What is Dementia?

Dementia is an umbrella term used to describe a group of conditions that affect how well our brains work.

Dementia can affect anyone, and as people get older the chances of developing dementia increase.

The most common form of dementia is Alzheimer’s disease – which around two-thirds of people with dementia have.

The symptoms each person experiences depends on the parts of the brain that are affected. However, the most common dementia symptoms include changes in memory, thinking, behaviour, personality and emotions. These changes affect a person’s ability to perform everyday tasks and interfere with their everyday lives.

Dementia is progressive, which means that for most people the changes gradually spread through the brain and lead to the symptoms getting worse. Dementia is different for everyone – what people experience, and how quickly they are affected is unique to them. What they can do, remember and understand may change from day to day.

Types of Dementia.

No one single factor has been determined as the cause of dementia. It is likely that a combination of factors, including age, genetic inheritance and environmental factors, are responsible. Some of the most common forms are:

Alzheimer's disease

This is the most common form of dementia - around two-thirds of people with dementia have Alzheimer's disease. Although we are still learning about the causes, there are typical changes seen in the brain - shrinkage and a build-up of abnormal proteins (plaques and tangles).

Alzheimer’s disease is progressive, starting as forgetfulness and mild confusion, progressing to memory loss, disorientation and changes in personality and behaviour. The specific symptoms can vary, depending on the part of the brain that is affected.

Vascular dementia

This is the second most common form of dementia. This group of conditions is caused by poor blood supply to the brain as a result of a stroke or several mini-strokes, or by the slow accumulation of blood vessel disease in the brain. Vascular dementia symptoms can begin suddenly after a stroke or gradually as disease in the blood vessels worsen. Some people will have both vascular dementia and Alzheimer’s disease.

Lewy Body disease

This condition is characterised by the presence of ‘Lewy Bodies’, which are abnormal clumps of protein in the brain. These cause changes in movement, thinking, behaviour and alertness. People with Lewy Body disease can fluctuate between almost normal functioning and severe confusion within short periods, and may also have hallucinations, seeing things that aren't really there.

Frontotemporal Dementia

Fronto-temporal dementia is a group of conditions which affect the frontal and/or temporal lobes of the brain. If a person has affected frontal lobes they will have increasing difficulty with motivation, planning and organising, controlling emotions and maintaining socially appropriate behaviour. If temporal lobes are affected the person will have difficulty with speaking and/or understanding language. Symptoms often begin in a person's 50s or 60s.

Memory Lapses or Memory Loss?

It’s important to understand what is dementia and what isn’t. We all forget things from time to time and often complain our memory isn’t what it used to be, but this doesn’t necessarily mean we’re getting dementia.

Memory loss from dementia is quite different to occasionally forgetting things. Memory loss from dementia isn’t just occasional and it keeps getting worse. It may affect a person’s ability to work and carry out everyday tasks, which may eventually include how to dress, bathe, walk or recognise family members.

It helps to know what are probably just normal changes in the brain as we age and what may be linked to dementia. If you’re worried about your memory, go and see your GP, because depression, stress, the side effects of some medication, and other treatable conditions might be behind any memory loss.

· An older person’s memories may sometimes be vague.

o A person with dementia may forget all or part of an event.

Words or names

· An older person might sometimes forget or have words or names that are on the ‘tip of the tongue’

· Someone with dementia may progressively forget words or names, or use the wrong word for something.

Stories on TV, in movies or books

· An older person is able to follow storylines.

· People with dementia may become increasingly unable to follow storylines.

Written and verbal directions

· An older person is able to follow directions.

· People with dementia can become increasingly unable to follow directions.

Knowledge and information

· Although recall may be slower, an older person can essentially remember information.

· Over time, a person with dementia can lose known information such as historical or political events.

Everyday tasks such as dressing and cooking

· Unless there’s a physical reason, an older person can perform these tasks.

· A person with dementia can progressively lose the ability to do these everyday tasks.

Ten warning signs of dementia

1. Recent memory loss that affects daily life

· It’s normal to forget meetings, names or telephone numbers occasionally and then remember them later.

· A person with dementia might have trouble remembering recent events.

2. Difficulty performing regular tasks

· It’s normal to make a wrong turn occasionally while driving.

· Someone with dementia might have regular difficulty driving a familiar route.

3. Problems with language

· Many people have trouble finding the right words sometimes.

· But someone with dementia might have difficulty following, or initiating a conversation.

4. Disorientation of time and place

· It is normal to occasionally forget what day it is or where you are going

A person with dementia may be confused about the time of day, and what is appropriate for that time.

5. Decreased or poor judgment

· Making a bad decision once in a while is normal.

· A person with dementia might make bad decisions more frequently and start paying less attention to their physical appearance.

6. Problems with abstract thinking

· It’s normal to have difficulty balancing a budget.

· A person with dementia might completely forget what the numbers are and what needs to be done with them.

7. Misplacing things

· Anyone can misplace their wallet or keys.

· A person with dementia might repeatedly put things in inappropriate places.

8. Changes in mood and behaviour

· Everyone becomes sad or moody from time to time.

. A person with dementia can have rapid mood swings, from calm to tears to anger, for no apparent reason.

9. Changes in personality

· People's personalities can change a little with age

· A person with dementia might have problems in social situations they have previously been comfortable with.

10. Loss of initiative

· It is normal for people to tire of housework, business activities or social obligations.

· A person with dementia may no longer initiate things that they once enjoyed.

Getting a Diagnosis.

If you think you or someone you care about may have dementia, it is important to see a GP for an assessment as soon as possible.

The benefits of an early diagnosis include some peace of mind in knowing what is going on, the opportunity to find out more about the condition, access to services and support and the ability to plan for the future. For some people, medication which might delay the progression of cognitive problems is available.

The GP will do a complete medical assessment. They may decide the symptoms are a result of a treatable condition, or they may confirm dementia.

An assessment may include:

· discussing medical history

· talking to family/whānau (with appropriate permission)

· undergoing a physical examination

· laboratory tests, which may include a blood and urine tests

· cognitive testing, which assesses how the brain is working – in particular memory, language, attention span and problem solving

· brain imaging, which looks at the brain’s structure and is used to rule out other medical conditions or diagnose the particular type of dementia

· mental health assessment, which may identify treatable conditions such as depression, and to manage some symptoms experienced as part of the dementia.

Some hints for seeing the doctor:

The GP should provide advice and support, listen to your opinions, explain things so you can understand them, answer your questions and make you feel comfortable and respected. If you think you're not getting that from your GP, don’t hesitate to look for another that suits your needs.

· Make the appointment for a time of the day where you or the person you are concerned about is at their best. Don’t be afraid to ask for a longer appointment than normal if you feel you need it.

· Make a list of questions before you go, and it is a really good idea to ask a family member or friend to go to the appointment with you, rather than going alone.

· Keep a folder about conversations you have with your GP. Ask your doctor to write things down if necessary.

· Don’t be afraid to speak up for yourself and ask questions.

· If you don’t understand what is being said, ask to have it explained in a different way.

If you or your loved one does receive a diagnosis of dementia there is lots of support available. Find out more about what to think about after a diagnosis or get in touch with your local Alzheimers organisation for information and support.