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The Royal College of Psychiatrists Improving the lives of people with mental illness

Dementia: key facts

 

Introduction

We all tend to get more forgetful as we get older. But dementia is different. It is a brain disease which often starts with memory problems, but goes on to affect many other parts of the brain, producing:

  • difficulty coping with day to day tasks
  • difficulty communicating
  • changes in mood, judgment or personality.

It usually gets worse over time. It is much more common in older people. Dementia can sometimes occur in younger people and may run in families, although this is rare.

 

What causes dementia?

Alzheimer’s disease is the commonest cause of dementia. Damaged tissue builds up in the brain to form deposits called ‘plaques’ and ‘tangles’. These cause the brain cells around them to die. 

 

Alzheimer's also affects the chemicals in the brain which transmit messages from one cell to another, particularly acetylcholine. It comes on gradually and develops slowly over several years.  It can sometimes run in families and it is more likely to affect people with Down’s syndrome.

 

Alzheimer’s disease produces particular problems with memory and thinking. Learning new information becomes harder – you can't remember recent events, appointments or phone messages. 

 

Vascular dementia is when the arteries supplying blood to the brain become blocked. This leads to small or big strokes - parts of the brain die as they are starved of oxygen. It is more common if you are a smoker or if you have high blood pressure, diabetes or high cholesterol.

 

Lewy body dementia seems to be caused by protein deposits (Lewy bodies) building up in the brain. 

 

Fronto-temporal dementia seem to affect the front of the brain more than other areas. It often starts in people in their 50s and 60s.

 

Mild cognitive impairment is a term used when memory problems are more than you would expect for your age, but not bad enough to be called dementia. About 1 in 3 people with this problem may develop dementia, but we can't yet predict who these people will be.

 

Other illnesses that can cause memory problems

  • Depression can cause a 'pseudo-dementia' which can get better with antidepressants and talking therapy.
  • Heavy alcohol drinking.
  • Physical illnesses which cause memory problems include:
    • kidney, liver or thyroid problems
    • shortage of some vitamins (rare), diabetes 
    • chest or urine infections can lead to confusion and can be treated with antibiotics
    • rarer conditions such as Huntington’s disease, which causes dementia in younger people. 

What does it feel like to have dementia?

Sometimes people with dementia do not feel there is anything wrong with them and get cross when people try to help. Carers often comment that the Alzheimer's has changed the personality, so the person behaves and reacts differently to how they did before they became ill.

Alzheimer's disease produces particular problems with memory and thinking. Learning new information becomes harder - you can't remember recent events, appointment or phone messages.

You may forget the names of people or places and may struggle to understand or communicate with others. Commonly, you just can't find the right ward for objects or people you know well. This can make you frustrated and depressed. You may think that people have taken or stolen your things when all that has happened is that you have lost them.

On Vascular dementia, problems will depend on which party of the brain is affected. There may be memory loss, poor concentration, word finding difficulties, mood swings and depression. Some people have hallucinations (where they see or hear something that is not there). Physical problems can develop, such as difficulties with walking and incontinence.

It is difficult to predict how fast your brain functions will deteriorate. It can be stable for several months or years but then, when more strokes happen, you get further deterioration.

Lewy body dementia causes symptoms which overlap with Alzheimer's disease and Parkinson's disease. The level of confusion can very during the course of the day, but visual hallucinations of people or animals are more common. They may also have a tremor, muscle stiffness, falls or difficulty in walking.

Because fronto-temporal dementia affects the front of the brain, it is more likely to cause personality and behavioural changes. So a person who is usually very polite and proper might start to become irritable and rude.

Treatments that can help

If you are worried about your memory, see your doctor.  He or she can do a simple memory test, a physical examination and order blood tests.  They can then refer you to a specialist team or a memory clinic who will test your memory in more detail and arrange a brain scan if needed.

Treatment will depend on the diagnosis and your circumstances. Unfortunately there are no cures for many of these conditions.

There is a group of drugs called acetyl cholinesterase inhibitors which may slow the progression of Alzheimer’s dementia (see our factsheet).  These drugs may also help in Lewy Body dementia if hallucinations are a problem.  In Vascular dementia, a small dose of aspirin may help to prevent further strokes or medication may help to control high blood pressure or raised cholesterol.  It is also important to stop smoking, eat healthily and take exercise.

How you can help yourself

  • Use a diary to help you remember appointments and make lists.
  • Keep your mind active by reading or doing crossword puzzles, Sudoku’s and other mind exercises.
  • Get regular physical exercise (it can help whatever your age).
  • Eat a healthy diet. Supplements such as Vitamin E and Ginkgo Biloba don't seem to help.

Charities such as the Alzheimer’s Society are a very useful source of advice. A mental health nurse can help you understand more about the illness. They can give advice about medication and other help available.  Social services can help with home helps, meals at home or day care. You may be entitled to benefits. 

 

Plan for the future

There may come a time when it is difficult to make decisions about managing finances or medical decisions. You can give a trusted relative, friend or solicitor the right to make such decisions on your behalf if you cannot. This is called a Lasting Power of Attorney (LPA). A solicitor can help you to arrange an LPA.

