We all forget things as we get older. Many older people have a slight loss of memory. The brain is an organ that is also more affected by disease when getting older. Diseases that create a loss of mental skills are grouped under the name dementia. Alzheimer's disease is the most common cause of dementia, appr. 50% of people with dementia have Alzheimer's.
Dementia can cause problems with your memory and how well you can think and plan. Usually dementia gets worse over time. How long this takes is different for each person. Some people stay the same for years. Others lose skills quickly.
People rarely have dementia before age 60. But, after age 85, up to 40% of all adults have it. In our aging society, the number of patients is growing rapidly.
What causes dementia?
Dementia is caused by damage to or changes in the brain which affect the way signals are carried over in the brain. It is noticed in protein plaques building up and shortage of neurotransmitters.
Things that can cause dementia include strokes, tumours or head injuries. After Alzheimer's disease, strokes are the most common cause of dementia. This type of dementia is called vascular dementia. Diseases, such as Parkinson's, dementia with Lewy bodies, and frontotemporal dementia.
In a few cases, dementia is caused by a problem that can be treated. Examples include having an underactive thyroid gland, deficiency of vitamin B12 (alcoholism), and fluid build-up in the brain. In these cases, treating the problem may cure the dementia. In some people, depression can cause memory loss that looks like dementia. Depression can be treated. As you age, medicines may affect you more. Taking some medicines together may cause symptoms that seem like dementia. Examples are sleeping pills and tranquilisers, antidepressants and other drugs with an anticholinergic effect.
What are the symptoms?
People with dementia often don't look ill, especially in the early stages, and may have no particular symptoms. But family and friends may notice a change in the person's personality, or that they seem to have problems remembering things.
The condition usually progresses slowly, and three types of symptoms may appear:
· Cognitive problems - a disturbance of understanding, memory, thinking, learning capacity, language and judgement.
· Functional problems - difficulty carrying out complex tasks and, as the condition progresses, difficulty with daily living activities, such as personal hygiene and dressing.
· Emotional problems - changes in mood, loss of emotional control (i.e. aggression or becoming angry) and a withdrawal from previous interests, activities and social interactions.
Different types of dementia show slightly different patterns of disease. For example, in Lewy body dementia, severity varies markedly from day to day, while in Alzheimer's there is only slight variation from day to day.
How is dementia diagnosed?
There is no single test for dementia. Diagnosis takes an extensive anamnesis, your doctor will:
· Do a physical exam.
· Ask questions about recent and past illnesses and life events. The doctor will want to talk to a close family member to check details.
· Ask you to do some simple things that test your memory and other mental skills. Your doctor may ask you to tell what day and year it is, repeat a series of words, or draw a clock face. The doctor may do tests to look for a cause that can be treated. For example, you might have blood tests to check your thyroid or to look for an infection. You might also have a test that shows a picture of your brain, like an MRI and a CT scan. These tests can help your doctor find a tumour or brain injury. This can be a sign of dementia.
How is it treated?
There are medicines you can take for dementia. They cannot cure it, but they can slow it down for a while and make it easier to live with. Their effect is limited and often helps only 10% of the patients. 30% of patients using reminyl, exelon or aricept are affected by side effects (vomiting / diarrhoea that force them to stop the therapy. Ebixa is a newer drug that is used for more severe dementia and so far mainly used in institutional settings.
Gingko Biloba is touted as herb with a positive effect on brain functions. It has anti-oxidative properties and is proven to have a positive effect on the blood flow in the brain. It is not yet clear if this has a significant clinical effect. In the US, vitamin E in high doses and selegiline are used to delay the progress of the disease. Vitamin E can have an effect on blood clotting, I would not advise to supplement doses higher than 400IU for preventive health.
As dementia gets worse, a person may get depressed or angry and upset. Next to counselling, anti-depressant medications may be used. Maintaining an active social life will also help. If aggression and sleeplessness play a role, short term use of short acting benzo's may help. If the effect is not established, a neuroleptic like haldol may be used.
If a stroke caused the dementia, there are things you can do to reduce the chance of another stroke. Stay at a healthy weight, exercise, and keep your blood pressure and cholesterol at normal levels. If you have diabetes, keep your blood sugar in your target range.
Keeping both your mind and your body active is a good idea for anyone; so is not smoking.
How can I help my loved one with dementia?
There are many things you can do to help your loved one be safe at home. For example, get rid of throw rugs, and put handrails in bathrooms to help prevent falls. Post reminder notes around the house. Put a list of important phone numbers by the telephone. You also can help your loved one stay active. Play cards or board games and take walks.
Work with your loved one to make decisions about the future before dementia gets worse. It is important to write a will and a power of attorney to decide who can take care of your matters if you cannot anymore.
Watching a loved one slip away can be sad and scary. Caring for someone with dementia can leave you feeling drained. Be sure to take care of yourself and to give yourself breaks. Ask family members to share the load, or get other help.
Your loved one will need more and more care as dementia gets worse. In time, he or she may need help to eat, get dressed or use the bathroom. You may be able to give this care at home, or you may want to think about using a nursing home. A nursing home can give this kind of care 24 hours a day. You are not alone. Many people have loved ones with dementia. Look for support groups in your surroundings or online.
