There are many other diseases that can lead
to dementia. These are rare: together they account for only about five per cent
of all dementia. They tend to be more common among younger people with dementia
(under the age of 65).
These rarer causes include alcohol-related brain
damage (including Korsakoff's syndrome), corticobasal degeneration, progressive
supranuclear palsy, HIV infection, Niemann-Pick disease type C, and
Creutzfeldt-Jakob disease (CJD).
Some people with Parkinson's disease or
Huntington's disease develop dementia as the illness gets worse. People with Down's syndrome are also at a
particular risk of developing Alzheimer's disease as they get older.
Mild cognitive impairment
Some people have problems with their memory or
thinking but these are not severe enough to interfere with everyday life. In
this case, a doctor may diagnose mild cognitive
impairment (MCI). Research shows that people with MCI have an increased risk
of developing dementia; about 10-15 per cent of this group will develop
dementia each year.
However, MCI can also be caused by other conditions
such as anxiety, depression, physical illness and side effects of medication.
Because of this, some people with MCI do not go on to develop dementia, and a
small number of people will even get better.
Who gets dementia?
It is predicted there will be around 850,000 people
in the UK with dementia in 2015. It mainly affects people over the age of 65
(one in 14 people in this age group have dementia), and the likelihood of
developing dementia increases significantly with age. However, it can
affect younger people: there are more than
40,000 people in the UK under 65 with dementia. Dementia can affect men and
women.
Scientists are investigating the ways dementia
might run in the family. In a very small
number of people, certain types of dementia are inherited as a single gene that
causes the disease, usually before age 65. A much larger number of people will
inherit a combination of genes that increases or decreases their risk of
developing dementia in much less direct ways.
How can I tell if I have dementia?
Becoming a bit more forgetful does not necessarily
mean that you have dementia. Many people notice that their memory becomes a bit
less reliable as they get older - for example they might forget someone's name.
Memory loss can also be a sign of stress, depression or certain physical
illnesses.
However, anyone who is worried that their memory is
getting noticeably worse, or who has other symptoms such as those listed above,
should discuss their concerns with the GP.
Diagnosing dementia
It is very important to get a proper assessment of problems
with memory or thinking. They may be caused by a treatable condition such as
depression or an infection, rather than dementia.
If the cause is dementia, a diagnosis has many
benefits. It provides someone with an explanation for their symptoms, gives
access to treatment, advice and support, and allows them to prepare for the
future and plan ahead. Knowing the type of dementia (eg Alzheimer's disease,
vascular dementia) may allow appropriate drug treatments to be offered.
Dementia will usually be diagnosed by a specialist
doctor such as a psychiatrist (a mental health specialist), a geriatrician (a
doctor specialising in the physical health of older people) or a neurologist
(someone who concentrates on diseases of the nervous system). Occasionally a GP
or specialist nurse will make the diagnosis, depending on their expertise and
training.
There is no single test for dementia. A diagnosis
is based on a combination of things:
- taking a 'history' - by the doctor talking to the person and someone who knows them well about how their problems developed and how they are now affecting their daily life
- cognitive tests of mental abilities (eg memory, thinking) - simpler tests will be carried out by a nurse or doctor, more specialist tests by a psychologist
- physical examination and tests (eg blood tests) - to exclude other possible causes of the symptoms
- a scan of the brain - if this is needed to make the diagnosis.
A common pattern is for the GP to make an initial
assessment and then refer the person to a memory clinic or other specialist
service for more detailed assessment. A specialist doctor
will have more expertise in dementia and will be able to arrange more detailed
tests and brain scans if needed. The diagnosis should be communicated clearly
to the person and usually also those closest to them, along with a discussion
about the next steps.
How is dementia treated?
The vast majority of causes of dementia cannot be
cured, although research is continuing into developing drugs, vaccines and
other medical treatments. There is also a lot that can be done to enable
someone with dementia to live well with the condition. Care and support should
be 'person-centred', valuing the person as a unique individual.
Non-drug treatments and support
A range of support, therapies and activities that
don't require medication can help someone to live well with dementia. The GP, memory service or
local Alzheimer's Society should be able to advise on what is available.
Support for the person and their carer after a
diagnosis should give them a chance to talk things over with a specialist, ask
questions about the diagnosis, and think about the future. Information should
be given on where to get help if needed in the future and how to stay
physically and mentally well.
Talking therapies, such as
counselling, can help someone come to terms with their diagnosis. Another
treatment called cognitive behavioural therapy (CBT) may be offered to help
with depression or anxiety.
Cognitive rehabilitation can enable an individual
to retain mental skills and raise their confidence. There is also lots that can
be done at home to help someone with dementia remain independent and live well
with memory loss. Support ranges from devices such as pill boxes or calendar
clocks to practical tips on how to develop routines or break tasks into simpler
steps.
Activities that help to
keep the mind active, such as cognitive stimulation, are popular. As the
condition progresses, many people with dementia enjoy reminiscence and life
story work (in which the person is encouraged to share their life experiences
and memories). Such activities may help improve someone's mental abilities,
mood and wellbeing.
It is vital that people with dementia stay as
active as they can - physically, mentally and socially. Everyone needs
meaningful activities that they enjoy doing and which bring confidence and
self-esteem.
Drug treatments
There are drugs that can help to improve the
symptoms of dementia or that, in some cases, may stop them progressing for a
while.
A person with mild to moderate Alzheimer's disease or mixed
dementia may be prescribed donepezil (often known by the brand name Aricept),
rivastigmine (eg Exelon) or galantamine (eg Reminyl). These may temporarily
relieve memory problems and improve alertness, level of interest and daily
living. In the moderate or severe stages of Alzheimer's disease someone may be
offered memantine (eg Ebixa). This may help with mental abilities and daily
living, and ease distressing or challenging behaviours and delusions.
Donepezil, rivastigmine and galantamine can be
helpful for someone with dementia with Lewy
bodies who has distressing hallucinations or delusions,
or who has behaviours that challenge.
For a person with vascular dementia, drugs will be
offered to treat the underlying conditions. These conditions often include high
blood pressure, high cholesterol, diabetes or heart problems. Controlling these
may help slow the progression of dementia.
A wide range of other drugs may be prescribed at
different times for a person with dementia. These include drugs for depression or
anxiety, sleeping tablets or antipsychotics. Note that some of these drugs can
have severe side effects. Not all are recommended for all types of dementia.
Health professionals will generally advise that a non-drug approach is tried
first before prescribing medication.
Can dementia be prevented?
It is not usually possible to say for sure why a particular
person has developed dementia. It is known that high blood pressure, lack of
physical exercise and smoking - all of which lead to narrowing of the arteries
- increase the risk of developing
Alzheimer's disease and vascular dementia. There is evidence that a healthy
lifestyle, especially in mid-life, can help reduce the risk of dementia.
Regular physical exercise (eg cycling, brisk walking), maintaining a healthy
weight, not smoking, and drinking only in moderation are all linked to a
reduced risk of dementia.
It is important that conditions such as diabetes,
heart problems, high blood pressure and high cholesterol are all kept under
control. Getting depression treated early is also important.
A balanced diet may help to reduce risk. A balanced
diet is one which is low in saturated fat, does not have too much salt, dairy
or meat, and includes plenty of fish and fresh fruit and vegetables.
All these healthy lifestyle choices will also
reduce the risk of other serious conditions such as stroke, heart disease and
cancer.
It also seems that keeping socially and mentally
active into later life may help lower the risk of dementia. Being socially
active could include visiting friends or going to a place of worship, while
being mentally active could include doing puzzles or reading.
SOURCE: Alzheimers Society
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