Advance Decisions - it is possible to make known decisions to refuse certain medical treatments in the future should you lose the capacity to make decisions. These will be respected by the professionals providing care. This can be made at the same time or separately from a LPA.

How other people can help

  • Others may notice early symptoms, so they can help by encouraging you to talk to your doctor. The earlier you are diagnosed the better.
  • Help you to remember things by prompting you.
  • Encourage and help you to continue doing the things you have always done.
  • Be patient and not do things for you because it is quicker.
  • Help you adapt your lifestyle and maintain your confidence.
  • Explain things that you don't understand.

For more in-depth information see our main leaflet: Dementia and Memory Problems

This leaflet reflects the most up-to-date evidence at the time of writing.

Produced by the RCPsych Public Education Editorial Board.

Series Editor: Dr Philip Timms

Reviewed by Elaine Ellis

© March 2014. Due for review: March 2016.  

Coping after a traumatic event

Introduction

A sudden illness, an accident or an assault, or a natural disaster - these are all traumatic experieCoping with traumances which can upset and distress us. They arouse powerful and disturbing feelings in us which usually settle in time, without any professional help.

This leaflet may be useful if:
 
  • you have been through a traumatic experience and want to understand more about how you are feeling
  • you know someone who has been through a traumatic experience, and want to get a better idea of how they might be feeling.
  • It describes the kind of feelings that people have after a trauma, what to expect as time goes on, and mentions some ways of coping and coming to terms with what has happened.

A traumatic event occurs when a person is in a situation where there is a risk of harm or danger to themselves or other people. Situations like this are usually frightening or cause a lot of stress. In such situations, people feel helpless.

What is a traumatic event?

Examples of traumatic events include:

  • serious accidents
  • being told you have a life-threatening illness
  • bereavement
  • violent personal assault, such as a physical attack, sexual assault, robbery, or mugging
  • military combat
  • natural or man-made disasters
  • terrorist attack
  • being taken hostage
  • being a prisoner of war.

What happens immediately after a trauma?

Immediately after a traumatic event, it is common for people to feel shocked, or numb, or unable to accept what has happened.

Shock  - when in shock you feel:

  • stunned or dazed or numb
  • cut off from your feelings, or from what is going on around you.

Denial -  when in denial, you can't accept that it has happened, so you behave as though it hasn't. Other people may think that you are being strong or that you don't care about what has happened.

Over several hours or days, the feelings of shock and denial gradually fade, and other thoughts and feelings take their place.
 

What happens next?

People react differently and take different amounts of time to come to terms with what has happened. Even so, you may be surprised by the strength of your feelings. It is normal to experience a mix of feelings. You may feel:

  • Frightened … that the same thing will happen again, or that you might lose control of your feelings and break down.
  • Helpless … that something really bad happened and you could do nothing about it. You feel helpless, vulnerable and overwhelmed.
  • Angry … about what has happened and with whoever was responsible.
  • Guilty … that you have survived when others have suffered or died. You may feel that you could have done something to prevent it.
  • Sad … particularly if people were injured or killed, especially someone you knew.
  • Ashamed or embarrassed … that you have these strong feelings you can't control, especially if you need others to support you.
  • Relieved … that the danger is over and that the danger has gone.
  • Hopeful … that your life will return to normal. People can start to feel more positive about things quite soon after a trauma.

What else might I notice?

Strong feelings affect your physical health. In the weeks after a trauma, you may find that you:

  • cannot sleep
  • feel very tired 
  • dream a lot and have nightmares
  • have poor concentration
  • have memory problems
  • have difficulty thinking clearly
  • suffer from headaches
  • experience changes in appetite
  • experience changes in sex-drive or libido
  • have aches and pains
  • feel that your heart is beating faster.

What should I do?

  • Give yourself time
    It takes time - weeks or months - to accept what has happened and to learn to live with it. You may need to grieve for what (or who) you have lost.
  • Find out what happened
    It is better to face the reality of what happened rather than wondering about what might have happened.
  • Be involved with other survivors
    If you go to funerals or memorial services, this may help you to come to terms with what has happened. It can help to spend time with others who have been through the same experience as you.
  • Ask for support
    It can be a relief to talk about what happened. You may need to ask your friends and family for the time to do this - at first they will probably not know what to say or do.
  • Take some time for yourself
    At times you may want to be alone or just with those close to you.
  • Talk it over
    Bit by bit, let yourself think about the trauma and talk about it with others. Don't worry if you cry when you talk, it's natural and usually helpful. Take things at a pace that you feel comfortable with.
  • Get into a routine
    Even if you don't feel much like eating, try to have regular meals and to eat a balanced diet. Taking some exercise can help - but start gently.
  • Do some 'normal' things with other people
    Sometimes you will want to be with other people, but not to talk about what has happened. This can also be part of the healing process.
  • Take care
    After a trauma, people are more likely to have accidents. Be careful around the home and when you are driving.

