What is dementia?
Dementia is a general term for a number of progressive conditions affecting memory, thinking, problem-solving and language. It is caused by diseases which damage brain cells and interfere with the normal workings of the brain. Dementia is characterised by a decline in mental ability severe enough to interfere with everyday activities.
Everyone with dementia can expect to experience it differently, depending on the cause, on which parts of the brain are affected, and their own personality and circumstances.
Dementia is not a normal part of ageing, it should not be accepted as “senility”. huru believes that dementia should be diagnosed early and treated actively. Eventually, huru hopes that brain health will be treated much like many other areas of physical health (e.g. cardiovascular health), with a focus on prevention, early diagnosis and regular monitoring.
According to Alzheimer’s Research UK there are around 820,000 people living with dementia in the UK. The majority are older people, with one in 20 over the age of 75, and one in five over the age of 85, affected. However it is possible for younger people to have dementia, dementias that are diagnosed before the age of 65 are known as ‘early-onset’.
Worldwide in 2020 the World Health Organisation (WHO) estimated that 50m people were living with dementia. By 2050 WHO expect this number to increase to 152m*.
Alzheimer’s disease is the most common form of dementia (accounting for around 60% of cases), followed by vascular dementia, dementia with Lewy bodies and Fronto-temporal dementia. There are a large number of less common causes of dementia and some people have more than one form at the same time, known as ‘mixed dementia’. Dementias occur in the brain however the mental effect can often cause physical effects, for example in Parkinson's Disease Dementia.
8 Modifiable risk factors for dementia
The Life-course model identifies 8 factors that both significantly increase the risk of dementia and are modifiable by changing lifestyle, or with other known interventions.
Different factors are identified and quantified depending on the phase of life (mid or late).
Graphic adapted from its original. See original and read the full paper (here)
The Life-course model of contribution to modifiable risk factors to dementia.
Alzheimer’s disease is the most common form of dementia. It was first observed by Dr Alois Alzheimer in 1901.
It is a progressive illness caused by chemical changes in the brain that allow abnormal proteins to build, forming clumps known as plaques or tangles. The plaques are usually first seen in the area of the brain that makes new memories, and memory loss, or difficulty remembering words, is often one of the earliest symptoms.
Everyone is different and each person experiences Alzheimer’s in a way that is personal to them. Typical symptoms of early Alzheimer’s include:
Regularly forgetting recent events, names and faces
Regularly misplacing items or putting them in odd places
Confusion about the time of day
Disorientation, especially away from normal surroundings
Problems finding the right words
Mood or behaviour problems such as apathy, irritability, or losing confidence
As the disease progresses, communication, perception, orientation and mobility can be affected as the brain’s ability to control the body declines.
Alzheimer’s symptom checklist
Drug Treatments for Alzheimer’s
There is currently no cure for Alzheimer’s disease. However, drugs are available that can slow down symptoms in some people.
Aricept, Exelon and Reminyl work by maintaining levels of acetylcholine in the brain. Side-effects are usually minor but may include diarrhoea, nausea, insomnia, fatigue and loss of appetite. Taking these medications with food, preferably a full meal can reduce the Glycemic Index (GI) effects and is normally recommended.
Aduhem (aducanumab) is the only disease modifying drug currently approved to treat Alzheimer's disease. This medication is a form of Immunotherapy that helps reduce the amyloid plaques associated with Alzheimer’s disease. The side-effects included brain bleeds and swelling, headaches, falls, diarrhoea and confusion.
Ebixa (trade name for the drug memantine) is recommended for people in both the moderate and severe stages of Alzheimer’s disease. It is believed to work by regulating the brain chemical Glutamate, which improves the transmission of signals in the brain and allows some people to maintain independence in daily task longer than without the medication; for example using the bathroom independently. Side-effects may include dizziness, headaches and tiredness, and rarely, hallucinations or confusion.
People with Alzheimer’s disease may also exhibit behavioral problems including sleeplessness, wandering and agitation. Their doctor may prescribe medication/s to manage this which may include sleep aids, anti-anxiety medication, and anti-convulsants. Their doctor will work with them and their caregiver in deciding upon using these medications.
All drugs for Alzheimer’s should be taken regularly and as prescribed by your Doctor. Medications should be taken at the same time each day to maintain levels of the drug in your body and when it is done regularly, it becomes a ‘habit’ and easier to adhere to. Make sure your Doctor is aware of all the medication you are currently taking including vitamins and supplements. Your doctor should be informed of any side-effects straightaway. Always consult your doctor before making any changes to your medication regime.
Coping Strategies for Alzheimer’s
Knowing more about the disease and understanding why the changes are happening, can help the person and those around them to cope better.
Coping strategies include slowing down the pace of life, following routines, using clear communication and focusing on what the person affected can still do and enjoy doing, rather than on their limitations.
There are a wide range of tools available to support in these areas, depending on the individual want or need. For people living with Alzheimer’s, huru can be particularly useful for reminders, supporting and maintaining a routine and providing alerts and feedback to family members if there are problems. This can help people living with Alzheimers’ retain independence and help family members with the tools and reassurance they need to support and look out for their loved ones.
