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Dementia

Dementia mainly affects the older generation and is caused by several different diseases that have an impact on the memory and brain function.

Neuraxpharm provides medication alternatives for dementia and once your doctor has determined your specific needs, they can prescribe the product that best adapts to your needs and condition.

Find out about the main types of dementia, common symptoms and what you can do to help prevent it.

What is dementia?

Dementia is a broad term that is used to describe many different diseases that affect the brain, causing cognitive function to deteriorate beyond what is considered normal ageing. The word dementia refers to a set of common symptoms including memory loss and difficulties with other thinking abilities, such as language, problem solving and decision making, however symptoms can vary greatly among the different forms of dementia. Sometimes people with dementia are also affected by changes to their mood and behaviour. 

While dementia can affect younger people, it mainly affects older people and is one of the major global causes of disability and dependency among the older generation. However, it’s not a normal part of ageing and it can have a severe impact on the lifestyle of those diagnosed and their families and carers.

What are the main types of dementia?

There are many different types of dementia. These are some of the most common:

  • Alzheimer’s disease: The most common form of dementia, this is thought to account for 60-70% of cases1 and generally affects the over-65s.
  • Vascular dementia: This is the second-most common form of dementia in the over-65 age group.
  • Frontotemporal dementia: Caused by the death of nerve cells and pathways in the frontal and temporal lobes of the brain, this is more likely to be diagnosed in people under the age of 65.
  • Mixed dementia: More than one type of dementia occurring at the same time is known as mixed dementia. This mostly involves Alzheimer’s disease and vascular dementia and is more likely in people aged over 75.
  • Lewy body dementia: A progressive condition that affects the ability to think and move, this is thought to affect around 10-15% of people with dementia2.
  • Parkinson’s dementia: If the onset of dementia occurs a year or more after the onset of motor symptoms that are associated with Parkinson’s disease, it is called Parkinson’s dementia. If dementia symptoms appear before or at the same time as Parkinson’s symptoms, it is called dementia with Lewy bodies3.
  • Other: Young onset dementia, also known as ‘early onset’ or ‘working age’ dementia; refers to dementia that is diagnosed before the age of 65.

How many people have dementia?

The World Health Organization (WHO) reports that around 50 million people have dementia worldwide, with nearly 10 million new cases every year. In Europe, around 10 million people are currently diagnosed with dementia and this is expected to double by 20304.

Symptoms

The specific symptoms experienced by people with dementia will depend on the disease that is causing the dementia and the parts of the brain that are affected.

What are the symptoms of dementia?

Memory loss is one of the most common – and most widely-recognised – symptoms of dementia, but there are lots of other signs to look out for.

Typical symptoms can include:

  • Memory loss – for example, repeatedly asking the same question or forgetting where things are kept
  • Language problems – such as forgetting simple words mid-conversation
  • Orientation problems – this may result in getting lost when out and about or at home
  • Difficulties with decision-making
  • Inability to complete daily tasks such as cooking a meal
  • Personality changes – for example experiencing mood swings, paranoia or depression

What are the stages of dementia?

If someone experiences persistent memory problems that are considered worse than those expected at their age, but is still able to continue with everyday activities, it is known as mild cognitive impairment (MCI). While people with MCI often go on to develop Alzheimer’s or another form of dementia, this isn’t the case for everyone with MCI. This stage is also referred to as the prodromal phase.

Following this, the onset of dementia can be broadly divided into three stages: early, middle and late.

1. Early phase

Many forms of dementia are progressive, so the early signs of dementia are often quite subtle and then gradually get worse over time. Early on, symptoms may include forgetfulness and losing track of time, although these are often overlooked or dismissed as normal signs of ageing.

2. Middle phase

In the middle stage, the symptoms become more noticeable – for example, forgetting people’s names or getting lost at home. Everyday tasks, such as getting dressed or making lunch, may become too much, and behavioural changes like wandering around for no reason or being paranoid can also become more common.

3. Late phase

The late stage of dementia is more acute, and often leads to a person becoming highly dependent and inactive. They may not recognise loved ones, have no concept of time or place and struggle to walk and communicate. At this stage, people with dementia usually need full-time care. For some, behaviour may change so much that their personality appears completely different and this can be one of the most difficult aspects for family and friends to adjust to.

