Dementia
Living with dementia can be challenging, but there are ways to manage it.
Dementia
Dementia is an umbrella term used to describe a range of neurological conditions affecting the brain that get worse over time. It is the loss of the ability to think, remember, and reason to levels that affect daily life and activities. Some people with dementia cannot control their emotions and other behaviors, and their personality may change.
Key facts
Dementia is a syndrome in which there is deterioration in cognitive function beyond what might be expected from the usual consequences of biological ageing.
Although dementia mainly affects older people, it is not an inevitable consequence of ageing.
Currently more than 55 million people live with dementia worldwide, and there are nearly 10 million new cases every year.
Dementia results from a variety of diseases and injuries that primarily or secondarily affect the brain. Alzheimer’s disease is the most common form of dementia and may contribute to 60-70% of cases.
Dementia is currently the seventh leading cause of death among all diseases and one of the major causes of disability and dependency among older people globally.
Dementia has physical, psychological, social and economic impacts, not only for people living with dementia, but also for their carers, families and society at large.
Dementia is a syndrome – usually of a chronic or progressive nature – that leads to deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from the usual consequences of biological ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by changes in mood, emotional control, behaviour, or motivation.
Dementia results from a variety of diseases and injuries that primarily or secondarily affect the brain, such as Alzheimer’s disease or stroke.
Dementia is currently the seventh leading cause of death among all diseases and one of the major causes of disability and dependency among older people worldwide. Dementia has physical, psychological, social and economic impacts, not only for people living with dementia, but also for their carers, families and society at large. There is often a lack of awareness and understanding of dementia, resulting in stigmatization and barriers to diagnosis and care.
In the past, dementia was sometimes referred to as “senility” and was thought to be a normal part of aging, likely because it is more common as people age. As many as half of all people age 85 or older may have dementia. But dementia is not a normal part of aging. Not everyone develops dementia as they get older, and, in rare cases, some people develop dementia in midlife.
There are many different forms of dementia.
Alzheimer’s disease
Vascular dementia
Lewy Body disease (Lewy body disease is caused by the degeneration and death of nerve cells in the brain. The name comes from the presence of abnormal spherical structures, called Lewy bodies, which develop inside nerve cells. It is thought that these may contribute to the death of the brain cells. They are named after the doctor who first wrote about them. It is sometimes referred to as Diffuse Lewy body disease.).
Frontotemporal dementia (Frontotemporal dementia (FTD) is the name given to dementia when it is due to progressive damage to the frontal and/or temporal lobes of the brain.
The right and left frontal lobes at the front of the brain are involved in mood, social behaviour, attention, judgement, planning and self-control. Damage can lead to reduced intellectual abilities and changes in personality, emotion and behaviour.).
Alcohol related dementia (Alcohol related dementia, as the name suggests, is a form of dementia related to the excessive drinking of alcohol. This affects memory, learning and other mental functions. Korsakoff’s syndrome and Wernicke-Korsakoff syndrome are particular forms of alcohol related brain injury which may be related to alcohol related dementia.).
Down syndrome and Alzheimer’s disease (Studies show that by the age of 40, almost 100% of people with Down syndrome who die have the changes in the brain associated with Alzheimer’s disease. Amyloid precursor protein (APP), which is the abnormal breakdown that yields the toxic amyloid protein that forms plaques in the brain and probably damages brain cells and their connections, is coded for chromosome 21. Because people with Down syndrome have an extra copy of chromosome 21, they make 1.5 times as much APP as other people, and this seems to result in an excess tendency for the abnormal amyloid breakdown product to build up. This appears to cause earlier appearance of the brain changes typical of Alzheimer’s disease. However, a significant number of people with Down syndrome are older than 40 and show no signs of having Alzheimer’s disease.).
HIV associated dementia (When someone has the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) they may develop a complication to the disease which is known as HIV associated dementia, or as AIDS Dementia Complex (ADC). ADC is a complicated syndrome made up of different nervous system and mental symptoms that can develop in some people with HIV disease. The incidence of ADC is uncommon in people with the early stages of the disease, but may increase as the disease advances to around 7% in people not taking anti-HIV drugs.).
Chronic Traumatic Encephalopathy (CTE) dementia
Alzheimer’s disease is the most common form and may contribute to 60-70% of cases. Other major forms include vascular dementia, dementia with Lewy bodies (abnormal aggregates of protein that develop inside nerve cells), and a group of diseases that contribute to frontotemporal dementia (degeneration of the frontal lobe of the brain). Dementia may also develop after a stroke or in the context of certain infections such as HIV, harmful use of alcohol, repetitive physical injuries to the brain (known as chronic traumatic encephalopathy) or nutritional deficiencies. The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
As we age, it’s normal to lose some neurons in the brain. People living
with dementia, however, experience far greater loss. Many neurons
stop working, lose connections with other brain cells, and eventually
die. At first, symptoms can be mild, but they get worse over time.
