Dementia is defined as a decline in cognitive functioning which is serious enough to interfere with daily life. The term dementia covers a number of symptoms accompanying certain diseases or disorders, resulting in deterioration of intellectual functioning, for example in memory, perception and routine. There are many different causes of dementia and they vary in progression and complexity.
This definition categorises dementia as a syndrome that is not one particular type of condition but a variety of conditions with similar or common features. The word ‘dementia’ alone cannot describe the whole story; a more precise diagnosis is required to inform practice and instigate timely and appropriate care. Some of the most common causes of dementia are described below:
- Alzheimer’s disease is the most common cause of dementia. The presence of amyloid plaques and neurofibrillary tangles in the brain were first identified by Alois Alzheimer in 1907. Amyloid plaques are toxic to cells which change the chemical structures of the brain causing irreparable damage to the brain cells. The brain becomes atrophied with extensive loss of the grey matter.
- Vascular dementia is caused by the occlusion of oxygen to parts of the brain damaged by small strokes (trans-ischemic attacks), or small vessel disease. Vascular dementia often has a sudden or dramatic onset and can be focal; for example loss of visual awareness and language skills. A history of a step wise progression in cognitive impairment, being emotionally labile and lacking in motivation can aid a diagnosis. This can be associated with evidence of stroke when the prevalence of dementia is ten times higher than the general population.
- Frontotemporal dementia is an umbrella term for a number of uncommon diseases, including Pick’s Disease and is more commonly associated with people under 65. In the early stages, symptoms include changes in behaviour and personality, differing from vascular dementia and Alzheimer’s disease in that in the early stages the memory often remains intact. The process of diagnosis for this type of dementia is often long and complicated therefore impacting on the family at a very early stage.
- Lewy bodies dementia is caused by small spherical protein deposits that develop within the nerve cells of the brain. These interrupt the brain’s normal functioning, affecting memory, concentration, language skills and motor response. The main features of dementia with Lewy Bodies are fluctuating cognition, visual hallucinations with Parkinsonism, extreme sensitivity to antipsychotic agents and rapid eye movement causing sleep disorder.
Who does it affect?
- There are around 800,000 people with dementia in the UK
- Dementia can affect a person of any age, but is most common in older people. Age and female gender are associated with a higher prevalence, with one person in 1000 aged 40-65 years; one in 20 aged over 65; and one person in 5 over 80 living with a form of dementia.
- The total number of people with dementia in the UK is forecast to rise to 940,110 by 2021 and 1,735,087 by 2051 - an increase of 38% over the next 15 years and 154% over the next 45 years.
- Carers support has been valued at a staggering £57 billion per year.
- By 2037, the number of carers will have to rise to 9 million
- In the UK there are over 1.5 million people aged 60 or over providing unpaid care. Over 8,000 carers are aged 90+, 4,000 of these very aged carers provide 50 or more hours care each week.
What are the symptoms?
As there are several different causes of dementia, symptoms can vary from person to person, and could be affected by lifestyle, personality, history, co-morbidity, quality of life, relationships and health. Some of the more common symptoms include:
- Loss of memory
- Problems with language and communication
- Problems with cognition
- Difficulties with thinking and planning
- Trouble recognizing people places or objects
How is it diagnosed?
A range of tests and procedures can be used to diagnose dementia, which includes the following:
Questionnaires are often used to help test the mental abilities of the person with symptoms of dementia to understand how severe they are.
These tests may look at:
- short- and long-term memory
- attention span
- language and communication skills
- ability to plan
- ability to understand instructions
Blood tests for dementia
A person with suspected dementia may have blood tests to check their overall level of health and to rule out other conditions that may be responsible for their symptoms, such as thyroid hormones and vitamin B12 levels.
Dementia brain scans
Brain scans are usually used for diagnosing dementia. They are needed to check for evidence of other possible problems that could explain a person's symptoms, such as a major stroke or a brain tumour. Several types of brain scans can be used to help diagnose dementia.
How is it treated?
Treatment options for Alzheimer’s disease are medication based on the ‘cholinergic hypotheses’ which maintains that as a result of underlying pathological processes, neurons that use acetylcholine, critical to memory and learning are affected. Recent advances have seen the production and prescribed use of acetylcholinesterase inhibitors. These drugs increase the amount of neurotransmitter available by inhibiting the action of the enzyme responsible for its deterioration.
Examining the psychosocial approach to dementia reminds us that a person with dementia is no less a person than anyone else and efforts should be made to maintain and improve quality of life by respecting and preserving the individual’s personhood. To develop this further means that we take the perspective of how the person with dementia views their life rather than our perspective of how they should lead their life. As Kitwood argued the ‘dementia’ is not the problem; the problem is ‘our’ (individual, carer, professional, society) inability to accommodate ‘their’ view of the world (Kitwood 1997).
At the heart of Kitwood’s (1997) conception of person-centred care is ‘personhood’:
‘Personhood: it is a standing or status that is bestowed upon one human being, by others, in the context of relationships and social being. It implies recognition, respect and trust.’
(Kitwood 1997 p. 8)