There are many causes of dementia. The commonest cause is Alzheimer’s disease, The second commonest cause is vascular dementia. Other causes include dementia with Lewy bodies, brain tumour, head injury, excessive drugs and alcohol use, as well as vitamin B12 deficiency, etc. About 10 to 15% of cases of dementia in the elderly are potentially reversible. Hence, it is important to seek medical advice early so that tests can be done to look for reversible causes.
Alzheimer’s disease is a degenerative disorder of the brain. The symptoms may include problems with memory, cognitive ability, insight, language and spatial awareness.
Alzheimer’s disease tends to develop quite slowly over time. The patients become progressively confused and disorientated especially when out. At home they may encounter difficulty in performing everyday simple tasks such as getting dressed, going to toilet and feeding themselves etc.
Vascular dementia is also known as multi-infarct dementia (MID) which means that many repeated episodes of small strokes cause pockets of brain cell damage. Unlike Alzheimer’s disease, it often follows a more stepwise deterioration followed by a period of relative recovery. Language and communication may be more affected than memory. It is possible to have mixed dementia which is caused by a combination of Alzheimer’s disease and vascular dementia.
Frontotemporal dementia is sometimes called frontal lobe or Pick’s disease which is more commonly found in younger people, between ages 45 and 65. It is relatively uncommon and can be difficult to diagnose. It can cause disinhibition and inappropriate behaviour, particularly in public so this form of dementia may be confused with other diagnoses such as depression, psychosis or obsessive compulsive disorder.
Dementia with Lewy Bodies
In Dementia with Lewy Bodies, cognitive impairment can fluctuate but on the whole progressively worsens over time. A person with Lewy Bodies may have symptoms similar to those experienced by patients with Parkinson’s disease. Movements and motor control including swallowing may be affected. Visual or auditory hallucinations are often present. Memory is often less affected but sudden bouts of confusion can occur. People with Lewy Bodies tend to fall asleep easily during the day and experience disrupted sleep at night together with having intense dreams or nightmares.
Young onset dementia
The diagnosis is often unexpected. It is particularly problematic for the family owing to the loss of income. The partner may have to give up work to care for the patient. Even young children may have to take on caring roles as the disease progresses.
In early stages and in familiar places it is easier for people with dementia to hide some of their difficulties.
Some of the common symptoms are:
Memory problems – short term memory is most often affected first with new information difficult to retain. They may get lost in familiar places and experience confusion with names. Family members or close friends may be the first one to notice their memory loss.
Cognitive ability – people with dementia may experience confusion in unfamiliar environments. They may also have difficulty in time as well as place orientation. Their ability to concentrate and to reason may be affected. They may get a sense of restlessness and prefer to keep moving than sitting still.
Communication – They often tend to repeat themselves which carers or family members may find annoying and difficult to live with. Reading and writing may become difficult. They may have changes in personality and behaviour, mood swings, anxiety and depression so they may lose interest in socialising.
Prevalence and incidence rates of dementia in the UK
We are seeing more and more people with dementia as we live longer and longer. The Alzheimer’s Society (2015) reports there are over 850,000 people living with dementia in the UK today. Of these, approximately, 40,000 are people with young onset dementia. The number of people living with dementia in the UK by 2025 may rise to over 1 million.
Dementia is still significantly under diagnosed. An accurate diagnosis is essential in order that patients and carers can receive timely advice, support and treatment.
Reduce the risk of developing dementia
Developing a healthy lifestyle such as giving up smoking, eating a healthy diet, regular exercise and reducing alcohol intake will mitigate some of the risks causing vascular dementia. Keeping socially active, reducing blood cholesterol and lowering blood pressure will have a positive impact on health and well-being. It has been said what’s good for the heart is also good for the brain.
Stigma causes negative feelings and is often a primary concern for the people living with dementia and their carers. Stigma exists partly because of the lack of public awareness and understanding of the diseases causing dementia preventing them from:
Seeking medical treatment when symptoms are present
Receiving an early diagnosis or any diagnosis at all
Living the best quality of life possible while they are able to do so
Making plans for their future
Benefiting from available treatments
Developing a support system
Participating in disease research and clinical trials