Read on to learn more about four different types of dementia.
Living with dementia can be challenging, but there are ways to manage it.
The early signs of dementia are very subtle and vague and may not be immediately obvious. Early symptoms also vary a great deal. Usually though, people first seem to notice that there is a problem with memory, particularly in remembering recent events.
Other common symptoms include:
Confusion
Personality change
Apathy and withdrawal
Loss of ability to do everyday tasks
Sometimes people fail to recognise that these symptoms indicate that something is wrong. They may mistakenly assume that such behaviour is a normal part of the ageing process. Or symptoms may develop gradually and go unnoticed for a long time. Sometimes, people may refuse to act even when they know something is wrong.
Ten warning signs
This is a checklist of common symptoms of dementia. Go through the list of the symptoms, if there are several that you say ‘yes’ to, a doctor should be consulted for a complete examination of the person with the symptoms.
Recent memory loss that affects job skills
It is normal to forget meetings, colleagues’ names, or a business associate’s telephone number occasionally, but then remember them later.
A person with dementia may forget things more often, and not remember them later.
Difficulty performing familiar tasks
Busy people can be so distracted from time to time that they may leave the carrots on the stove and only remember to serve them when the meal has finished.
A person with dementia might prepare a meal and not only forget to serve it, but also forget they made it.
Problems with language
Everyone has trouble finding the right word sometimes.
A person with dementia may forget simple words or substitute inappropriate words.
Disorientation of time and place
It is normal to forget the day of the week or your destination for a moment.
People with dementia can become lost on their own street, not know where they are, how they got there or how to get back home.
Poor or decreased judgement
Dementia affects a person’s memory and concentration and this in turn affects their judgement. Many activities, such as driving, require good judgement and when this ability is affected, the person will be a risk, not only to themselves, but to others on the road.
Problems with abstract thinking
Managing finances can be difficult for anyone.
A person with dementia may have trouble knowing what the numbers means or what to do with them.
Misplacing things
Anyone can temporarily misplace a wallet or keys.
A person with dementia may repeatedly put things in inappropriate places.
Changes in mood or behaviour
Everyone becomes sad or moody from time to time.
Someone with dementia can have rapid mood swings from calm to tears to anger, for no apparent reason.
Changes in personality
People’s personalities can change a little with age.
A person with dementia can become suspicious or fearful, or just apathetic and uncommunicative. They may also become dis-inhibited, over-familiar or more outgoing than previously.
Loss of initiative
It is normal to tire of housework, business activities or social obligations.
The person with dementia may become very passive and require cues prompting them to become involved.
Dementia risk reduction
Being brain healthy is relevant at any age, whether you are young, old or in between. However, it is particularly important once you reach middle age as this is when changes start to occur in the brain.
While we cannot change getting older, genetics or family history, scientific research suggests that changing certain health and lifestyle habits may make a big difference to reducing or delaying your risk of developing dementia.
There are 12 recommendations for reducing risk for cognitive decline released by the World Health Organisation:
Be physically active
stop smoking
eat a balanced diet, like the Mediterranean diet
drink alcohol in moderation
cognitive training
be socially active
look after your weight
manage any hypertension
manage any diabetes
manage any cholesterol
manage depression
look after your hearing and manage hearing loss.
Social and economic impact
Dementia has significant social and economic implications in terms of direct medical and social care costs, and the costs of informal care. In 2019, the estimated total global societal cost of dementia was US$ 1.3 trillion, and these costs are expected to surpass US$ 2.8 trillion by 2030 as both the number of people living with dementia and care costs increase.
Impact on families and carers
In 2019, informal carers (i.e. most commonly family members and friends) spent on average 5 hours per day providing care for people living with dementia. This can be overwhelming . Physical, emotional and financial pressures can cause great stress to families and carers, and support is required from the health, social, financial and legal systems. Fifty percent of the global cost of dementia is attributed to informal care.
Disproportionate impact on women
Globally, dementia has a disproportionate impact on women. Sixty-five percent of total deaths due to dementia are women, and disability-adjusted life years (DALYs) due to dementia are roughly 60% higher in women than in men. Additionally, women provide the majority of informal care for people living with dementia, accounting for 70% of carer hours.
Human rights
Unfortunately, people with dementia are frequently denied the basic rights and freedoms available to others. In many countries, physical and chemical restraints are used extensively in care homes for older people and in acute-care settings, even when regulations are in place to uphold the rights of people to freedom and choice.
An appropriate and supportive legislative environment based on internationally-accepted human rights standards is required to ensure the highest quality of care for people with dementia and their carers.