Causes, risk factors and life expectancy

A range of different diseases can cause dementia. Many of these are linked to an unusual build-up of proteins in the brain. These proteins can cause a decline in the function of nerve cells, shrinking different areas of the brain.

What causes dementia?

Each dementia disease is caused in its own way:

  • Alzheimer’s disease: Alzheimer’s disease is thought to be caused by a build-up of proteins in the brain which form abnormal structures called ‘plaques’ and ‘tangles’. Scientists do not know exactly what causes the process to begin, but as the disease progresses, nerve cells in the brain are lost, affecting the signals between brain cells.
  • Vascular dementia: This is a term that includes a group of conditions caused by problems with blood circulation to the brain, whereby small blood clots stop oxygen from reaching the brain tissue.
  • Frontotemporal dementia: This is another umbrella term that refers to a group of conditions. This time, it is caused by dead nerve cells and pathways in the frontal and temporal lobes of the brain. Abnormal proteins are formed and these interfere with the way that brain cells communicate.
  • Lewy body dementia: Lewy bodies are abnormal clumps of protein that gather in the parts of the brain that are linked to thought, movement, alertness and visual awareness.
  • Parkinson’s dementia: the symptoms of Parkinson’s are triggered when dopamine-producing nerve cells in the brain deplete and die. Researchers believe that the death of the nerve cells is linked to a combination of age, genetic and environmental factors, such as exposure to certain chemicals.
  • Other: Dementia in people under the age of 65 (known as young onset dementia) can be caused by a range of different diseases. Younger people are more likely to get rarer forms of dementia and also more likely to inherit dementia than those in older age groups (although the likelihood of inheriting dementia is very low).

Is dementia hereditary?

Many people worry about getting dementia, particularly if a family member has suffered from the condition. However, in most cases, dementia is not directly caused by genes inherited from parents.

In some types of Alzheimer’s disease and frontotemporal dementia, a faulty gene which can be passed down in families can cause dementia to develop, but if you have an elderly relative with dementia it does not necessarily mean that you will develop it in later life, and many people with dementia have no family history of the disease.

Who gets dementia?

The following risk factors can play a part in who might get dementia:
  • Age: This is the biggest risk factor for developing most types of dementia – especially for people in their late 70s and early 80s.
  • Gender: A 2020 report by Alzheimer Europe5 found that women are disproportionately affected by dementia compared to men. It found that 6,650,228 women are living with dementia in Europe – more than double the number of men, which is 3,130,449.
  • Family: As explained above, in some cases family history can increase the risk of developing dementia.
  • Smoking and alcohol: Being a smoker and drinking more than 21 units of alcohol6 a week both increase the risk of developing dementia.
  • Diabetes: Type 2 diabetes is a risk factor for both Alzheimer’s disease and vascular dementia7.

How long can you live with dementia?

There is currently no cure for dementia, so for those who are diagnosed with dementia, it is a lifelong condition. However, when an early diagnosis is made, there is a higher chance of being able to reduce the symptoms by finding the right treatment and support than when diagnosis is made later. Various studies have looked at how dementia affects life expectancy, however it is a complicated area because people are usually diagnosed with dementia when they are in their later years, a time when other conditions may also affect their life expectancy.  The length of time that someone with dementia can expect to live depends on their age at diagnosis and whether they were diagnosed early in the progression of the disease or later. Research published in the British Medical Journal showed that people diagnosed with dementia between the age of 60 to 69 lived 6.7 years, falling to 1.9 years for those diagnosed at 90 or older8.

Diagnosis

Diagnosis of dementia can take time – your doctor will carry out a range of assessments and these may need to be followed up by specialists.

How is dementia diagnosed?

If you are concerned about your own memory or brain function, or that of someone you know, the first step is to talk to your doctor or healthcare professional. 

They will start by asking you questions about the changes you have noticed to your memory, as well as any other difficulties you may be experiencing in everyday life. They may also use specific questionnaires to assess your memory, language and orientation abilities. If you’re able to take a friend or relative along with you the doctor may find it helpful to talk to them about what they have noticed too.

