia


• a score of 10 to 20 suggests moderate dementia


• a score below 10 implies severe dementia

Your GP will refer you to a specialist doctor or assessment centre for more detailed tests. This will help to determine what type of dementia you have. You may also be asked to have a brain scan, such as a CT scan.

Treatment of dementia

There isn't a cure for dementia. However, for some types of dementia there are medicines that can treat your symptoms and prevent them coming on as quickly. The treatment you're offered will depend on which type of dementia you have.

Medicines

Alzheimer's disease medicines

If you have moderate Alzheimer's disease, your doctor may prescribe one of the following medicines:

• donepezil


• galantamine


• rivastigmine

These can temporarily slow down the progression of symptoms in some people.

There are several medicines that are also licensed in the UK to treat mild Alzheimer's disease. However, they aren't currently recommended by the National Institute for Health and Clinical Excellence (NICE), which provides national guidance on treatment.

NICE doesn't currently recommend these medicines to treat other types of dementia. More research is needed to determine whether or not they are effective.

Another medicine called memantine works in a different way and is only used in severe dementia. NICE doesn't recommend that you're prescribed this unless you're taking part in a clinical trial to test its effectiveness.

It's important to be aware that doctors working for the NHS can only prescribe medicines recommended by NICE. NICE hasn't recommended the use of these medicines even though they are licensed in the UK. Licensing involves proving that a medicine is safe to use and isn't based on its effectiveness.
Medicines for other symptoms

There is a range of other medicines to treat the symptoms of dementia, such as tranquilisers if you feel aggressive or restless, medicines to treat anxiety and antidepressants.

Talking therapies

You may find other therapies helpful, such as:

• group activities and discussions - these aim to stimulate your mind (this is sometimes referred to as cognitive stimulation therapy)


• reminiscence therapy - discussing past events in groups, usually using photos or familiar objects to jog your memory, although there are conflicting opinions on whether this is effective

Complementary therapies

It's possible that aromatherapy will help you to feel less agitated. However, there is only a small amount of evidence to support this.

Help and support

It's important for you and your family to seek help so you get the support that is on offer.

As well as family and friends, emotional and practical support is available from a range of services including:

• your GP


• Admiral nurses (specialist dementia nurses)


• occupational therapists


• voluntary organisations


• health and social care services

The availability of these varies depending on where you live.

Health and social care staff can help you to maintain your independence. They can offer advice on mobility and daily living activities, and on how to adapt and develop skills to help you live with dementia.

The Department of Health is working to improve services for dementia patients and has a number of objectives to achieve. This includes giving everyone with dementia their own personal dementia adviser. He or she will help you find the right information, care, support and advice. Ask your GP for more information.

It's important that carers looking after someone with dementia at home receive plenty of help and support. Respite care, to give carers a break, is an important part of looking after someone with dementia.

Helping to keep someone with dementia safe, for example preventing them from wandering or from having accidents at home, is also important. For help and advice on keeping your loved one safe, or for more information about respite care, contact the Alzheimer's Society or Carers UK.