What is dementia?
Dementia is a term used to describe the symptoms of many disorders that affect the brain. It is not therefore one specific disease. Because there are so many causes of dementia which affect people differently, and which change over time, no two people will experience dementia in the same way.
There are more than 55 million people world-wide with dementia, and about 1,600 in Jersey.
Because dementia mainly affects older people and because we can now expect to live well into our 80s or 90s, it is more common than even 100 years ago. This rise in numbers is also in part due to people having better access to medical care and there being better ways of diagnosing this. There is also significant evidence that life-style factors may be influencing the increase in the number of people with dementia, so there is a renewed focus on brain health and risk reduction strategies.
Although the risk of dementia increases with age, younger people in their 30s – 60s can also have dementia. The term ‘younger onset dementia’ is used for any form of dementia under the age of 65.
What causes dementia?
There are many different conditions that can cause dementia, which we sometimes think of as the types of dementia.
The most common types are, Alzheimer’s disease, vascular dementia, Lewy body disease, frontotemporal dementia, and alcohol acquired dementia (sometimes called Korsakoff’s syndrome. While quite a lot is known about the changes that are happening in the brain with these conditions, why people develop dementia is mostly unknown, apart from some types of vascular dementia and alcohol related dementia.
Anyone can get dementia but the likelihood of having dementia increases with age. We also know that our health and lifestyles, and for a very small number of people diagnosed, genes may be a cause.
Dementia occurs when nerve cells in the brain are damaged. These cells carry messages between different parts of the brain and to other parts of the body and as more nerve cells are damaged the brain becomes less able to work properly.
Alzheimer’s disease, which is the most common type of dementia, is a physical disease of the brain. This occurs when brain neurons are damaged by the build-up of proteins called amyloid and tau around them, which then affects the way they transmit messages. These changes may affect the whole of a person’s brain or just part and are progressive.
Vascular dementia is the second most common type of dementia which can affect any part of the brain. There are 4 types of vascular dementia with different causes, but all are related to the flow of blood in the brain and the resulting damage to brain cells because of this.
Lewy Body Disease
Lewy body disease is a type of dementia caused by Lewy bodies which are clumps of protein that build up in the nerve cells and reduce the levels of some important chemicals needed to send messages across the brain. This then leads to the death of nerve cells. Many people with Lewy body disease also have the build-up of the other proteins that cause Alzheimer’s disease.
Frontotemporal dementia is one of the less common types and is sometimes called Pick’s disease. This is the name given to damage in the front (frontal) and side (temporal) parts, or lobes, of the brain. As more nerve cells are damaged and die, these lobes get smaller and lead to more specific symptoms.
Alcohol related Dementia
This type of dementia is usually caused by the toxic effect of the alcohol damaging nerve cells and blood vessels in the brain, and because excessive alcohol can lead to reduced levels of vitamin B1 (also called thiamine) which is essential for good brain health. Further to this, a person who regularly drinks too much alcohol is at higher risk of repeated head injury which can cause lasting damage to the brain.
Symptoms of dementia
People with dementia do not always have the same symptoms. This is because, particularly in the early stages, different types of dementia usually have different symptoms, and people may respond to the changes they are experiencing differently.
However, these are some of the common symptoms people may have.
- Problems remembering things that happened quite recently
- Repeating things or asking the same question many times
- Problems concentrating or working things out
- Finding it harder than usual to do routine tasks
- Problems finding the right word
- Problems following conversations
- Getting lost in familiar place
- Problems judging distances
- Finding they are more anxious, sad, irritable, or frightened
- Changes in their personality or the way they react to things
As dementia progresses, the person with dementia and their families caring for them are likely to need the help and support of various health care professionals. These professionals can help care for the person in their own home or in residential care. Support is also available in Jersey for the family and friends of people with dementia.
Because the symptoms of dementia usually develop slowly, it may be some time before a diagnosis can be confirmed. To reach a diagnosis, doctors usually spend some time listening to their patients explain the symptoms they are experiencing and arrange for them to have some tests. These tests usually include a scan, blood and urine tests and an ECG (a test to check for any abnormalities in the patient’s heart). The results of these are carefully considered by a specialist doctor before they can determine a diagnosis. The diagnosis may be for a particular brain condition such as Alzheimer’s disease, or vascular dementia, but if the symptoms are mild and no specific condition is identifiable, the patient may be asked to return for further tests in the future, or may be given a diagnosis of mild cognitive impairment (MCI). This is not a diagnosis of dementia, but just indicates that a person may be experiencing some minor problems with cognition (mental processing).
It is important that anyone who is experiencing any problems as outlined above seeks medical assistance. This will help rule out any other treatable conditions that can have similar symptoms. If dementia is diagnosed, the person and their family will then be able to access further assistance, which may include medication, other therapeutic activities or professional cacre. It will also mean that if there are decisions to be made such as writing a will or arranging powers of attorney, these can be done while the person has capacity to do so.
Treatments for dementia
Unfortunately, there are no cures for dementia but there are some medications that can help manage some of the symptoms experienced, and if a person is diagnosed with vascular dementia, then other medications may be prescribed to manage any problems related to this. These medications are not suitable for everyone and if prescribed they will be reviewed regularly, and any side-effects will be discussed.
From time to time the national news reports new breakthroughs in medications for dementia. There have sadly been no new medications for many years, and none are likely to be available any time soon for people currently diagnosed with dementia. If such medications ever become available in the future, and if they are suitable for you, your doctor will make these known to you and reassess your situation.
Other things that will help
What we do know to be helpful in managing the symptoms of dementia is for people to remain actively involved in their usual interests, learn new things that are of interest to them and maintain their current relationships. We also know that those around them can help significantly in the way they engage with the with person with dementia and learn about the condition. People may also benefit from meeting others with a similar diagnosis and from talking therapies, enabling them to share things that might be troubling them, to find strategies for managing symptoms, and for exploring things that are important to them.
Did you know?
Lack of knowledge about dementia leads to inaccurate assumptions about its effects on the person and their family and negative stereotypes about how a person with dementia will behave.