What should I NOT do?

  • Don't bottle up your feelings
    Strong feelings are natural. Don't feel embarrassed about them. Bottling them up can make you feel worse and can damage your health. Let yourself talk about what has happened and how you feel, and don't worry if you cry.
  • Don't take on too much
    Being active can take your mind off what has happened, but you need time to think to go over what happened so you can come to terms with it. Take some time to get back to your old routine.
  • Don't drink or use drugs
    Alcohol or drugs can blot out painful memories for a while, but they will stop you from coming to terms with what has happened. They can also cause depression and other health problems.
  • Don't make any major life changes
    Try to put off any big decisions. Your judgement may not be at its best and you may make choices you later regret. Take advice from people you trust.

When should I get professional help?

Family and friends will probably be able to see you through this difficult time. Many people find that the feelings that they experience after a traumatic event gradually reduce after about a month. However, you may need to see a professional if your feelings are too much for you, or go on for too long.

You should probably ask your GP for help if:

  • you have no one to share your feelings with
  • you can't handle your feelings and feel overwhelmed by sadness, anxiety, or
  • nervousness
  • you feel that you are not returning to normal after six weeks
  • you have nightmares and cannot sleep
  • you are getting on badly with those close to you
  • you stay away from other people more and more
  • your work is suffering
  • those around you suggest you seek help
  • you have accidents
  • you are drinking or smoking too much, or using drugs to cope with your feelings.

What is post-traumatic stress disorder?

Following a traumatic event, some people experience a particular condition called post-traumatic stress disorder (PTSD). Symptoms that are most commonly experienced by people with PTSD include:

  • re-experiencing the trauma through vivid and distressing memories or dreams
  • avoiding situations that remind them of the traumatic event
  • feeling numb, as though they don't have the same range of feelings as normal
  • being in a state of 'alertness' - watching out for danger.

If you are experiencing problems that might be PTSD, you should seek professional help.

What professional help is available?

Your GP might suggest that you talk with someone who specialises in helping people cope with traumas. They will usually use a talking treatment, such as counselling or psychotherapy. For example, a talking treatment called cognitive behavioural therapy has been shown to be helpful.

You may find that there is a support group for people who have been through a similar trauma to yourself. It can be helpful to hear that others have had similar feelings and experiences.
 

Can my doctor prescribe any medication to help me cope?

Medication can sometimes be helpful following a trauma, but it is still important to see your doctor regularly to check how you are doing.

Tranquillisers

There are drugs that can help to reduce the anxiety that can follow a trauma. They can also help you to get off to sleep. They are often called 'tranquillisers'. Common ones include diazepam (Valium), lorazepam (Ativan) and temazepam.

In the short term, tranquillisers can help you to feel less anxious and to sleep. However, if they are used for longer than a couple of weeks:
  • your body gets used to their effect and they stop working
  • you have to take more and more to get the same effect
  • you may get addicted to them.

Antidepressants

You can become ill with depression following a trauma. Depression is different form normal sadness - it is worse as it affects your physical health and it goes on for longer. Depression can be treated with either antidepressant medication, or with talking treatments such as counselling or psychotherapy.

Useful web links

Further reading

Overcoming Traumatic Stress by Claudia Herbert and Ann Westmore is a self-help book. It is based on cognitive behavioural therapy and demonstrates, with practical advice and exercises, how to find new and effective ways of coping with and overcoming traumatic stress. Published by Constable & Robinson.
 

References

  • Bisson J.I., Roberts N. & Macho G. (2003). The Cardiff traumatic stress initiative: an evidence-based approach to early psychological intervention following traumatic events. Psychiatric Bulletin, 27, 145-147.
  • Bisson J.I., Bolton J., Mackway-Jones K. and Guthrie E. (2007) Major disaster planning, in Handbook of Liaison Psychiatry, Eds. Lloyd G.G. and Guthrie E. Cambridge University Press.
  • Bonanno, G.A. (2004). Loss, trauma, and human resilience. Have we underestimated the human capacity to thirve after extremely aversive events? American Psychologist, 59, 20-28.
  • Galea, S., Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., & Vlahov, D. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine, 346, 982-987.
  • Mellman T.A., Bustamante V., David D., et al. (2002). Hypnotic medication in the aftermath of trauma. Journal of Clinical Psychiatry, 63, 1183-1184.
  • National Collaborating Centre for Mental Health (2005). Post-traumatic stress disorder: the managemnt of PTSD in adults and children in primary and secondary care. London?Leicester: Gaskell and the British Psychological Society.
This factsheet was produced by the Royal College of Psychiatrists' Public Education Editorial Board and the Faculty of Liaison Psychiatry.
 
This leaflet reflects the best available evidence at the time of writing.
Series Editor: Dr Philip Timms
Lead authors: Dr Jim Bolton, Professor Jonathan Bisson, Professor Elspeth Guthrie, Mr Steve Wood.
Expert reviewer: Dr Jim Bolton.
 
© March 2011. Due for review: March 2013. Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.
 

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