Diagnosing and treating dementia
Although dementia is a relatively common disease, it is not an inevitable part of growing old. According to Dementia UK, the condition affects 1 in 14 people over the age of 65 years, rising to 1 in 6 people over the age of 80.
An Overview
Dementia is not a disease with one cause, it is a syndrome – a collection of related symptoms, which can be triggered by a number of different causes. These symptoms occur as the brain struggles to cope with the demands of everyday living.
A short explanation of dementia (video by Alzheimer’s Society)
In some cases, it is possible to slow the effects of dementia, but for most people it is a progressive disease, meaning the symptoms worsen over time.
Diagnosing Dementia
Dementia affects a person by slowing down their thinking speed and mental agility. As a result, they may have difficulty expressing themselves, recalling memories, display poor judgement and struggle to control their emotions.
In day-to-day life these problems may display themselves as:
– Difficulty following a simple recipe.
– Finding it harder to recall a recent event than a memory from long ago.
– Being unable to count out the correct change in a shop.
– Speaking less as the person is unable to keep up with the flow of conversation or find the right words to express themselves.
– Emotional outbursts triggered by frustration at being unable to do a previously effortless task.
At The Doctor’s Office
The GP will ask about the symptoms causing concern and give the person a physical examination. They will also organise a blood test and review existing medications for possible causes of the symptoms described.
To assess a person’s mental agility and memory, the GP will also ask the person to complete a few mental exercises. The most widely used test is the Mini Mental State Examination (MMSE).
During the test, the person is asked to complete activities such as remembering items on a shopping list and identifying a date on a calendar. The test provides a good measure of the person’s current short and long term memory, attention span, concentration, language and communication skills, ability to plan, and ability to understand instructions.
Following a diagnosis of dementia, your GP or specialist will monitor your condition through assessments every 6-12 months.
Causes of Dementia
A Video explaining the difference between dementia and alzheimer’s disease (video by Trinity College Dublin)
Alzheimer’s disease causes 62% of dementia cases in the UK.
The main area affected by Alzheimer’s disease is the grey matter covering the brain, known as the cerebral cortex. This area is responsible for processing thoughts and complex functions like retrieving and storing memories, calculation, spelling, planning and organising.
It is thought that clumps of protein, known as ‘plaques’ and ‘tangles’ form inside the brain. The plaques buildup in the spaces between nerve cells and tangles develop inside the brain cells. Together they interrupt the communication mechanisms between nerve cells and disrupt the processes essential to the cells’ survival.
Medical treatments are available to slow the onset of dementia symptoms caused by Alzheimer’s disease. Cholinesterase inhibitor medications, which include donepezil, rivastigmine and galantamine have been shown to be beneficial. These drugs make the brain cells work a bit harder reducing symptoms.
Vascular dementia occurs when the brain’s blood supply is slowly restricted causing brain cells to die.
Alongside more common dementia symptoms (slower mental agility and memory loss), it can also cause muscle weakness and paralysis on one side of the body. The symptoms are similar to the symptoms of a stroke.
Vascular dementia is caused by atherosclerosis, the narrowing and hardening of the blood vessels in the brain that is usually a result of fatty deposits along the vessel walls. In smaller blood vessels, these fatty deposits buildup, clogging the vessels, gradually depriving the brain of blood and therefore oxygen. This is known as small vessel disease.
Atherosclerosis is more common in people with type one diabetes, high blood pressure, and those who smoke. A history of stroke or small vessel disease can also increases the chances of a person developing vascular dementia.
A person with this type of dementia will display the usual symptoms of poor memory, confusion and weaker cognitive ability plus they may also experience alternating periods of alertness and drowsiness, fluctuating levels of confusion, visual hallucinations, and less fluid physical movement. The symptoms may look similar to Parkinson’s disease as the two conditions are closely related.
Lewy bodies are small circular clumps of protein that develop inside brain cells. It is unclear why they develop, or how they damage the brain, but it is thought they have an effect on the neurotransmitters that send information from one brain cell to another. The same cholinesterase inhibitor medications used to treat Alzheimer’s disease have also shown to be beneficial in cases of dementia with Lewy bodies. By encouraging the unaffected brain cells to work harder, the medication can improve the dementia symptoms.
