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The Royal College of Psychiatrists Improving the lives of people with mental illness

Dementia: key facts

 

Introduction

We all tend to get more forgetful as we get older. But dementia is different. It is a brain disease which often starts with memory problems, but goes on to affect many other parts of the brain, producing:

  • difficulty coping with day to day tasks
  • difficulty communicating
  • changes in mood, judgment or personality.

It usually gets worse over time. It is much more common in older people. Dementia can sometimes occur in younger people and may run in families, although this is rare.

 

What causes dementia?

Alzheimer’s disease is the commonest cause of dementia. Damaged tissue builds up in the brain to form deposits called ‘plaques’ and ‘tangles’. These cause the brain cells around them to die. 

 

Alzheimer's also affects the chemicals in the brain which transmit messages from one cell to another, particularly acetylcholine. It comes on gradually and develops slowly over several years.  It can sometimes run in families and it is more likely to affect people with Down’s syndrome.

 

Alzheimer’s disease produces particular problems with memory and thinking. Learning new information becomes harder – you can't remember recent events, appointments or phone messages. 

 

Vascular dementia is when the arteries supplying blood to the brain become blocked. This leads to small or big strokes - parts of the brain die as they are starved of oxygen. It is more common if you are a smoker or if you have high blood pressure, diabetes or high cholesterol.

 

Lewy body dementia seems to be caused by protein deposits (Lewy bodies) building up in the brain. 

 

Fronto-temporal dementia seem to affect the front of the brain more than other areas. It often starts in people in their 50s and 60s.

 

Mild cognitive impairment is a term used when memory problems are more than you would expect for your age, but not bad enough to be called dementia. About 1 in 3 people with this problem may develop dementia, but we can't yet predict who these people will be.

 

Other illnesses that can cause memory problems

  • Depression can cause a 'pseudo-dementia' which can get better with antidepressants and talking therapy.
  • Heavy alcohol drinking.
  • Physical illnesses which cause memory problems include:
    • kidney, liver or thyroid problems
    • shortage of some vitamins (rare), diabetes 
    • chest or urine infections can lead to confusion and can be treated with antibiotics
    • rarer conditions such as Huntington’s disease, which causes dementia in younger people. 

What does it feel like to have dementia?

Sometimes people with dementia do not feel there is anything wrong with them and get cross when people try to help. Carers often comment that the Alzheimer's has changed the personality, so the person behaves and reacts differently to how they did before they became ill.

Alzheimer's disease produces particular problems with memory and thinking. Learning new information becomes harder - you can't remember recent events, appointment or phone messages.

You may forget the names of people or places and may struggle to understand or communicate with others. Commonly, you just can't find the right ward for objects or people you know well. This can make you frustrated and depressed. You may think that people have taken or stolen your things when all that has happened is that you have lost them.

On Vascular dementia, problems will depend on which party of the brain is affected. There may be memory loss, poor concentration, word finding difficulties, mood swings and depression. Some people have hallucinations (where they see or hear something that is not there). Physical problems can develop, such as difficulties with walking and incontinence.

It is difficult to predict how fast your brain functions will deteriorate. It can be stable for several months or years but then, when more strokes happen, you get further deterioration.

Lewy body dementia causes symptoms which overlap with Alzheimer's disease and Parkinson's disease. The level of confusion can very during the course of the day, but visual hallucinations of people or animals are more common. They may also have a tremor, muscle stiffness, falls or difficulty in walking.

Because fronto-temporal dementia affects the front of the brain, it is more likely to cause personality and behavioural changes. So a person who is usually very polite and proper might start to become irritable and rude.

Treatments that can help

If you are worried about your memory, see your doctor.  He or she can do a simple memory test, a physical examination and order blood tests.  They can then refer you to a specialist team or a memory clinic who will test your memory in more detail and arrange a brain scan if needed.

Treatment will depend on the diagnosis and your circumstances. Unfortunately there are no cures for many of these conditions.

There is a group of drugs called acetyl cholinesterase inhibitors which may slow the progression of Alzheimer’s dementia (see our factsheet).  These drugs may also help in Lewy Body dementia if hallucinations are a problem.  In Vascular dementia, a small dose of aspirin may help to prevent further strokes or medication may help to control high blood pressure or raised cholesterol.  It is also important to stop smoking, eat healthily and take exercise.

How you can help yourself

  • Use a diary to help you remember appointments and make lists.
  • Keep your mind active by reading or doing crossword puzzles, Sudoku’s and other mind exercises.
  • Get regular physical exercise (it can help whatever your age).
  • Eat a healthy diet. Supplements such as Vitamin E and Ginkgo Biloba don't seem to help.

Charities such as the Alzheimer’s Society are a very useful source of advice. A mental health nurse can help you understand more about the illness. They can give advice about medication and other help available.  Social services can help with home helps, meals at home or day care. You may be entitled to benefits. 

 

Plan for the future

There may come a time when it is difficult to make decisions about managing finances or medical decisions. You can give a trusted relative, friend or solicitor the right to make such decisions on your behalf if you cannot. This is called a Lasting Power of Attorney (LPA). A solicitor can help you to arrange an LPA.

Advance Decisions - it is possible to make known decisions to refuse certain medical treatments in the future should you lose the capacity to make decisions. These will be respected by the professionals providing care. This can be made at the same time or separately from a LPA.

How other people can help

  • Others may notice early symptoms, so they can help by encouraging you to talk to your doctor. The earlier you are diagnosed the better.
  • Help you to remember things by prompting you.
  • Encourage and help you to continue doing the things you have always done.
  • Be patient and not do things for you because it is quicker.
  • Help you adapt your lifestyle and maintain your confidence.
  • Explain things that you don't understand.

For more in-depth information see our main leaflet: Dementia and Memory Problems

This leaflet reflects the most up-to-date evidence at the time of writing.

Produced by the RCPsych Public Education Editorial Board.

Series Editor: Dr Philip Timms

Reviewed by Elaine Ellis

© March 2014. Due for review: March 2016.   Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.

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