Dementia: key facts
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What is dementia?
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, judgement or personality.
It usually gets worse over time. With
dementia you tend to have to rely on other people more and more as
the illness progresses. It is much more common in older
people, but can start as early as 40.
About 1 in every 20 over-65s have dementia and
by the age of 80 about 1 in 5 will have some degree of
dementia.
What causes dementia?
Alzheimer’s disease is the
commonest cause. 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.
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 word for objects or people
you know well. This can make you frustrated and depressed. You may accuse people of taking
things when all that has happened is that you have lost them.
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 or reacts differently to how
they did before they became ill.
Vascular dementia - the
arteries supplying blood to the brain become blocked. This
leads to small strokes - parts of the brain die as they are starved
of oxygen. It is more common if if you are a smoker or if you
have high blood pressure, diabetes or high cholesterol.
It is difficult to predict how fast it will
deteriorate. It can be stable for several months or years but then,
when more strokes happen, you get further deterioration.
The problems caused by vascular dementia will
depend on which part of the brain is affected. There may be
memory loss, poor concentration, word finding difficulties, mood
swings or depression. Some people have hallucinations (where
they see or hear something that is not there). Physical
problems can develop, such as difficulties with walking or
incontinence.
Lewy body dementia - People
with Lewy body dementia have symptoms which overlap with
Alzheimer’s disease and Parkinson’s disease. The level
of confusion can vary 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 with
walking.
Fronto-temporal dementia – if
the dementia affects the front of the brain more than other areas,
it is more likely to cause personality changes as well as memory
problems.
Other causes of dementia
Many other illnesses can cause memory
problems. Depression can cause a 'pseudo-dementia' which can get
better with antidepressants and talking
therapy. Physical illnesses which cause memory problems
include:
- kidney, liver or thyroid problems
- shortage of some vitamins (rare)
- 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 is mild cognitive impairment?
Many of us worry about our memory as we get
older. This term is used when the problem is more than you
would expect for your age but not bad enough to be called
dementia.
About 1 in 20 of people with this problem may
develop dementia, but we can't yet predict who these people will
be.
Getting 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 to you
a specialist team or a memory clinic who will test your memory in
more detail and arrange a brain scan if needed.
Simple practical steps to help with memory
problems
- 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.
Treatment
This depends 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.
Planning for the future
Discuss any worries you have with your doctor,
mental health nurse or social worker. Charities such as the
Alzheimer’s Society are also 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. You may
also wish to complete a Lasting Power of Attorney. This means
that someone you trust can look after your affairs when you find
that you can't do this yourself.
For more in-depth information see
our main
leaflet.
This leaflet is made available through the
generosity of the Charitable Monies Allocation Committee
of the mental health charity St Andrew's, Northampton
June 2011. Due for review
June 2013. This is an abridged version of our main
leaflet.
© Royal
College of Psychiatrists http://www.rcpsych.ac.uk/.
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