Live in care at Home – Elderly home care blog

Many people assume a loss of mental agility is an evitable part of ageing. In fact, there’s no reason why the mind shouldn’t remain sharp. But, like any other organ, the brain is susceptible to disease, which can lead to dementia.

Who’s affected?
The older a person is, the greater the chance they will develop a disease that harms the brain. Diseases that damage the areas that control thinking, memory, reasoning and language can lead to dementia.

It’s rare in people under the age of 60, but affects one person in 20 over the age of 65 and one in five over 80.

What causes it?

In a small number of cases the disease is reversible

When someone is diagnosed with dementia it’s vital the cause is established as far as possible because in a small number of cases the disease is reversible.

Even when the cause is not reversible, a clear diagnosis is important as different drugs are recommended in different types of dementia.

Causes include:

– Diseases resulting in progressive degeneration or death of nerve cells. These include Alzheimer’s (which accounts for more than half of all cases), Parkinson’s disease, Huntington’s disease, Creutzfeldt-Jakob disease and a group of conditions referred to as frontotemporal dementia (FTD). Another condition, called Lewy Body dementia, affects 20 per cent of people with dementia.
– Conditions, such as atherosclerosis, that harm the blood vessels supplying the brain. This type of dementia is known as vascular dementia and accounts for about 20 per cent of dementia cases.
– Conditions producing a dementia that can be reversed with treatment. These include hypothyroidism (underactive thyroid), vitamin B12 deficiency, folate deficiency, syphilis of the nervous system, subdural haematoma (a blood clot round the brain, usually following a blow to the head), hypercalcaemia (abnormally high calcium levels), undiagnosed diabetes, brain tumours or infections, and a condition called normal pressure hydrocephalus.
– Some medicines can interfere with concentration and memory, producing dementia-like symptoms. These include tranquilisers and sleeping pills, antidepressants and certain drugs with an anticholinergic effect (for example, some hayfever and cold remedies, some stomach ulcer drugs and treatments for diarrhoea).

What are the symptoms?
People with dementia often don’t look ill, especially in the early stages, and may have no particular symptoms. But family and friends may notice a change in the person’s personality, or that they seem to have problems remembering things.

The condition usually progresses slowly, and three types of symptoms may appear:

– Cognitive problems – a disturbance of understanding, memory, thinking, calculation, learning capacity, language and judgement.
– Functional problems – difficulty carrying out complex tasks and, as the condition progresses, difficulty with daily living activities, such as personal hygiene and dressing.
– Emotional problems – changes in mood, loss of emotional control and a withdrawal from previous interests, activities and social interactions.

Different types of dementia show slightly different patterns of disease. For example, in Lewy Body dementia, severity varies markedly from day to day, while in Alzheimer’s there is only slight variation from day to day.

In frontotemporal dementia (including Pick’s disease), shrinking of the frontal and temporal lobes of the brain typically causes problems with either behaviour and/or language but not with memory.

People with FTD often become disinhibited and irritable, rude, aggressive or apathetic. They may change their normal habits, become more interested in sex and neglect basic personal hygiene.

At the same time, they lose insight and don’t understand why their behaviour’s causing distress. Alternatively, or at the same time, they may progressively struggle to speak or understand speech. FTD tends to affect younger people (average age of onset is 60), has a strong inherited pattern and is usually relentlessly progressive with behaviour that’s difficult to control.

How is it diagnosed?
There’s no single test that can identify dementia, although a range of blood tests and sophisticated brain scans can help and are important in ruling out reversible causes.

Diagnosis is made by an assessment of symptoms and the use of brief questionnaires that test ability to remember facts, or draw simple diagrams.

What’s the treatment?
Most types of dementia progress slowly. People may live with the condition for ten years or more, requiring increasing levels of support as they become less independent. By carefully planning the person’s environment, and giving structure to their day with supportive activities, it may be possible to reduce the impact of the symptoms.

While there is no treatment that can cure progressive dementia, drugs (especially a type known as cholinesterase inhibitors) play an important part in controlling symptoms and can enable a person with dementia to live independently in the community for longer.

These treatments may also help behavioural symptoms such as restlessness or agitation, and improve the quality of life for the person with dementia and their carers. Some people don’t respond to any existing treatments.

Possible future treatments
Scientists are investigating the use of stem cell therapy, antioxidants and vaccination to stop plaque build-up in the brain.

It’s unclear how beneficial the herb Gingko biloba is in delaying the progression of Alzheimer’s and vascular dementia, and relieving their symptoms. There’s some evidence suggesting it may help.

Mental activity is believed to slow the progress of certain types of dementia, so keeping the brain active by doing puzzles and crosswords, for example, is recommended.

Depression is common among people with dementia and antidepressants can also help to improve symptoms.

This article was last medically reviewed by Dr Rob Hicks in January 2008

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society