What is dementia
Dementia is the term given to a group of symptoms, which includes confusion, memory loss, problem-solving and poor concentration.
There are many diseases, which lead to dementia, the most common being Alzheimer’s disease, which accounts for approximately 60% of all cases.
People with dementia differ in terms of their signs and symptoms and the speed and extent to which their dementia progresses.
Dementia usually occurs in older people. About 3 in 100 people over the age of 65 are affected and 10-15 in 100 people over the age of 80.
Dementia in people under 65 is known as early onset dementia (previously known as pre-senile dementia) and is rare, affecting only 1 in 1000 people. Most older people will never get dementia, and it is not a normal part of growing old.
Symptoms of dementia
The symptoms of dementia vary enormously, depending on the type of dementia and how far it has progressed. In most cases, the dementia progresses gradually and the early signs of dementia are subtle.
People with dementia usually experience:
- Confusion. This may include misunderstanding who or where they are.
- A significant reduction in memory. This may include forgetting people’s names or how to get home
- Problems with speech and language. Small differences of meaning are lost, language becomes simplified, and conversation becomes repetitive and often irrelevant.
- Loss of interest in the outside world. This may mean the person gives up interests and hobbies or is indifferent to social conventions and to the opinions of others.
Some forms of dementia may cause the individual to experience:
- Changes in personality
- Impaired judgement
- Lack of inhibition/ Inappropriate sexual behaviour
- Obsessional, repetitive behaviour
- Difficulties recognising familiar objects
- Disturbed sleep
- Sudden anger, aggression or inappropriate tearfulness
- Depression and bad temper
- Standards of personal care and hygiene may decline
- Physical deterioration, loss of appetite, loss of weight and high susceptibility to infection
Causes of dementia
Dementia is caused by damage to brain cells, often in the part of the brain that deals with thought processes. This damage may be caused by:
- Organic brain shrinking (Alzheimer’s Disease)
- Lack of blood and therefore oxygen supply to these brain areas
- Head injury
- Pressure (such as from a tumour)
- Infection (such as in Aids)
Approximately 60% of cases diagnosed as dementia are due to the organic brain- shrinking disorder, Alzheimer�s disease and the cause is unknown.
After Alzheimer’s disease, the second most common type of dementia is vascular dementia (also known as multi-infarct dementia), which occurs as a result of lack of blood and oxygen to the brain in a series of tiny ‘strokes’.
Other types of dementia are rarer, and may be due to:
- Lewy body disease
- Pick’s disease
- Huntingdon’s disease or chorea
- Creutzfeld-Jakob disease (CJD)
- Dementia as part of a neurological (brain) illness such as Parkinson’s disease
- A brain tumor
- Fluid build-up- and water on the brain (hydrocephalus)
- A long period of excessive alcohol intake or drug intoxication
- Dementia may be misdiagnosed in some psychiatric conditions, such as depression or schizophrenia
- Dementia may occur some untreated organic disorders such as severe thyroid gland underactivity (see hypothyroidism), hormone deficiency and urine infections.
Diagnosis of dementia
The GP will normally check that the person does not have another condition such as depression or a urine or chest infection which produce similar symptoms to dementia, especially in older people.
Intelligence testing, a full medical history, careful examination, and, if necessary, a computerized tomography scan (CT scan) of the brain will aid diagnosis of dementia.
Most types of dementia cannot be cured. The exceptions are those dementias related to vitamin or hormone deficiency (which can be treated with supplements) and head injury (which may be treated through surgery).
An underactive thyroid gland (hypothyroidism) can be treated with thyroid hormone (thyroxine). Reduction of the blood supply to the brain due to cardiac or respiratory failure or anemia may also be to some extent treatable.
Alzheimer’s Disease cannot be cured. However, for some people in the early and middle stages of the disease, the drugs donepezil, rivastigmine or galantamine may help prevent some symptoms from becoming worse for a period of time.
Medical researchers are currently looking at other medical treatments including anti-oxidants, brain stem cell therapy and a vaccination to stop the build up of plaques in the brain (a hallmark of Alzheimer’s disease).
Alternative therapies i.e. non-medical interventions such as music therapy, aromatherapy and reminiscence therapy may be helpful to some people. It is also helpful to give the person the choice to be alone or with others.
It seems that gentle encouragement to use the brain and keeping the environment quite stimulating is a good idea. But it is important not to overwhelm people with demands that may only frustrate them if they can’t meet them.