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We have all had instances where we have forgotten something – “Where did I put my keys?” – or you can’t recall someone’s name.
It’s frustrating but this forgetfulness or memory problem doesn’t automatically point to dementia. When we are tired, stressed, suffering certain illnesses or taking some medication, forgetfulness can be quite a normal side effect. It can be annoying but unless it is starting to affect your everyday life, it is nothing to worry about.
However, if you or someone you know is becoming increasingly forgetful, particularly if you or they are over the age of 65, then this may be the early signs of dementia and you should seek advice from your GP. It is important to remember, though, that getting older doesn’t automatically mean you will develop dementia.
According to Alzheimer’s Research UK, the total number of people in the UK with a dementia diagnosis in 2020 was 525,315. However, they estimate that there are currently 850,000 people living with dementia in the UK, more than ever before. They predict that this number is likely to increase to 1 in 3 people born in the UK this year developing dementia in their lifetime. Currently, 1 in 14 people over 65 have dementia in the UK, that is 1 in 79 of the whole population, and the condition affects 1 in 6 people over the age of 80. Age is the biggest risk factor for dementia; increasing life expectancy is the driving force behind this projected rise.
What is Dementia?
Dementia is not a specific disease but is rather a general term or syndrome (a group of related symptoms) for the impaired ability to remember, think, or make decisions which is associated with an ongoing decline of brain functioning that interferes with doing everyday activities. Dementia is not only about memory loss. It can also affect the way you speak, think, feel and behave. Some of the common symptoms and early signs may include:
Memory loss or subtle changes that tend to involve short-term memory. A person may be able to remember events that took place years ago but not what they had for breakfast. Other symptoms of changes in short-term memory include forgetting where they left something, forgetting why they entered a room, or not recalling what they were supposed to do on any given day.
Language, such as using words incorrectly, or trouble speaking. Another early symptom of dementia is struggling to communicate thoughts. A person with dementia may have difficulty explaining something or finding the right words to express themselves. Having a conversation with a person who has dementia can be difficult, and it may take longer than usual to get to the point.
Comprehension – a classic early symptom of dementia. People with dementia sometimes forget the meanings of words they hear or struggle to follow or join in with conversations or have difficulty following storylines in TV programmes or films.
Repetition is common in dementia because of memory loss and general behavioural changes. The person may repeat daily tasks, such as shaving, or they may collect items obsessively. They also may repeat the same stories time and again or ask the same questions in a conversation even after they have been answered.
Mood – a person with symptoms could lose interest in hobbies or activities. They may not want to go out anymore or do anything fun. They may lose interest in spending time with friends and family, and they may seem emotionally flat; depression, for example, is typical of early dementia. They may also find social situations difficult and you might also see a change in personality. Typically, someone with dementia may change from being shy to being outgoing. This is because the condition often affects judgement.
Judgement – many activities require good judgement. When this ability is affected by dementia, the person may have difficulty making appropriate decisions, such as what to wear in cold weather or the inability to recognise danger, for example they wander away from their home and they try to walk across a very busy road during rush hour, sometimes stopping in the middle of the road, confused. There are also financial judgements such as inability to keep a check on bank statements, forgetting to pay bills, buying unnecessary items or even giving money away even if they have none in the bank. If this is becoming a concern you may wish to arrange a capacity assessment.
Mental agility and thinking speed are aligned to judgement; the person may find planning and organising difficult. They may also not be able to react quickly, which is why driving, which requires the use of multiple aspects of our brains, can be questionable for someone developing dementia. Their ability to judge distance or speed may be impaired, so getting an evaluation of their driving ability is crucial not only for their own safety but also for others.
A failing sense of direction – getting lost in a familiar neighbourhood along with not recognising once-familiar landmarks and forgetting regularly used directions are all signs of dementia. The person may also struggle to recall how they got somewhere or how they can get home. They can feel disorientated which can make it harder to follow a series of directions.
Personal grooming and hygiene – you begin to notice that the person could benefit from a bath or shower more frequently. They may rarely seem to wash or comb their hair, something they usually took pride in. It doesn’t seem to make a difference when you remind them you are going out for a special occasion. They appear irritated when you suggest a change of clothes and continue to try to wander out the door dressed inappropriately.
Adapting to change is also a typical symptom of early dementia. Because of this, the person might crave routine and be afraid to try new experiences, which may cause fear.
Visual hallucinations – seeing things that are not really there, for example people or animals. These often happen repeatedly and are realistic and well-formed. Occasionally, smell hallucinations, detecting unusual odours such as burning, fish or smoke when there is nothing there.
What Are the Most Common Types of Dementia?
Dementia is most common in people over the age of 65, but it can affect younger people too. Early onset of the disease can begin when people are in their 30s, 40s, or 50s.
Possible causes of dementia include:
Alzheimer’s disease, vascular dementia and Lewy bodies are the most common forms of dementia.
Alzheimer’s Disease is named after Alois Alzheimer, the doctor who first described it. This is the most common cause of dementia, accounting for 60 to 80 per cent of cases. It is caused by specific changes in the brain. The brain is made up of billions of nerve cells that connect to each other. In Alzheimer’s disease, connections between these cells are lost. This is because proteins build up and form abnormal structures called ‘plaques’ and ‘tangles’.
