10 dementia facts
In this article we will describe facts about 10 dementia. Let’s start with the basics.
1. What is dementia?
Dementia is not a single disease but a term for a group of brain diseases characterised by memory loss, mental quickness, language (such as using words incorrectly, or trouble speaking) and understanding, judgement, mood and personality, and movement.
All of this interferes with doing everyday activities. Therefore dementia has a physical, psychological, social, and economic impact, not only on people with dementia, but also on their carers, families and society at large.
Alzheimer’s disease is the most common type of dementia. None of the types of dementia are just a problem with memory, and all types tend to get worse over time. Treatment may slow the progression down in some people.
2. Who gets dementia?
Dementia is common in older people, affecting 10% of people at 80 years, and 20% at 90 years. This equates to over 1 million people in the UK. Twice as many women as men have dementia.
Dementia can affect a person at any age but it usually starts over the age of 65 years.
3. What are the types of dementia?
There are two main types of dementia (neither type usually runs in families):
- Alzheimer’s Disease – is caused by a build-up of an abnormal protein called beta-amyloid in the brain
- Vascular dementia – is caused by problems in the supply of blood to the brain, commonly due to strokes, or ‘mini strokes’ called transient ischaemic attacks (TIAs).
Some people to have ‘mixed dementia’ or the presence of two or more different types of dementia. For example, someone may have memory impairment associated with Alzheimer’s as well as motor functioning issues associated with vascular dementia or language issues associated with frontotemporal dementia (another type of dementia).
It is important that a clear diagnosis is made, and the problems are not just linked to ageing. Dementia is not a ‘natural part’ of ageing.
4. Causes of dementia
There is no single cause of dementia. However, research suggests that the risks of developing dementia can be influenced by a range of genetic and environmental factors. These include:
- Age – as stated above, there is a link between age and dementia. This is likely to be because of factors associated with ageing (high blood pressure, increased incidences of diseases such as heart disease/stroke, and changes in nerve cells/DNA and cell structure)
- Gender – there is a greater proportion of women with dementia
- Genetics – there are less than 1,000 cases of hereditary dementia and research regarding the hereditary nature is ongoing with relatively little evidence to date.
- Medical history – certain conditions increase the risk of dementia e.g. Multiple Sclerosis; Huntingdon’s disease; Down’s Syndrome and HIV.
- Head injuries – people regularly experiencing head trauma (such as boxers) have a greater chance of experiencing a form of dementia.
5. What investigations are done for dementia?
There’s no single test for dementia. A diagnosis is based on a combination of assessments and tests. These may be done by a GP or a specialist at a memory clinic at a hospital.
- Blood tests
- Full blood count, ESR, CRP
- Kidney, liver or thyroid function
- Haemoglobin A1c (to check for diabetes)
- Vitamin B12 and folate levels
- Chest xray
- CT head.
6. What are alternative diagnoses?
In order to diagnose someone with dementia, doctors need to rule out all other conditions that may cause similar symptoms; including infections, depression, vitamin deficiency, thyroid problems and the side effects of medication.
In order to rule out alternative conditions, a GP may refer you a range of hospitals specialists such as
- Geriatricians (doctors specialising in the care of older people) – they run memory clinics
- Neurologists (diseases of the nervous system)
- Psychiatrists (mental health).
7. Can you have other brain diseases at the same time as dementia?
Yes. This is partly as they are common; and partly as there is a lot of overlap between dementia, depression and Parkinson’s Disease (PD). This is because the symptoms can be similar.
For example, PD can affect your memory (like dementia). And both dementia and PD can make you fed up and depressed. So it is important that your GP and specialist focuses on (and treats) all three if you have them. Ask them.
8. What is the treatment of dementia?
The main treatments are drugs called:
- Acetylcholinesterase inhibitors (this is often shortened to ‘cholinesterase inhibitors’) – Donepezil, rivastigmine and galantamine are examples
- NMDA receptor antagonists – Memantine is an example.
There is currently no cure. But there are things you can do, which we will now describe.
9. What can I do to improve my dementia?
- Other brain diseases (see above). Hence is important that your GP and specialist focuses on (and treats) all three if you have them. Ask them
- Lifestyle changes. It is also good idea not to smoke, keep trim, exercise and keep your alcohol consumption down
- Take your tablets carefully. Patients with dementia are often on a lot of medication. A dosette box is useful to make it easier to take the tablets at the correct time. Ask your pharmacist
- Charity. Contact a major patient charity, and join the local branch of that charity. Dementia UK and the Alzheimer’s Society are important ones.
10. What can the NHS do?
- GP. Many patients can be looked after by an NHS GP alone. But if things are not settling, or the diagnosis is unclear, you should be referred to a hospital consultant. They normally work in a Memory Clinic at your local hospital
- Hospital consultant. The consultant may be a specialist in the care of the elderly or a brain specialist (called a neurologist). Either way, when you see a consultant (or their deputy, called a registrar), only let them discharge you when you feel the dementia is fully investigated and the condition is stable. In the meantime, ask for review every 3-6 months – this can be virtual. They can also get you to see a hospital (or community based) dementia nurse
- GP Practice Nurse. Many GPs have a practice nurse that runs a ‘long-term condition’ clinic. Ask for three monthly review there. Some of them work with a clinical pharmacist who can fulfil a similar role.
Summary
We have described 10 dementia facts. If you do all of the above, you will get better care. And your dementia may stabilise, or at least, slow down.
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