Overview
Dementia is not one disease. It is the name for a loss of memory, thinking, language and everyday ability that is bad enough to interfere with daily life, caused by damage to the brain.
Alzheimer's disease causes most cases. Others include vascular dementia, which follows damage to the brain's blood supply, dementia with Lewy bodies, and frontotemporal dementia. More than one can be present together.
Symptoms
Symptoms begin quietly and get worse over months and years. Early on, a person often notices that:
- Recent events and conversations are forgotten, while old memories stay clear
- The same question is asked again and again
- Familiar routes and places become confusing
- Handling money, cooking or using the phone becomes difficult
- Words are hard to find, and speech becomes vague
- Mood and behaviour change, with anxiety, suspicion or withdrawal
Later, people need help with washing, dressing and eating, may not recognise family, lose bladder and bowel control, and become unsteady on their feet.
When to see a doctor
See a doctor within a few days for memory that has slipped over months, getting lost on familiar routes, difficulty with money or medicines, trouble finding words, or a change in personality or self-care.
Causes
Dementia is caused by diseases that damage brain cells. In Alzheimer's disease, abnormal proteins build up in and around the cells. In vascular dementia, strokes or narrowed small vessels cut the blood supply.
Memory loss can also come from causes that are not dementia and often improve with treatment: an underactive thyroid, vitamin B12 deficiency, depression, alcohol, infection, poor sleep and the side effects of some medicines.
Risk factors
- Older age, which is the strongest factor
- High , diabetes, high and obesity
- Smoking and heavy drinking
- Physical inactivity and social isolation
- Hearing loss that is not corrected
- Depression, head injury, stroke, and a family history of dementia
Complications
As dementia advances, people are at risk of falls, wandering, poor eating and weight loss, difficulty swallowing and chest infections. Confusion often worsens sharply during any other illness. The strain on the family member who provides care is a real part of the illness, and their own health and rest need attention.
Prevention
- Keeping , blood sugar and controlled
- Being physically active most days
- Not smoking, and limiting alcohol
- Keeping a healthy weight and a diet rich in vegetables, fruit and whole grains
- Getting hearing tested, and using a hearing aid if advised
- Staying socially active and mentally engaged
- Treating depression, and protecting the head from injury
Diagnosis
The doctor takes a history from the person and from someone who knows them well, since the family often notices changes first. Memory and thinking are tested with simple pen and paper questions.
Blood tests look for treatable causes such as thyroid disease, vitamin B12 deficiency and infection. A CT or looks for strokes, bleeding or other conditions, and helps tell one type of dementia from another.
Treatment
There is no cure for most dementias. Medicines from the cholinesterase inhibitor group, and one that acts on a different brain chemical, can ease symptoms for a period in some types, and the doctor reviews whether they are helping.
Much of the benefit comes from care rather than tablets: a steady routine, clocks and calendars in view, familiar surroundings, gentle activity, company, good light, treating pain and constipation, and reviewing medicines that cloud thinking.
Support for the family carer, planning money and legal matters while the person can take part, and treating other conditions such as high all make a real difference.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Forgetting things is just old age. Every old person becomes like this.”What is true?
Fact
Ageing can make recall slower, but dementia is caused by disease of the brain and is not an inevitable part of growing old. Many people stay mentally sharp into late life, and memory loss that interferes with daily tasks always deserves a check.
Myth“There is no point going to a doctor, because nothing can be done.”What is true?
Fact
Some causes of memory loss can be reversed, such as thyroid disease, vitamin B12 deficiency, depression, infection or the side effects of medicines. Even when dementia is confirmed, treatment, routine and support reduce distress, and an early diagnosis lets the family plan while the person can still take part in decisions.
Myth“Dementia only affects memory, so odd or rude behaviour is deliberate.”What is true?
Fact
Dementia changes judgement, mood, language and behaviour as well as memory. Agitation, suspicion, repeating questions or wandering come from the damaged brain, not from stubbornness. Understanding this makes care easier and kinder.
Myth“Once a person has dementia they must be kept at home and hidden from visitors.”What is true?
Fact
People with dementia do better with company, conversation, familiar routines and activity. Shutting them away speeds up the loss of skills and adds loneliness. People with dementia keep the same rights to dignity, company and choice as everyone else.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How is dementia different from ordinary forgetfulness?
Ordinary forgetfulness means misplacing keys or taking a moment to recall a name, while daily life carries on normally. In dementia the forgetting interferes with living: bills go unpaid, the stove is left on, familiar routes are lost, and the person often does not realise how much has changed.
Is Alzheimer's disease the same thing as dementia?
Dementia is the general term for the loss of memory and thinking caused by brain disease. Alzheimer's disease is the most common disease that causes it, contributing to most cases. Other causes include vascular dementia, dementia with Lewy bodies and frontotemporal dementia.
Will my children get it because I have it?
For most people dementia is not directly inherited. Having a parent with dementia raises the risk somewhat, but age and health factors such as blood pressure, diabetes, smoking, hearing loss and inactivity matter more, and those can be acted on. Rare family forms that pass directly from parent to child do exist and are usually early in onset.
How can the family manage repeated questions and agitation?
Answer calmly, keep to a familiar routine, and use notes, clocks and photographs as reminders rather than testing the person's memory. Agitation often has a cause such as pain, hunger, constipation, poor sleep, a full bladder or a noisy room, and finding it usually helps more than medicine. The doctor should be told if distress is frequent.
