Dementia explained

Dementia is the term used to describe the symptoms of a number of illnesses that affect the brain. It is not one specific disease.

Dementia causes a progressive decline in a person’s functioning, affecting thinking, behavior and the ability to perform everyday tasks. The most common cause is Alzheimer’s disease.

Dementia is not a normal part of ageing#

The risk of dementia increases with age, but it is important to remember that most older people do not develop it. Dementia can happen to anybody, though it is more common after the age of 65. When it develops in people between the ages of 40 and 60, it is called younger-onset dementia. As populations age, the number of people living with dementia is expected to rise.

Early symptoms#

The early symptoms of dementia are often subtle and may not be immediately obvious. Common early signs include:

• progressive and frequent memory loss
• confusion
• personality changes
• changes in behavior
• apathy and withdrawal
• a gradual loss of ability to perform everyday tasks

Types of dementia#

There are many different types of dementia. The most common include:

• Alzheimer’s disease – the most common form of dementia.
• Vascular dementia – caused by problems with blood supply to the brain.
• Lewy body disease – the symptoms of which can overlap with Parkinson’s disease.
• Frontotemporal dementia – a group of dementias caused by degeneration in one or both of the frontal or temporal lobes of the brain, which often develops in people under the age of 65.
• Alcohol-related dementia – linked to excessive alcohol intake, especially when combined with a poor diet low in vitamin B1 (thiamine).
• Dementia caused by Huntington’s disease – an inherited, degenerative brain disease that affects the brain and body and causes dementia in most cases.
• HIV-associated dementia – a very rare form related to human immunodeficiency virus.

Getting a diagnosis#

It is important to consult a doctor when symptoms are in the early stages, so that a medical assessment can confirm or rule out a diagnosis. A diagnosis can:

• rule out other conditions that can be mistaken for dementia, such as depression, stress, pain or infection
• allow early planning for the future, while the person affected can still take an active part
• allow support to be arranged for the person with dementia and for their carers and family

A doctor or specialist should carry out a full assessment. If the person will not see a doctor, or you feel your concerns are not being taken seriously, seek advice from a dementia support organization.

A number of conditions have symptoms similar to dementia, including stroke, depression and some vitamin deficiencies. In many cases, treating the underlying condition means the symptoms improve or disappear. This is why it is essential to get an early medical diagnosis when symptoms first appear, so that anyone with a treatable condition is identified and treated correctly.

Is dementia inherited?#

Most cases of dementia are not inherited. Researchers still have limited information about the genes involved. A number of genes may be associated with different types of dementia, but in most cases it is not caused by specific changes to a single gene.

Familial Alzheimer’s disease does have a clear pattern of inheritance, but it is very rare, with symptoms sometimes appearing from the ages of 30 to 60. Researchers have identified several genes associated with this form, and more may be found in future. Alzheimer’s disease associated with Down syndrome, and the familial form of frontotemporal dementia, are also caused by genetic changes.

Whether genes are involved depends on the cause of the dementia, so a firm medical diagnosis is important. If you have concerns about the risk of inheriting dementia, discuss them with your doctor or a counselor.

Treatment and support#

At present, there is no prevention or cure for most forms of dementia. Even so, support is vital, and the help of families, friends and carers can make a positive difference to managing the condition. Many practical changes can help the person living with dementia and those around them.

Some medications can help to reduce certain symptoms, including cognitive (memory and thinking) problems and associated symptoms such as depression, anxiety and sleep disturbance. It is important to remember that all medications have side effects. People with dementia may take several medications, and your doctor can help you understand how they might interact.

Medications for cognitive symptoms#

Medications are available to help with the cognitive (memory and thinking) problems of dementia for people with Alzheimer’s disease, and they may also be useful for some people with vascular dementia or Lewy body disease. There are two main types:

• Cholinesterase inhibitors increase the levels of acetylcholine, a brain chemical important for memory, which can help some people.
• Memantine blocks the action of another brain chemical (glutamate), which can improve thinking problems in some people.

Depression and anxiety#

Many people with dementia experience depression. If it becomes significant, it can further affect memory and thinking, so treatment with medication may be helpful, while keeping side effects to a minimum.

Anxiety, panic attacks and unreasonable fearfulness can be distressing for the person and for their family and carers. Mild symptoms are often helped by reassurance, adjustments to the environment or an improved daily routine. More severe anxiety may be linked to underlying depression, in which case antidepressant medication can help. Antipsychotic or specific anti-anxiety medications are other options, but they can have unwanted side effects and are usually not recommended for anxiety in dementia.

Sleep and night-time wandering#

Waking at night and wandering can cause problems for the person with dementia and for their carers and families. Speak to your doctor before using any medication for sleep disturbance, as some sedatives given during the day can lead to increased alertness at night.

Planning ahead#

The earlier help is found, the better the person and their family will be able to cope. It helps to:

• Plan ahead – while the person can still legally sign documents, arrange powers of attorney for financial affairs, medical decisions and guardianship.
• Get information – find out about dementia and what lies ahead, so you feel informed and more in control.
• Seek support – many people find it helpful to talk through what a diagnosis means and how to make adjustments.
• Organize practical help – home help, respite care, day trips and day-center stays can all make a positive difference.

A wide range of community services is available to help both the person with dementia and their carers, including support and information groups, carer education and training, counseling, practical advice, support groups, telephone support, day centers, respite care and in-home and out-of-home flexible care.

Key Points#

• Dementia describes the symptoms of a number of illnesses that affect the brain.
• The most common cause of dementia is Alzheimer’s disease.
• Dementia can happen to anybody but is more common after the age of 65.
• Early symptoms are subtle and may not be immediately obvious.
• Common early symptoms include progressive memory loss, confusion and changes in personality and behavior.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).