As this form of dementia affects the temporal lobe and frontal lobe, it typically has a greater effect on personality and behaviour. A person may seem cold and unfeeling as they have difficulty relating to the emotions of others. They may also lose their inhibitions resulting in erratic behaviour. Language problems may occur including loss of speech and difficulty finding the right words.
This is one of the more common causes (after Alzheimer’s disease) of early onset dementia.
It is estimated that in 15-40% of frontotemporal dementia cases the person has inherited a genetic mutation from their parent.
Parkinson’s disease is caused by progressive damage to the brain resulting in tremor, slow movements, and body stiffness. A person with Parkinson’s disease may be diagnosed with one of two forms of dementia: Parkinson’s dementia or dementia with Lewy bodies, depending on the timing of the onset of symptoms in relation to the physical symptoms caused by Parkinson’s disease.
Treating Dementia
Lifestyle Changes
You should maintain a healthy blood flow to the vessels in the brain, by keeping blood pressure within a normal range through a healthy diet and adequate levels of exercise. If you smoke or use alcohol to excess, this can make dementia symptoms worse.
Medication
For some types of dementia, specifically Alzheimer’s disease and dementia with Lewy bodies, medication can be used to delay the onset of symptoms. Medication may also be useful in treating other conditions, such as Vitamin B deficiency or depression that could be making symptoms worse.
Cognitive Stimulation
Cognitive stimulation is a psychological therapy designed to help people with dementia cope with the symptoms they experience. The therapy is often completed in a group-based environment. The activities are designed to improve your memory, problem-solving skills and language ability. Evidence suggests that regular engagement with cognitive stimulation therapy helps slow the deterioration caused by dementia. It is the only psychological treatment recommended by the National Institute for Health and Care Excellence (NICE).
Behavioural Therapy
Working from the view that all behaviour is meaningful, the carer can seek to understand what drives the behaviour presented by a person with dementia, and then with the guidance of a healthcare professional, devise a strategy to change it. For example, someone who restlessly wanders about in the early evening may not be receiving enough exercise during the day to be able to feel restful in the evening. One strategy to change this behaviour might be to introduce a daily walk in the afternoon.
Living Well With Dementia
Some of the untold issues of living with dementia (image by Number 10 as part of the PM’s #dementiachallenge in association with Alzheimer’s Society)
Although dementia is not curable, it is certainly possible to live well with the disease. A few lifestyle adjustments and adaptations to the home can enable a person with dementia to continue living independently for some time after diagnosis.
Significant weight loss is common in people with dementia.
Dementia often affects a person’s ability to make decisions and the ability to follow simple instructions, making meal planning challenging. A simple list of tried and trusted meal and snack ideas, especially if presented as photos rather than just words, can help a person decide what they would like to eat. A carer may need to help prepare meals.
If dementia is affecting a person’s ability to speak and swallow, they must seek medical advice. An inefficient swallow mechanism can cause food particles to enter the airways, resulting in a chest infection.
It is important not to make multiple major changes to the home at once. However, there are a few minor adaptations that can be made to enable the person to live independently at home as long as possible:
– Use a bright contrasting colour to make the important features of a room more visible, for example, the toilet seat, armchair, or bed linen.
– Keep important telephone numbers on display next to the telephone.
– Declutter the space and reduce the amount of furniture in the home to reduce the risk of trips and falls.
– Ensure all rooms are well lit.
– A daily newspaper delivery can help a person keep track of the day and date, combined with a calendar listing all forthcoming appointments and events.
– Reflective surfaces can be frightening for someone with dementia if they can no longer recognise their own reflection.
– Use written labels or photographs posted on doors and cupboards to help navigate around the home.
Dementia Research and Cures
Estimated number of people to be diagnosed with dementia over the next 40 years (image by Number 10 as part of the PM’s #dementiachallenge in association with Alzheimer’s Society)
Research is currently focused in three areas: gene therapy, development of a vaccine, and stem cell research.
The disease costs the UK £23bn each year, more than total costs associated with stroke, cancer and heart disease combined. Yet annual spending on dementia research currently sits at £50m, less than 10% of the £590m spent annually researching cancer.
While a cure for dementia may be a long way off in the UK, considerable investment is being made in improving support services for people with dementia and their carers. The combined effect of these measures means it is increasingly possible to live independently, and live well with dementia.
A look at dementia in the UK (infographic by Acorn Stairlifts)
