Dementia is the result of many different illnesses causing damage to the brain and leading to loss of brain cells over time. Some of this damage may occur many years before there are any noted changes in memory or thinking and becomes exposed as ageing progresses. In order to give a diagnosis of dementia to someone, a doctor will need to demonstrate that there have been significant declines in at least two areas of thinking and memory and that these are changing the person's everyday function. All dementias are progressive; this means that they cannot be cured.
Not all memory loss means dementia is present. Some memory changes are due to normal declines of age, and some may be due to minor problems in the brain but which do not affect everyday function. Many people become aware of the normal changes with age but worry about these (after all they haven't any experience of ageing changes) and this worry will then make the changes worse. A formal assessment may help to explain this. Depression is also a common experience and this too can make the brain work less well. Assessing mood is an important part of a memory assessment as is looking for alternative explanations such as underlying physical illness.
Vascular means "related to the blood supply." The brain needs a good blood supply to work properly. Damage to the blood vessels supplying your brain can occur at any age and cause brain cells to die leading to increasing difficulties with memory, thinking and physical skills. Changes can occur suddenly (such as during a stroke) or over a longer period (such as damage from high blood pressure or diabetes).
The rate of progression of vascular dementia varies from person to person. It may be possible to slow the progression by:
- Taking medication to treat other conditions such as: stroke, high blood pressure, cholesterol, diabetes or heart problems.
- Adopting a healthier lifestyle; remaining active for longer has many positive effects on the disease. Changes may include stopping smoking, taking regular exercise, maintaining a good diet and reducing any alcohol intake whilst enjoying good social interaction.
- Occupational therapy, speech therapy and physiotherapy may help maximise and regain lost functions.
Mild Cognitive Impairment (MCI)
Mild Cognitive Impairment describes changes in memory and thinking which are more than expected in normal ageing but which are not severe enough to be described as dementia.
It is also used to describe relatively mild difficulties which do not significantly affect daily activities.
Some people with MCI will be in the earliest stages of a dementia but others may be anxious, depressed, stressed, sleep deprived or have other physical illnesses which are affecting their brain function. About 15% of people with a diagnosis of MCI will progress to a diagnosis of dementia each year.
Because a healthy lifestyle can have an effect on brain health and reduce the rate of decline, this is strongly recommended to people receiving this diagnosis. Physical, social and mental activity, along with healthy diet and stress reduction, may help to prevent memory and other cognitive difficulties from deteriorating.
For further information see "Living Well with Memory Difficulties Booklet"
This disease is characterised by difficulties with memory, problem solving and language, and is the most common form of dementia. During the course of the disease, proteins build up in the brain, causing loss of connections between nerve cells. This eventually leads to cell death. Also in Alzheimer's, people have a shortage in the chemicals needed in the brain. These chemicals are used to send messages around the brain and when there is a shortage, the messages cannot be sent properly.
As Alzheimer's is progressive, so more parts of the brain will be damaged over time.
Each person's experience of Alzheimer's is different, and their disease progression will also not be the same.
There are different types of Alzheimer's, and your doctor will be able to give you information on the different types.
Lewy Body Dementia
'Lewy' bodies, (named after the doctor who first described the illness) are tiny protein deposits found in nerve cells.
Their presence in the brain gets in the way of the brain's normal functioning, interrupting the action of the important chemical messengers.
The characteristics of this dementia can be:
- Fluctuations in thinking ability, at times the person will be alert and then suddenly have episodes of confusion. They may often forget what they are talking about in the middle of a conversation.
- Detailed and convincing visual hallucinations. They are not necessarily frightening to the person who recognises them as hallucinations
- Falling asleep easily by day, restless legs and disturbed nights with vivid dreams often causing the person to move/ talk in their sleep.
- Fainting, falling or having funny turns and feeling light headed on standing.
In this disorder, the front and temporal lobes of the brain are damaged and work less well. This can be caused by several different illnesses which affect people in different ways, but in general we divide this dementia into frontal variants (primarily affecting the front parts) or a language variant (mainly affecting the temporal lobes at the side of the brain).
In frontal variants there may be a change of personality, the person may become more disinhibited, making comments that are inappropriate, become fixed in their routines and display a lack of interest in the world and people around them. They may neglect their personal care and become apathetic. This can be a very slowly progressive form of dementia and changes to personality have often occurred several years before the thinking changes are apparent.
In language variants the person may experience increasing difficulties with getting the right word or understanding what others are saying. This reduces their communication with others and make cause great frustration at not being able to "get a word out as needed." Many of their other skills may remain well preserved. Speech therapists can help to maximise language and communication skills.
In both of these conditions people may start to favour sweet foods.