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Dementia causes a loss of mental ability and other related symptoms. Symptoms develop gradually and typically become worse over a number of years. The most important part of treatment is good quality support and care for the person with dementia, and for their carers.
Dementia is a condition of the brain which causes a gradual loss of mental ability. In addition, other features commonly develop such as changes in personality, a decline in social function, and a decline in the ability to look after oneself. Dementia is not a single disease as there are various different causes.
Dementia usually affects older people and becomes more common with increasing age. Sometime after the age of 65 about 1 in 20 people develop dementia. About 1 in 5 people over the age of 80 have dementia. Rarely, younger people develop dementia. Dementia is not a normal part of ageing. It is also different to the mild forgetfulness that is common in many older people.
Dementia can be caused by various diseases which affect the parts of the brain involved with thought processes. However, most cases are caused by Alzheimer's diseases or vascular dementia. All of the types of dementia cause similar symptoms, but some features may point to a particular cause. So, quite often it is not possible to say which disease is causing the dementia in each individual case.
This causes about 6 in 10 cases of dementia. It is named after the doctor who first described it. In Alzheimer's disease the brain shrinks (atrophies) and the number of nerve fibres in the brain gradually reduce. The amount of some brain chemicals (neurotransmitters) is also reduced, in particular one called acetylcholine. These chemicals help to send messages between brain cells. Tiny deposits or 'plaques' also form throughout the brain. It is not known why these changes in the brain occur, or exactly how they cause dementia.
There is no way of predicting who will develop Alzheimer's disease. It is not hereditary and anyone may develop it.
This causes about 2 in 10 cases of dementia. This is due to problems with the small blood vessels in the brain. The most common type is called 'multi-infarct' dementia. In effect, this is like having many tiny strokes throughout the 'thinking' part of the brain. A stroke is when a blood vessel 'blocks' and stops the blood getting past. So, the section of brain supplied by that blood vessel is damaged or dies. As each 'infarct' occurs, some more brain tissue is damaged. So the mental ability gradually declines.
The risk of developing this type of dementia is increased by the same things that increase the risk of stroke. For example: high blood pressure, smoking, high cholesterol level, lack of exercise, etc.
Over 60 diseases can cause dementia. Many are rare, and in many the dementia is just part of other problems and symptoms. In most cases the dementia cannot be prevented or reversed. In some disorders the dementia can be prevented, or stopped from getting worse if treated. For example, dementia caused by alcohol abuse or infections such as syphilis, both of which can be treated.
The symptoms of all types of dementia are similar and include the following:
Symptoms tend to develop slowly, often over several years. In the early stages of the disease, many people with mild dementia cope with just a small amount of support and care. As the disease progresses more care is usually needed. A 'typical' person with Alzheimer's disease takes about 8-10 years to go from the first signs of memory problems, to being severely affected and ultimately to die due to frailty of body and mind.
However, the speed of progression of symptoms can vary greatly between different people.
Dementia is suspected by the typical symptoms which are usually reported by a relative or friend. A doctor may do a standard 'memory test' to confirm the diagnosis. However, some other conditions (sometimes treatable) have similar symptoms to dementia. Not all 'confusion' is due to dementia.
For example, depression in older people can sometimes cause memory problems. A person who reports a failing memory themselves, rather than a relative or friend, is just as likely to have depression as dementia. Depression is often treatable. Also, some physical problems such as thyroid disorders and brain tumours may cause 'confusion' in an older person and mimic dementia. Some tests may be done if symptoms are not typical, or if other conditions are suspected.
There is no medicine that will reverse dementia. The following are some medicines that may be used to help:
Most people with dementia are cared for in the community. Often the main carer is a family member. It is important that carers get the full support and advice which is locally available. Support and advice may be needed from one or more of the following, depending on the severity of the dementia and individual circumstances.
The level of care and support needed often changes in time. For example, some people with mild dementia can cope well in their own familiar home. Some may live with a family member who does most of the caring. If things become worse, a place in a residential or nursing home may be best. The situation can be reviewed from time to time to make sure the appropriate level of care and support is provided.
Many carers struggle on beyond the point that is appropriate. If you are a carer, you can ask a GP or district nurse to assess a person with dementia if you feel that you need a greater level of support.
Reality orientation is thought to help in some cases. This involves giving regular information to people with dementia about times, places, or people to keep them 'orientated'. It may range from simple things such as having a board in a prominent place giving details of the day, date, season etc, to staff in a residential home 're-orienting' a person with dementia at each contact.
Reminiscence therapy is thought to help in some cases. This involves encouraging people to talk about the past so that past experiences are brought into their current thoughts. It relies on long-term memory which is often quite good in people with mild-to-moderate dementia.
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