Dementia: how to spot the signs

Dementia is one of the most common diseases among the elderly, but many people still do not know how to spot the signs or what to do next. Dan Parton reports.

In this article:

What is dementia?
Spotting the symptoms
Treatments 

With more than 700,000 people suffering from dementia in the UK, the vast majority of them over 65, the condition is one of the most common to affect older people, along with heart disease and strokes.

Indeed, one person in every 14 aged over 65 in the UK has dementia, rising to one in six over 80. One in three older people will end their lives with a form of dementia. Worldwide, some 24 million have the disease.

Meanwhile, more than 60% of all care home residents aged over 65 have a form of dementia.

But dementia is not just a disease of old age; some 15,000 people in the UK under 65 suffer from the condition.

As more people live longer, dementia is becoming a growing problem. The Alzheimer’s Society estimates that the number suffering from it in Britain will rise to more than 1 million by 2025 and 1.7 million by 2051.

What is dementia?

Dementia is something of a catch-all term for symptoms of various diseases and conditions that affect the brain’s ability to function, such as Alzheimer’s disease, strokes and blood clots.

Dementia is a progressive disease, which means symptoms gradually worsen, although how quickly is dependent on the person and their circumstances. In the latter stages of the disease, everyday tasks and functions can become beyond a sufferer and they may require 24-hour care.

The most common forms of dementia are:

• Alzheimer’s disease: This is the most common form of dementia, affecting around 450,000 people in the UK. With Alzheimer’s, ‘plaques’ and ‘tangles’ develop in the structure of the brain and lead to the death of brain cells. Additionally, Alzheimer’s sufferers are deficient in some chemicals in the brain.
• Vascular dementia: This is brought on by ‘wear and tear of the brain’, including tiny strokes, poor circulation, arteries furring up, minor head injuries and general aging, which affect the brain’s blood supply.
• Fronto-temporal dementia: This includes a range of conditions such as Pick’s disease. This form of dementia is caused by damage to the frontal lobe and/or the temporal parts of the brain - the areas responsible for behaviour, emotional responses and language. This sort of dementia is more likely to affect people under 65.
• Lewy Body disease: This is similar to Alzheimer’s and often characterised by the sufferer experiencing paranoid thoughts or hallucinations. Many sufferers also fall over for no apparent reason or have problems judging distances. Lewy Body generally progresses more quickly than Alzheimer’s.

Dementia can also be brought on by other diseases, such as Huntingdon’s, Parkinson’s or multiple sclerosis, but this is less common.

Prolonged heavy drinking can also bring on a dementia-like condition called Korsakoff’s syndrome, where sufferers suffer from short-term memory loss. This is brought about by a thiamine (vitamin B1) deficiency, which comes from poor nutrition and/or inflammation of the stomach lining caused by alcohol, which can impede the body’s ability to absorb key vitamins.

But if the sufferer gives up alcohol and adopts a healthy diet with vitamin supplements, the symptoms can be halted completely. However, it is not known if additional thiamine can improve the brain once damage has occurred.

Spotting the symptoms

The most common – and well known - symptom of dementia is memory loss. Usually, the short-term memory is affected, such as forgetting names, places or how to get to somewhere. This is often dismissed as ‘just a part of aging’, which is why dementia is often missed or ignored until the symptoms become worse.

Indeed, 66% of people in the UK are not aware of what the early signs of dementia are, while only 5% believe they are well informed, according to a survey by market research firm YouGov.

Also, it seems that one of the most common sign is often ignored; 62% of those polled believe that memory loss is a natural part of aging, while 20% do not consider it to be a serious medical problem. Meanwhile, 10% say they would not bother their doctor over the condition.

As a result, unsurprisingly, only a third of people with dementia receive a formal diagnosis, which is often only given in the latter stages of the disease.

But dementia is more than forgetting names occasionally; it involves more significant lapses, such as:

• Communication problems – a decline in the ability to read, write and talk. Conversations can also become difficult as the sufferer may forget what they were talking about
• Mood swings – dementia sufferers moods can change for no apparent reason, which is why the disease can be mistaken for depression
• Loss of function – a dementia sufferer can suddenly lose the ability to do something that is usually second nature, such as an electrician forgetting how to wire a plug
• Poor judgement – a dementia sufferer may go out in a jumper and winter coat on a summer’s day.

If you suspect you or a loved one has the beginnings of dementia, the first person to consult is your GP. The GP can then refer you/your loved one to a specialist or consultant, such as a neurologist or geriatrician for an in-depth assessment.

There are various charities, such as the Alzheimer’s Society, which have regional branches to provide support and advice to people with dementia and their carers.

Treatments

As yet there are no cures for dementia, although stories of scientific breakthroughs that could lead to a cure or a treatment are carried regularly in the media. However, most potential cures are at an early stage and even if further research backs up the initial findings, any cure is still years away from being commercially available.

In the meantime, there are some drug treatments available, but these can only slow the symptoms temporarily.

The most common drug treatments are Aricept, Exelon and Reminyl. Alzheimer’s sufferers do not have enough of a chemical called acetylcholine in their brains, which nerve cells use to communicate. These three drugs prevent an enzyme known as acetylcholinesterase from breaking down acetylcholine in the brain. Increased concentrations of acetylcholine lead to increased communication between nerve cells and can ease the symptoms.

But these drugs are not effective for everyone and only work on people with mild to moderate dementia. Aricept, Exelon and Reminyl are all available on NHS prescription, but only for people in the moderate stages of the disease - not early or advanced. However, these drugs are freely available privately.

Dementia sufferers can also benefit from a newer drug, Ebixa, which blocks a messenger chemical, known as a neurotransmitter glutamate. Glutamate is released in excessive amounts when brain cells are damaged by Alzheimer’s, which then causes the brain cells to be damaged further. Ebixa can protect brain cells by blocking the release of excess glutamate.

Meanwhile, some Lewy Body sufferers respond to dopamine replacement drugs used to treat Parkinson’s disease.

For sufferers in the early stages of dementia, there are strategies they can use to keep mentally sharp. Such things as keeping to a set routine, keeping written reminders or using a Dictaphone and reading newspapers can all help. However, as the disease progresses, these become less effective.

Complementary medicines can also have an effect, although these should be used in addition to drug treatments, rather than instead of.