What is dementia?

Dementia is a syndrome – usually of a progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal 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 deterioration in emotional control, social behaviour, or motivation.

Dementia results from a variety of diseases and injuries that affect the brain, such as Alzheimer’s disease or stroke. Sometimes a person suffers from a combination of insults to their brain.

(World Health Organization, 2019)

Are there different forms of dementia?

There are many different forms of dementia. Alzheimer 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 lobes of the brain). The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.

(World Health Organization, 2019)

What are the risk factors for dementia?

Although age is the strongest known risk factor, dementia is not an inevitable consequence of ageing. Furthermore, dementia does not exclusively affect older people – young onset dementia (defined as the onset of symptoms before the age of 65 years) accounts for up to 9% of cases.

Studies show that people can reduce their risk of dementia by getting regular exercise, not smoking, avoiding harmful use of alcohol, controlling their weight, eating a healthy diet, and maintaining healthy blood pressure, cholesterol and blood sugar levels, Additional risk factors include depression, low educational attainment, social isolation, and cognitive inactivity.

Dementia prevalence (the percentage of the older people population that suffer from dementia) has actually decreased slightly over recent decades, most likely due to baseline higher levels of educational achievement and better general health, especially the better management of cardiovascular risk.

The latter includes more assertive management of blood pressure and cholesterol levels in the community. In spite of these improvements, the numbers of cases is rapidly growing in the community, due to the increasing numbers of older people.

(World Health Organization, 2019)

What are the signs and symptoms of dementia?

Dementia affects each person in a different way, depending upon the impact of the disease, the type of dementia and the person’s personality before becoming ill. The signs and symptoms linked to dementia can be understood in three stages.

Early stage:

the early stage of dementia is often overlooked, because the onset is gradual. Common symptoms include:

  • Forgetfulness
  • Losing track of conversations
  • Struggling with complex tasks such as financial management or cooking.
  • Behavioural changes such as apathy or low mood.
    (It is important to recognise that simple forgetfulness for names or similar, is a common experience in old age, and does not signify impending dementia.)

Middle stage:

as dementia progresses to the middle stage, the signs and symptoms become clearer and more restricting. These include:

  • Being forgetful for significant recent events
  • Becoming lost at home or out in the community
  • Having increasing difficulty with communication
  • Needing help with personal care and household tasks
  • Experiencing behaviour changes, such as wandering and repeated questioning.

Late stage:
the late stage of dementia is one of near total dependence and inactivity. Memory disturbances are serious and the physical signs and symptoms become more obvious. Symptoms include:

  • Becoming unaware of the time and place
  • Having difficulty recognising family members and friends
  • Having an increasing need for assistance with intimate personal cares
  • Having difficulty mobilising and losing muscle strength
  • Experiencing behaviour changes that may escalate and include aggression.

(World Health Organization, 2019)

What challenges do people with Dementia face?

Dementia, as it progresses, can become a disabling condition for the person affected. The person’s reasoning and practical abilities are affected, their behaviour often changes, and their care needs escalate. They need increasing amounts of assistance from their families with everyday activities. The implications of these changes include:

  • Driving. When a person has moderate or severe dementia, they are no longer able to drive safely, and even some of those with mild dementia need to limit or stop their driving. This situation needs to be managed sensitively and other alternatives to driving explored.
  • Legal Capacity. As a person’s ability to think becomes compromised, they may no longer able to reason through options to safely make decisions for themselves. This may only happen late in the course of the illness. When this happens, they need to be supported to make decisions by a trusted person who holds their Power of Attorney or is appointed as a Guardian by court. This needs to be organised with the assistance of their lawyer. There may also be occasions when a person’s capacity to make a new will or sign a contract needs to be checked.
  • Behavioural changes. The brain changes that underlie dementia may also cause changes in the person’s mood or behaviour. Some may experience psychosis. Sometimes aggressive behaviour may occur. These need to be dealt with effectively and quickly.
  • Carer stress. As dementia progresses more and more is asked of family carers, both in a practical sense but also emotionally. Support and sharing of these responsibilities is important.
  • Going into care. Some people with dementia, in the later stages end up needing care in an Aged Residential Care home. Choosing an appropriate home at the right level of care is important.

Hinengaro Clinic has the expertise to assist the person and their families with all these challenges.

(World Health Organization, 2019)

Can dementia be treated?

While dementia cannot be cured, the symptoms can be reduced in severity and the progress of dementia slowed with diet, exercise and cognitive stimulation. Sometimes medications can help with cognitive functioning, but more often it is the stopping of some of their usual medications that helps, where these might be adding to a person’s confusion. The stresses on a patient’s loved ones can be significantly reduced with psycho-social interventions.

Where there are behavioural changes that are affecting relationships with family members or creating risk, these can be managed with support, advice, outside care and sometimes with medication.

(World Health Organization, 2019)

Can dementia be inherited?

There are a few rare types of dementia which are directly inherited, and in which specific gene abnormalities are present. Having a closely-related family member with dementia does slightly increase the chances of someone suffering from dementia in later life, However, in most cases, there is no inevitability that the person, having a first-degree relative with dementia, will get dementia themselves.

Dementia is often a complex mix of multiple pathologies, interacting with the person pre-existing strengths and general physical health. Therefore most often it does not inherit in any predictable manner from one family member to another.

(World Health Organization, 2019)