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DementiaPublished by BUPA's health information team, healthinfo@bupa.com, June 2007. This factsheet is for people with dementia, or who would like information about it. Dementia is a broad term for a range of symptoms that occur as a result of damage to your brain. It's more likely to affect you if you are over 65 - this is late-onset dementia. Dementia occurring before this age is called early-onset. Diseases such as Alzheimer's disease lead to dementia. You may also develop dementia if small blood vessels become blocked in your brain.
About dementiaYour brain is made up of billions of nerve cells (neurons) and these form complicated networks. Usually signals from your body or from outside pass between nerve cells across small gaps (synapses). Messages travel around your brain in this way and produce a response to the original signal. This process is helped by chemicals called neurotransmitters. If you have dementia, the nerve cells in your brain aren't working properly and your brain can't correctly process the signals going to it. You may have problems communicating, remembering things and carrying out daily activities. Usually, it won't be possible to cure your dementia, but some medicines can slow down its progress. Symptoms of dementiaYou may have some or all of the following symptoms if you have dementia.
Dementia is progressive and in time your symptoms will get more severe. It affects everyone differently - this is determined by factors such as your personality and the support available to you. Depending on what is causing your dementia symptoms, its course will vary. If it's a result of Alzheimer's disease, it will be degenerative (continue to get worse). It's often difficult to predict the rate at which vascular dementia will progress. Your symptoms may stay the same for some time and deterioration will be patchy. In vascular dementia, the blood vessels (vascular system) in your brain become blocked. Not enough blood and oxygen reach the nerve cells so they die. Areas of brain tissue that have died this way are called infarcts, so vascular dementia is also called multi-infarct dementia. This is the second most common type. Health conditions such as high blood pressure and diabetes may raise your risk of this, as does eating a diet high in salt and fat.It's difficult to say how long you will live once you are diagnosed with dementia - the type you have influences this. The average life expectancy for people with Alzheimer's disease is six years. Causes of dementiaThe main risk factor for late-onset dementia is ageing. Over 65, your risk is one in 20, rising to one in five if you are over 80. If you are aged 40 to 65, your risk of early-onset dementia is one in 1,400. There are more than 100 types of dementia. In the UK, the most common cause is Alzheimer's disease, accounting for nearly two-thirds of cases. If you have Alzheimer's disease, changes develop in your brain's structure. These lead to the death of nerve cells and disrupt your brain's usual activity. There is also less of the neurotransmitter acetylcholine. This is needed for communicating messages related to memory - having less of it affects your ability to remember things. Drinking excessive amounts of alcohol could result in alcohol-related dementia because your body doesn't have enough of the B vitamin thiamine. You may have more than one type at the same time, in particular Alzheimer's disease and vascular dementia. Your risk of dementia may be affected if someone else in your family has it. However, more research is needed to better understand this link. Diagnosis of dementiaIf you think you may be developing dementia, or that someone you know may be affected, it's best to see your GP. You won't usually get a definite diagnosis at your first visit, especially if you are in the early stages. Your GP may follow your progress for several months to make a more definitive diagnosis. Your GP is likely to ask about your medical history, as well as that of your family. He or she will probably give you a physical examination and may do blood and urine tests to rule out the possibility of other conditions that could be causing your dementia symptoms. Your GP may carry out memory tests - one that is often used is the mini mental state examination. Depending on the outcome of the tests, your GP may refer you to a specialist doctor, psychiatrist or psychologist. He or she may do more detailed tests and suggest that you have a brain scan (either a CT, MRI or SPECT scan) to provide more information. It's difficult for doctors to diagnose what type of dementia you have as the symptoms are very similar for all of them. However, as medicines advance, it's important to find out what is causing your dementia as some types can be treated and the symptoms slowed down. Treatment of dementiaIt may be possible to cure some cases of dementia caused by vitamin deficiency or head injury. In all other cases this won't be possible. However, medicines can treat your symptoms and prevent them coming on as quickly. Improving memory and concentrationThere are now three medicines that your doctor may prescribe if you are diagnosed with Alzheimer's disease. They are donepezil (Aricept), galantamine (Reminyl) and rivastigmine (Exelon). They reduce the rate at which acetylcholine is destroyed so there is more of it available to transmit messages around your brain. As with all medicines, you may have side-effects, including nausea and tiredness. It's worth carrying on taking the medicine as the side-effects usually fade after a few weeks. The National Institute for Health and Clinical Excellence (NICE) provides guidance on effective treatment. NICE has recommended that these medicines should only be offered if you have moderate Alzheimer's disease. If you have early Alzheimer's disease, you won't be eligible to receive the medication. The medicine memantine (Ebixa) works differently. It's used for severe dementia. Reducing psychiatric problemsAs dementia progresses, you may feel depressed. Your GP may prescribe you antidepressants but there isn't much evidence over whether they are effective. Your GP may also give you tranquilisers if there are changes in how you feel that cause you to be aggressive or restless. Other treatmentsThere is a range of other therapies that you may find helpful, such as:
Prevention of dementiaSome things you can do to try to reduce your risk of developing dementia include:
Living with dementiaCaring for someone at home with dementia can be a difficult and upsetting time. As their condition deteriorates, you are likely to notice changes in how they behave and symptoms may be hard to cope with. You may experience emotions such as:
As well as family and friends, emotional and practical support is available from:
Some hospitals and residential homes offer short-term care for people with dementia to give their carers a break. In time, you may need to find a care home for the person with dementia if you are no longer able to look after them and provide dementia care at home. Further information
Sources
Related topics
This information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Graham Stokes BA MSc PhD C Psychol AFBPsS, consultant clinical psychologist and BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: June 2007. Expected review date: June 2009.
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