What is dementia?

So here we’ll be looking at dementia and what the term dementia actually means. So dementia is a collective term for a number of neurodegenerative diseases. These include specifically Alzheimer’s disease, which is the most common dementia that we’ve probably all heard of. But we also have early as well as late onset Alzheimer’s disease. So those who are diagnosed with Alzheimer’s disease before the age of 65 years tend to be considered as having early onset Alzheimer’s disease. And those diagnosed after the age of 65 years of age are considered to have late onset Alzheimer’s disease. We also have vascular dementia, which is what we tend to see in our older population. It’s a different type of dementia to Alzheimer’s disease.

And what’s key to consider with dementia is that we’re looking at different proteins that are affecting the brain in certain parts of the brain, in different ways, which is why we have a different a number of different types of dementias. We also have Lewy Body dementia. Again, this is a different protein to that we to see with Alzheimer’s disease. And this has as a result, different effects on the individual and on their behaviours. And then we also have frontotemporal dementia, which again is somewhat different to the aforementioned dementias. So dementia differs from what we consider to be normal aging, which is important to consider. So when we all get older, we tend to become a little bit more forgetful.

But what we’re looking at when it comes to pathological aging and the onset of dementia is what kind of forgetfulness are we talking about. Is it more forgetfulness that we would expect? And is it also affecting certain types of memory? So we should still be able to remember certain things such as what a spoon looks like and what a spoon is called. But if we’re looking at a picture of dementia and a progressive picture of dementia, what we may find is that individuals may also struggle to remember the names of common household items. So dementia is more than just normal aging, even though the aging process is a risk factor for dementia.

So unfortunately, as we get older, we’re all by nature more likely to develop dementia. But there are a number of circumstances and various factors that influence that risk as well. So currently over 7% of people aged over the age of 65 years in the UK have dementia and this is going to keep rising. We have an aging population. So it’s important to keep in mind here is that dementia is affecting a number of people and it will affect even more in the years to come. And that has a significant impact financially on the UK economy. So it’s been estimated that the impact is around £26 billion per year.

And this is not only regarding treatments but also social care and so forth. So it is something that does require not only government investment but also research that helps us take action earlier on making life much more pleasant for these individuals, for patients of dementia, and also alleviating some of the financial burden on the national health system. So key symptoms as again per the ICD 11 and the DSM 5. What we tend to find here is that there is a slight variation depending on the type of dementia that we’re looking at. So if it’s Alzheimer’s disease and as we’ve said, this is the most common type of dementia.

What we’re looking at here are that certain types of memory are affected first. And then as the disease progresses and takes over more and more parts of the brain and that kind of underlying pathology spreads, then we tend to see more different memory systems being affected as well. So initially with Alzheimer’s disease, there may be difficulty remembering certain day to day things. Patients sending out Christmas cards or birthday cards twice as opposed to once in the same year. So there are certain subtle hints that we can pick up on at first. But over time, we tend to see a progressive worsening in memory. Vascular dementia is a little bit different.

What we tend to see here is a slowed thinking process so a bit of confusion, slowness in thinking. These tend to be the hallmark features along with some memory loss. So as with Alzheimer’s disease, vascular dementia also includes a degree of memory loss. Lewy body dementia, whilst also including memory loss, is quite interesting in nature because of the type of protein that we’re dealing with in the brain. What we tend to see is that patients tend to present with confusion. They also tend to experience hallucinations. These can be big spiders in the bedroom or deceased relatives in their bedroom. It could even be tactile hallucinations where spiders are crawling on their skin. Could be auditory nature, they hear things.

But they experiences hallucinations along with certain movement difficulties. So the movements may be a little bit more rigid. And that’s why we tend to find earlier on is that before the disease has progressed, patients with Lewy Body dementia are misdiagnosed as having Parkinson’s. So that’s important to consider. It’s important to consider the signs and symptoms in their totality so that we can make an accurate diagnosis. And then we also have frontotemporal dementia. And this is somewhat different because it again tells us what parts of the brain are being affected earlier on.

So we have the temporal lobe, which is key in memory, and we also have the frontal lobe of the brain which is that more recently evolved parts of the human brain that encompasses our higher cognitive functions, such as our ability to make decisions, to think in abstract terms, to plan, to resolve conflicts and so forth. And what we tend to find is that it also plays a role in language. So with frontotemporal dementia, we don’t only see difficulty in recalling certain things and memory disturbance, but we also see some language impairment. And in addition, we also find that the patients exhibit some changes in personality because our frontal lobe also plays a role in personality.

So frontal temporal dementia, again, somewhat different in nature. Now, causes for the for dementia we have genetics, which is key. There’s a lot of research going on in regards to genetics when it comes to dementia and different types of dementia. We know that family history is very important to consider. And we’re only becoming more aware of patients’ family histories now. In the old days, people were less aware of what dementia was. So you may hear terms such as senile, you know, my great uncle went senile. These are quite derogatory terms, but it also demonstrates a lack of understanding. We’re only developing a better understanding now where there is a family history of the dementia.

