April 2016
Dementia

Living with dementia

What is dementia?
Dementia is characterised by a loss of cognitive functions (the ability to process thought) leading to a gradual deterioration of social and occupational functioning. It is a brain disease that often begins with memory loss but can go on to affect other areas of the brain. This can affect thinking, orientation, comprehension, calculation, judgement, learning and language.

How common is it?
Dementia is a common disease. Worldwide there are 47.5 million people living with dementia (WHO). It is estimated that more than 75 million people will be living with dementia by 2030 (WHO). Driven by an ageing population this is estimated to triple by 2050 (WHO). According to the Royal College of Psychiatrists, 850,000 people in the UK are affected. Dementia mainly affects older people however, it can occur in younger people although this is rare. At the age of 65 about 5 in every 100 people will have dementia and by the age of 80 about 20 people in every 100 will have some degree of dementia (Royal College of Psychiatrists). Nearly 60% of people with dementia live in low-middle income countries (WHO). Anyone can develop dementia but there are certain medical conditions that can increase the risk including strokes, heart disease, high blood pressure as well as lifestyle factors such as poor diet, excessive smoking or alcohol consumption and lack of exercise. Genetics can play a part in dementia especially with Alzheimer’s disease and Fronto-temporal dementia.

The symptoms of dementia
The early stages of dementia are often overlooked as the process is a gradual process. The main symptom of dementia is an increasing tendency to forget or being unable to recall things. It can be difficult to find words while speaking, therefore affecting communication. The act of performing simple daily activities can become challenging. Other features include making errors in judgement, losing track of time, becoming more disorientated (getting lost in familiar places) and changes in mood or personality. These symptoms can become worse as the disease progresses with time. Later stages of dementia are often of total dependence and an inactive lifestyle. Care is required, there can be difficulties in mobility and there is difficulty in recognising friends and family. Behaviour changes can escalate and include aggression.

The causes of dementia
There can be many different causes, however they all include memory loss.

Alzheimer’s disease
Alzheimer’s disease is the most common cause of dementia and accounts for about 7 in 10 of all dementia’s (Royal College of Psychiatrists). According to the Royal College of Psychiatrists, damaged tissue accumulates in the brain forming deposits called ‘plaques’ and ‘tangles’. These cause the brain cells around them to die. It also affects the chemicals in the brain which are responsible for transmitting messages between cells, particularly acetylcholine. This is a gradual process and develops over a matter of years. It can sometimes run in families and it is more likely to affect people with Down’s syndrome.

 

Alzheimer’s disease causes particular problems with memory and the ability to think clearly. Learning and retaining new information becomes harder making it difficult to recall recent events or information such as time, places or the names of people. .

Vascular dementia
This is associated to a stroke where the arteries supplying blood to the brain can become blocked. Parts of the brain are starved of oxygen and therefore die. The symptoms of this condition depend on the areas of the brain which were affected. This type of condition is more common among people who smoke or have high blood pressure, diabetes or high cholesterol.

Lewy body dementia
This type of Dementia is caused by protein deposits (Lewy bodies) which build up in the brain.

Fronto-temporal dementia
This affects the front of the brain more than other areas and often starts in people in their 50s and 60s. As it affects the front part of the brain, it is more likely to cause personality and behavioural changes. Memory can however remain good for a long time.

Mild cognitive impairment (MCI)
This refers to memory problems which are more frequent than you would typically expect from someone of your age, but not severe enough to be called dementia. This could be something which the individual notices or it is noticed by others. According to the Royal College of Psychiatrists, approximately 1 in 3 people with this mild cognitive impairment may develop dementia.

Associated factors & Illnesses
Other illnesses or factors associated with increasing the risk of developing dementia include depression, heavy alcohol drinking and physical illnesses such as kidney, liver or thyroid problems, diabetes and rare diseases such as Huntington’s disease.

 

Dementia can also cause other mental illnesses such as depression and anxiety. Being unable to recall information can increase frustration and also cause the individual to worry and panic. Some people experience hallucinations especially with vascular or Lewy body dementia. Physical problems can also develop such as difficulties in walking and incontinence. Lewy body dementia has symptoms similar to Alzheimer’s disease and Parkinson’s disease, causing trembling of hands, muscle stiffness and increased falls or difficulty in walking.

How can dementia be diagnosed and treated?
A doctor can perform a simple cognitive test as well as a physical examination and blood tests to determine any issues with your memory. The tests can help identify problem areas and give an indicator as to what type of dementia is present. The doctor can refer you to a specialist team or memory clinic to examine in further detail any memory impairment and a brain scan can be arranged if necessary. The person may be seen by a range of professionals - psychiatrists, geriatricians, psychologists and nurses.

 

Unfortunately there is no complete or permanent cure for dementia. Psychological treatment called group cognitive stimulation has been shown to help with memory. Reminiscence Therapy includes discussing past activities, events and experiences with another person or in a group of people which has been shown to have beneficial cognitive effects.. Acetyl cholinesterase inhibitors may slow the progression of Alzheimer’s dementia and can also help in Lewy Body dementia if hallucinations are a problem. With 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. A healthy lifestyle is essential and individuals are encourages to quit smoking, eat a balanced healthy diet and to perform daily physical exercise.



The key goals for dementia care is

  • early diagnosis,

  • enhancing a healthy lifestyle (cognitive stimulation, physical health and well-being)

  • detecting and treating psychological symptoms

  • identifying and treating accompanying physical illnesses

  • Provide information and support to carers

Ways to stay well

  • Use a diary to help you remember appointments and make lists

  • Staying connected with others and attending support groups/forums.

  • Ask help from others around you. Ask them to prompt you to remember things, be patient with you and help explain things to you that you may not understand. Friends and family are crucial in helping you adapt to the changes in your life and help maintain your confidence and independence.

  • Keep your mind active by reading or doing crossword puzzles, Sudokus and other mind exercises

  • Look after your physical health, eat a balanced diet and exercise regularly. Both your general physician and psychiatrist can help you with this. Attend regular health checks, monitor your weight, blood pressure and stop smoking entirely.

The future
It is a good idea to plan for the future as there may be a time when it is difficult to make key decisions especially concerning financial arrangements and medical care. You could consider that you give a trusted relative, friend or solicitor the right to make such decisions on your behalf if you are unable to in the future.

 

‘WPA Public Education Initiative’

Dr. Avdesh Sharma, International Lead, WPA; Consultant Psychiatrist, India
Dr. Sujatha Sharma, Consultant Psychologist, India
Stefanie Radford, Senior Project Manager, United Kingdom
Rajeev Verma, Administrator, India
Pragya Mehra, Media Specialist, India
Jatin Kumar, Media Editor, India

Supported by Unrestricted Educational Grant by SUN Pharma SUN LOGO

>> Please click here the pdf version of this document

  

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