Dementia

The disease disrupts key areas of brain function:

• Memories – difficulty in remembering people, events, where they've put things and places
• Thoughts – speed of thought and mental sharpness declines
• Reasoning – difficulty finding words, incorrect language use, difficulty understanding or being able to use correct judgment
• Behavior and personality – low mood, slowed movement, and difficulty doing daily activities; difficulty socializing and changes to personality

Dementia has a complex effect on individuals. They may experience hallucinations - hearing or seeing things that other people may not be able to see. They can experience a change in personality due to their lack of memory and understanding in unfamiliar circumstances. This understandably affects their independence and mood, making them more withdrawn and less trusting. The symptoms worsen over time, and in the advanced stages, their ability to care for themselves and communicate effectively is completely diminished.

There are five main types of dementia:

• Alzheimer's disease is the most common, where clumps of proteins damage the healthy nerve cells in the brain.
• Vascular dementia occurs from damage to the vessels that supply blood to the brain - this slows down thinking, causing a loss of focus and clarity.
• Lewy Body dementia is associated with abnormal clumps of protein affecting the healthy nerve cells of the brain - typically, individuals have visual hallucinations, inattention, and Parkinson-type symptoms.
• Frontotemporal dementia affects the cells at the front of the brain - most associated with behavior, personality, and language.
• Mixed dementia, a combination of any of these.

Aside from the five causes mentioned above, dementia can also be associated with other neurological conditions such as Parkinson's disease, Huntington's disease (a genetic disorder), and traumatic brain injury, as experienced in boxers or American football players in later life.

Dementia-type symptoms, that is, a decline in brain function, can be reversed where there is a treatable underlying cause. For example, infections, hormonal problems related to the thyroid or low sugar levels, dehydration, an imbalance of essential salts in the blood such as sodium or calcium, vitamin or mineral deficiency such as low vitamin B12, or malnutrition as in alcoholism. Side effects of certain medications may also be to blame. In these cases, this is not true dementia as it is a temporary state and reverses with treatment.

Your doctor will talk to you about your symptoms and how it affects your daily activity. If possible, it is always better to take someone with you who knows you well and can help with what your (or their) concerns are or give examples of certain behaviors.

Your doctor will examine you thoroughly, and arrange for you to have some blood tests and urine tests to rule out reversible causes. Your doctor will ask you to complete a memory test to understand the severity of your symptoms. 

To confirm the diagnosis of dementia, your doctor will commonly refer you to a memory clinic with a team of healthcare professionals who specialize in making a diagnosis. They may arrange further brain investigations, like CT or MRI scans.

It is very important to maintain a healthy lifestyle by keeping your mind and your body active. Doing things that stimulate your mind: reading books, doing puzzles and mind games, addressing any low mood, and ensuring you have adequate sleep is important. It is also important to exercise and stay healthy: eat well-balanced nutritional meals, ensuring you get your recommended allowance of vitamins.

Avoiding anything that can cause damage to blood vessels is important to keeping a healthy mind, such as smoking, excessive alcohol, or obesity, and keeping conditions such as diabetes and high blood pressure under control. All of these can contribute to vascular dementia in particular.

Symptoms of dementia may often require a team of professionals including medical doctors, caregivers, specialist nurses, and occupational therapists, who can ensure your home is safe and appropriate modifications are made. Using the services of psychological therapists to support your mood and behavior is also important.

Discussion with your specialist team will help determine the best treatment for your type of disease. There is no cure for dementia, but depending on your type, there may be a medication that can help slow the progression of the disease, such as donepezil, rivastigmine, or memantine.