And also we have certain genetic predispositions with regards to certain genes. So we know that when it comes to Alzheimer’s disease specifically, there is a specific gene that does increase one’s risk of developing dementia, or specifically Alzheimer’s disease with age. So that’s the Apolipoprotein E epsilon 4, a bit of a mouthful,

gene variant. So it’s important to consider genetics in this regard as well. But medical history plays an important role in considering one’s risk and the causes for various kinds of dementias. So with vascular dementia, we know that vascular disease is very important to consider. For instance, a series of mini strokes can also increase one’s risk or predisposition to developing dementia later on in life. And it’s also important to consider that there are other conditions such as depression, which can have an impact on our cognition, our memory recall and so forth. So it’s important to also rule out things such as depression when we’re considering whether an elderly patient has dementia or not.

There are also certain life events that are important to consider, lifestyle factors. So we know that a healthy diet and a healthy lifestyle is protective in nature. Mediterranean diet specifically is considered to be quite protective. Not smoking, not drinking, those tend to be protective lifestyle factors as well to consider. But we also look at things such as head injuries. So we know that hit injury may increase the risk for certain kinds of dementia. And this is a dementia that we see in boxers, specifically dementia pugilistica, which tends to occur with repeated blows to the head. So there are certain other environmental factors that are important to consider, again with certain types of dementia.

And age, so we know that age is a risk factor for us all. Unfortunately, the older we get the more our risk increases. But dementia is not an inevitable outcome of aging. So as mentioned, there are differences between normal aging and pathological aging. Whilst we will all become somewhat more forgetful, we won’t all go on to develop dementia. Now in terms of how we diagnose dementia. We know that there are certain neurons in the brain that are affected by these proteins, these specific proteins that cause these kind of tangles within cells in the brain.

So in order to come to a sort of certain diagnosis, we can only do so after a patient has unfortunately passed away, because that’s only possible then with the autopsy. But what we tend to do is we rely on our clinical skills to assess not only whether a patient is presenting with dementia, but what type of dementia we’re looking at as well. So the first point of contact would be the GP. If you’re suspecting that a loved one is experiencing forgetfulness and you may be a bit worried about them in terms of their memory loss and certain other things that you’ve picked up on, GP would be the first person to actually do an initial assessment.

And if the GP agrees that something is probably going on here beyond the normal aging process, they will make a referral to a memory clinic or to a dementia specialist and that will involve further assessment. Now by further assessment, we look at certain interviews that take place, so nothing invasive. The specialist will ask certain questions that will assess specific types of memory and specific types of cognition because this will give a more accurate picture of what type of dementia we may be looking at, if we’re even looking at dementia at all. So the structured interviews that take place, there are a number of different ones that may be used. Most common tends to be the Mini Mental State Examination, MMSE.

But we also have the MOCA, the Montreal Cognitive Assessments, as well as the Addenbrooke’s Cognitive Examination developed, I believe, in Cambridge Addenbrooke’s Hospital. So these tend to be the most common diagnostic tools that are used. And what is important to keep in mind here is that we’re not only looking at a patient crossing a diagnostic threshold, but also there are certain domains that are assessed within each of these tools that look at the type of dementia that we may be dealing with. And if a dementia specialist requires them, they also request certain scans such as CT or MRI scans to perhaps confirm their suspicions or the results of certain previous tests.

Now, when it comes to treatment, what we’re looking at here is, again, a kind of bio psycho social approach, biological, psychological and social. So when a patient receives a diagnosis of dementia, we know that things will progressively unfortunately get worse. It’s neuro degenerative in nature. And as such, there is no cure at the moment, unfortunately. So what this also means is that the family and the loved ones will take on more responsibility in caring for the individual. So someone will take on the carer role. And it’s important to look at the government websites in this regard because carers should be entitled to more support financially as well.

So where there is a carer, it is important to consider the carers role and how the state and the NHS support the care in that regard. There are also certain cognitive interventions that we may use which can help the slowing of certain types of dementia. So there are interventions such as cognitive stimulation, cognitive training, that are offered to help with the kind of really abrupt changes in cognition and memory that we may see quite early on. But in most cases it does tend to be a gradual worsening over time. Earlier on, perhaps not even noticeable. Once it is noticeable that there is some memory loss, it is likely that the underlying pathology has been there for some time.

Social activities and exercise also very very important because these do help, as the ancient Greeks would say or used to say, a healthy mind in a healthy body. So very important to keep cognitive exercises as well as physical exercises up as much as possible, and social interactions help in that regard. And also managing in the other conditions the patient may have. So we know that with old age, patients tend to have perhaps a number of comorbidities, a number of different conditions and making sure that they are being treated and taking their medications for those other conditions as well.

There are certain medications that are very good that can help the slow of the disease, the progression of the underlying pathology and these act on certain receptors and certain neurotransmitters in the brain that help with memory and memory loss. Now, down the line, we also need to consider end of life care. And that’s something important that you will speak with a specialist About if you’re ever in a situation like that. But that that kind of care is always available through the NHS and they make life as comfortable as possible for your loved one as well as for the patient’s family as well.

So there are a certain number of websites that are also available for you to peruse for more information. So Dementia UK has more information regarding a number of different types of dementia that you might be interested in looking, looking through. There’s also Age UK, which is another charity. If you have any concerns about a loved one family member, make an appointment with your GP, your GP will be able to go through any concerns you have and, and to carry out a brief assessment to try to ascertain whether a follow up is required. In case of an emergency NHS is always on hand as well. Contact NHS 24 on 111, triple 1.

And for more information, there’s also the NHS website which provides not only useful information about dementia but also about support that’s available for patients and carers.