Tests to diagnose dementia

There is no set test to find out if you have dementia – instead, your doctor will carry out a range of initial assessments and then refer you to a specialist for further assessments if necessary. This might include a neurologist (who specialises in the brain and nervous system), a geriatrician (who specialises in elderly care), or a psychiatrist or other mental health specialist.

Tests used in the diagnosis of dementia may include:

  • Blood tests
  • Physical examinations
  • Mental ability tests
  • Brain scans such as a CT scan or an MRI scan

Often, memory problems can be caused by other factors, such as depression, an infection or an underactive thyroid. Taking these tests helps doctors to rule these out first.

Treatment and medication

There are many different treatment options for people living with dementia, and these should be tailored to the individual to reflect the type of dementia they have, as well as their specific needs.

How is dementia treated?

A range of medication is available, as well as non-drug treatments such as therapies, activities and support; often a combination of these is the most effective approach.

Medication

There is no specific medication to cure dementia, but some treatments can help to reduce certain symptoms. These include:

  • Cholinesterase inhibitors: These work by slowing down the breakdown of a brain chemical called acetylcholine involved in memory and attention.
  • NMDA receptor antagonist: These are a class of medications that work by blocking an excessive amount of a chemical called glutamate in the brain.
  • Antidepressants: Many people with dementia experience low mood and irritability, and antidepressants can help.
  • Anxiolytics: These may be prescribed to ease anxiety or restlessness.
  • Antipsychotics: These can help to control unwanted feelings and behaviours, such as aggression, agitation, delusions, or hallucinations.

Therapy and intervention

In middle to later stages of dementia, certain therapies that focus on memory and thinking skills are often used and can offer a positive mental boost. Therapies may include:

  • Reminiscence therapy: This involves talking about memories from someone’s past either one-to-one or in a group. Often, memories are stimulated with music, photos or items that are personal to the individual.
  • Cognitive stimulation therapy (CST): More useful in the earlier stages of dementia, this involves group activities that provide mental stimulation, such as cooking, singing or discussing world events.
Counselling and support can be extremely beneficial, especially when someone is coming to terms with a diagnosis of dementia and learning to accept the changes this brings to their life. Some people benefit from one-to-one counselling, while others prefer to talk about their experiences in a support group.  It’s important for carers to seek some help and support for their own needs, too, and similar support services are available for them. Caring for someone who has dementia can be tiring and stressful and seeing a loved one change can also be upsetting.

Diet

Research shows that healthy dietary changes in midlife9, such as modifying the quality of fats, eating more vegetables and limiting salt and sugar, are associated with a reduced risk of dementia in later life. 

People living with dementia should also be encouraged to eat well – not only does a healthy diet have an effect on physical health, it can influence brain health, too. Try to eat a balanced diet including lots of vegetables (especially leafy greens), wholegrains, fish, nuts and berries and poultry.

If you are caring for someone with dementia, it can be difficult to encourage them to eat a balanced diet. As mental abilities deteriorate, they may forget to eat or drink, have difficulties preparing food and find the physical act of eating gets harder. 

Tastes and appetites can also change dramatically. It’s important to keep mealtimes enjoyable, so factor in the foods they enjoy and try to balance these with healthy choices to make sure their nutritional needs are met.

Exercise

Not only is exercise a significant factor in helping to prevent the onset of dementia, it’s also a crucial part of treatment and care. People with dementia have more physical health problems than those of the same age without dementia, so keeping active is extremely important. 

Different types of exercise may be appropriate according to a person’s stage of dementia. In the early and middle stages of dementia, many people will remain as physically able as before and be able to enjoy gardening, dancing, walking and many sports activities. However, this may change significantly in the later stages. Modified seated exercise and some simple exercises to assist with balance and support may be beneficial.