Vascular dementia is the second most common form of dementia. It is caused by a reduction in blood supply to the brain. The brain is especially vulnerable to lack of blood suppy which can kill important brain cells. This results in difficulty with thinking skills. This may be sudden after a stroke that blocks a major blood vessel or it can be gradual from multiple small strokes or Transient Ischaemic Attacks (TIAs) that can cause more widespread damage.
Many experts prefer to use the term ‘Vascular Cognitive Impairment ‘ to 'Vascular dementia' as they feel it better describes the symptoms of thinking that can range from mild to severe.
Vascular dementia is also caused when deposits of chlolesterol and atherosclerosis cause narrowing and blockage of the blood vessels in the brain reducing oxygen and nourishment of the brain cells. The risk of getting Vascular dementia increases with high blood pressure, high cholesterol, diabetes, obesity, smoking, unhealthy diet, lack of exercise and too much alcohol.
Vascular dementia often presents with other dementias including Alzheimer’s disease.
Symptoms of vascular dementia include:
Becoming slower in thinking
Disorientation, especially away from normal surroundings
Difficulty finding words
Regularly misplacing items
Becoming more emotional
Difficulty walking or a change in the way a person walks
Treatment for Vascular dementia
There is no specific drug for vascular dementia, but there is clinical evidence that drugs prescribed for Alzheimer’s disease may have some benefit. Treatment strategy involves reducing the risk factors that may further damage the blood vessels. There is substantial clinical evidence that treatment of the risk factors may improve outcomes and prevent further decline.
Patients should work with their doctor to design a treatment plan. This may include :
Taking medication to treat any underlying conditions, such as stroke, high blood pressure, high cholesterol, diabetes or heart problems.
Adopting a healthier lifestyle by stopping smoking, taking regular exercise, eating healthily, and drinking alcohol only in moderation or not at all.
Rehabilitative support, such as physiotherapy, occupational therapy and speech therapy can also be helpful.
Fronto-temporal dementia is a less common cause of dementia than Alzheimer’s disease, and one that often affects people in the 45-65 year range. It includes a range of conditions in which there is damage to the front and sides of the brain. If affects personality, behaviour, language production and understanding language. It used to be known as Pick’s disease.
Symptoms of Fronto-temporal dementia can include:
Personality changes, such as loss of inhibition, apathy or inappropriate behavior of which the person is often unaware
Loss of emotional warmth and empathy for others
Decline in language abilities – including difficulty getting words out or problems with understanding words and names
Overeating or changes in dietary preference, particularly cravings for sweet food
Changes in sexual behaviour
Memory problems. Although day to day memory remains intact in the early stages, communication difficulties mean the problems can seem more severe
Motor problems involving balance, coordination and muscle stiffness
Treatment for Fronto-temporal dementia
There is no specific drug for fronto-temporal dementia. Alzheimer’s drugs like Aricept can make behaviour symptoms worse. Medications that treat agitation, irritation and/or depression may be used to improve the quality of life.
Some drugs can worsen symptoms so the treating physician should be aware of all medications the patients is taking, including supplements.
Speech therapy may be helpful for language problems.
Knowing more about the disease and understanding that the disease is the cause of the behaviour changes, can help the person and those around them to cope.
Coping strategies include avoiding confrontation and working round obsessions rather than trying to change the person’s behaviour.
Simplifying daily tasks, having a structured routine and maintaining a calm environment can also help.
Dementia with Lewy Bodies (LBD)
Dementia with Lewy bodies is caused by small clumps of protein that build up inside nerve cells in the brain, damaging the way they work and communicate with each other. These are named Lewy bodies after Dr Frederich Lewy, who first identified them. Lewy bodies are also present in Alzheimer’s disease and Parkinson’s disease dementia. Many people with Parkinson’s eventually develop lewy dementia and those with lewy body dementia can develop symptoms of Parkinson’s disease.
Repeated visual hallucinations which often involve people or animals.
Parkinson’s-type symptoms including slow movement and stiffness in the limbs.
Movements during sleep and vivid dreams.
Fluctuating alertness and thinking.
Symptoms similar to Alzheimer’s, including memory loss and disorientation.
Fainting and falls, urinary incontinence and fall in blood pressure all linked to the autonomic nervous system.
Marked variation in alertness and confusion which can fluctuate from hour to hour or day to day.
Treatment for Dementia with Lewy Bodies (LBD)
There are no specific drugs for Lewy Body Dementia, treatment strategy involves management of symptoms.
Alzheimer’s drugs such as Aricept, may be a consideration. These drugs may help with some of the symptoms. Anti-depressants may also be used. Clonaxepam may be used to treat REM sleep disorder.
Some drugs can worsen symptoms so the treating physician should be aware of all medications the patient is taking, including supplements.
Coping strategies include:
Tolerating the behaviour, some individuals are not distressed by the hallucinations.
Avoiding questioning and correcting, but instead offering reassurance and validation of the person’s concerns.
Reducing clutter, and having structure and routine during the day. This can help make life less confusing.