Eventually nerve cells die and brain tissue is lost. The main symptom is trouble remembering recent events, such as a conversation that occurred minutes or hours ago, while difficulty remembering more distant memories occurs later in the disease. Other concerns like difficulty with walking or talking or personality changes also come later.
There is no single test for Alzheimer’s disease. A GP will first need to rule out conditions that can have similar symptoms, such as infections, vitamin and thyroid deficiencies (from a blood test), depression and side effects of medication.
The GP will also talk to the person, and where possible someone who knows them well, about their medical history and how their symptoms are affecting their life. The GP or a practice nurse may ask the person to do some tests of mental abilities. They may feel able to make a diagnosis of Alzheimer’s at this stage. If not, they will generally refer the person to a specialist.
There are some drug treatments for Alzheimer’s disease that can help boost the levels of some chemical messengers in the brain. This can help with some of the symptoms. Alzheimer’s is a progressive disease. This means that gradually, over time, more parts of the brain become damaged. As this happens, more symptoms develop, and they also get worse.
Family history is the most important risk factor. Having a first-degree relative with Alzheimer’s increases the risk of developing the disease by 10 to 30 per cent.
Vascular Dementia is a general term describing problems with reasoning, planning, judgement, memory and other thought processes caused by brain damage from impaired blood flow to your brain. You can develop vascular dementia after a stroke blocks an artery in your brain, but strokes don’t always cause vascular dementia.
Whether a stroke affects your thinking and reasoning depends on your stroke’s severity and location. Vascular dementia can also result from other conditions that damage blood vessels and reduce circulation, depriving your brain of vital oxygen and nutrients.
Common conditions that may lead to vascular dementia include:
- Stroke (infarction) blocking a brain artery. Strokes that block a brain artery usually cause a range of symptoms that may include vascular dementia. But some strokes don’t cause any noticeable symptoms. These silent strokes still increase dementia risk. With both silent and apparent strokes, the risk of vascular dementia increases with the number of strokes that occur over time. One type of vascular dementia involving many strokes is called multi-infarct dementia.
- Narrowed or chronically damaged brain blood vessels. Conditions that narrow or inflict long-term damage on your brain blood vessels also can lead to vascular dementia. These conditions include the wear and tear associated with ageing, high blood pressure, abnormal ageing of blood vessels (atherosclerosis), diabetes, and brain haemorrhage.
Factors that increase your risk of heart disease and stroke — including diabetes, high blood pressure, high cholesterol and smoking — also raise your vascular dementia risk. Controlling these factors may help lower your chances of developing vascular dementia. The health of your brain’s blood vessels is closely linked to your overall heart health.
Taking steps to keep your heart healthy may also help reduce your risk of vascular dementia. Treatment often focuses on managing the health conditions and risk factors that contribute to vascular dementia. Controlling conditions that affect the underlying health of your heart and blood vessels can sometimes slow the rate at which vascular dementia gets worse, and may also sometimes prevent further decline.
Lewy Bodies Dementia (DLB) is the third most common type of dementia. For every 100 people with dementia, around 10-15 will have DLB. This means roughly 100,000 people in the UK are likely to have this form of dementia.
DLB is caused by small round clumps of protein that build up inside nerve cells in the brain. One of these proteins is called alpha-synuclein and the clumps it forms are called Lewy bodies. Lewy bodies damage the nerve cells and affect the way people communicate.
In DLB, the nerve cells that are affected by Lewy bodies are in areas of the brain that control thinking, memory and movement. DLB is closely related to Parkinson’s Disease. If dementia symptoms appear before or at the same time as people start to have movement problems, a diagnosis of DLB is likely to be given.
DLB is a progressive condition which means symptoms get worse over time. As the disease progresses, people will need more help eating, moving, dressing, washing and using the toilet. The diseases can progress slowly over several years, but the speed of change and type of symptoms can vary from person to person.
There is evidence that cholinesterase inhibitors may help to improve some of the symptoms of DLB, including thinking skills and visual hallucinations. Physiotherapy may also be offered to help someone with DLB with their movement problems. Non-drug treatments, such as cognitive therapies, exercises and group activities, may also help with some of the symptoms of DLB.
Living with Dementia
In the early stages of dementia, many people are able to live at home and enjoy life in the same way as before their diagnosis. However, as the illness progresses people will find it more difficult to care for themselves and their home.
They may need help with everyday activities such as shopping, cleaning, personal hygiene, and may require alterations or adaptations to their accommodation. Every case will be different, so it is important to apply for a needs assessment from the adult social services department of your local council.
Other practical assistance can include:
- Installing personal, fire and smoke alarms.
- Using pill dispensers to release medication at appropriate intervals.
- Using movement sensors to detect, for example, when someone has fallen out of bed.
- Pre-programme phones with frequently used telephone numbers.
- Using reminder functions on smartphones or tablets.
- Loading smartphones or tablets with photo albums with names, dates and places clearly displayed.
- Using voice-controlled virtual assistants.