Prevention

Research has shown that healthy lifestyle choices such as healthy diet, exercise, cognitive stimulation, low alcohol consumption and not smoking may decrease the risk of Alzheimer’s dementia10. The research found that simple modifications to a person’s lifestyle may reduce the risk of dementia, and that combining a range of different lifestyle factors could be the most effective method of prevention. For example, when four or five lifestyle factors were combined, it could reduce the risk of Alzheimer’s by 60% compared to adopting none or only one factor. A 2020 report on dementia prevention, intervention, and care commissioned by the Lancet came to similar conclusions. The report identified 12 ‘modifiable risk factors’ that account for around 40% of worldwide dementias, which could theoretically be prevented or delayed. The report emphasises the importance of prevention and stresses that it is never too early – or too late – for people to take preventative measures linked to these 12 risk factors: less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, low social contact, excessive alcohol consumption, traumatic brain injury and air pollution. Some of the key preventative measures that were recommended to be taken by individuals included:
  • Keeping cognitively, physically and socially active in mid- and late-life 
  • Using hearing aids to reduce the risk of dementia from hearing loss 
  • Taking regular exercise in midlife, and possibly later life to reduce the risk of obesity, diabetes and cardiovascular illness
  • Minimising exposure to air pollution and second-hand tobacco smoke
  • Limiting alcohol use
  • Avoiding or stopping smoking 

Scientific studies

There is ongoing research to find a cure for dementia and many studies into finding new medication. Alongside the race to find a new treatment, there has been good progress into the understanding and awareness of dementia. This includes the discovery of a new type of dementia, called LATE11, and the development of a simple blood test that is 94% accurate12 in detecting Alzheimer’s disease long before brain scans are able to.

Referenced sources

  1. World Health Organization. Dementia. Published September 2020. Accessed January 2021. https://www.who.int/news-room/fact-sheets/detail/dementia
  2. Dementia UK. Dementia with lewy bodies. Accessed February 2021. https://www.dementiauk.org/understanding-dementia/types-and-symptoms/dementia-with-lewy-bodies/

  3. National Parkinson Foundation. Parkinson’s dementia. Accessed February 2021. https://www.parkinson.org/sites/default/files/PD%20Dementia.pdf

  4. World Health Organization. Areas of work: dementia. Accessed January 2021. https://www.euro.who.int/en/health-topics/noncommunicable-diseases/mental-health/areas-of-work/dementia

  5. Georges J, Miller O, Bintener C. Dementia in Europe Yearbook 2019: estimating the prevalence of dementia in Europe. Luxembourg: Alzheimer Europe; 2020. doi:10.13140/RG.2.2.16880.81923
  6. Livingston G, Huntley J, Sommerlad A et al. Dementia prevention, intervention, and care:   2020 report of the Lancet Commission. Lancet. 2020;396(10248):413-446. doi:10.1016/S0140-6736(20)30367-6
  7. Cholerton B, Baker LD, Montine TJ, Craft S. Type 2 diabetes, cognition, and dementia in older adults: toward a precision health approach. Diabetes Spectr. 2016;29(4):210-219. doi:10.2337/ds16-0041
  8.  Rait G, Walters K, Bottomley C, Petersen I, Iliffe S, Nazareth I. Survival of people with clinical diagnosis of dementia in primary care: cohort study. BMJ. 2010;341:c3584. doi:10.1136/bmj.c3584
  9. Sindi S, Kåreholt I, Eskelinen M et al. Healthy dietary changes in midlife are associated with reduced dementia risk later in life. Nutrients. 2018;10(11):1649. doi:10.3390/nu10111649
  10. Dhana K, Evans DA, Rajan KB, Bennett DA, Morris MC. Healthy lifestyle and the risk of Alzheimer dementia: findings from 2 longitudinal studies. Neurology. 2020;95(4):e374-e383. doi:10.1212/wnl.0000000000009816
  11. Nelson P, Dickson T, Trojanowski JQ et al. Limbic-predominant age-related TDP-43 encephalopathy (LATE): consensus working group report. Brain. 2019;142(6):1503-1527. doi:10.1093/brain/awz099
  12. Schindler SE, Bollinger JG, Ovod V et al. High-precision plasma β-amyloid 42/40 predicts current and future brain amyloidosis. Neurology. 2019;93(17):e1647-e1659. doi:10.1212/WNL.0000000000008081
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