If you have dementia, you may have some or all of the following symptoms.
- Memory loss, particularly of recent events. For example, you may not be able to remember a conversation that you had earlier in the day. You will probably find your forgetfulness is mild at first, but it’s likely to get worse over time. Your long-term memory will not be affected in the same way.
- Communication difficulties. You may have problems finding the right words for things. For example, you may describe how an item works instead of what it’s called.
- Mood changes. You may become depressed, frightened or angry about having dementia and what is happening to you.
- Disorientation and an inability to recognise familiar places. As dementia progresses, you may become confused about the time of day. This could cause you to get up in the middle of the night, wanting to go out.
- Poor judgement. For example, you may become unaware of dangerous situations.
If you have noticed problems with your memory, but you’re managing your symptoms well, you may have a condition known as mild cognitive impairment. This is not dementia, but people who have this condition may be at an increased risk of developing it in future.
Dementia affects everyone differently. Your symptoms may stay the same for some time and you can have a good quality of life for a number of years. For example, you can live with dementia for seven to 12 years after diagnosis. However, generally, your symptoms will become more severe over time.
To help you understand how your dementia might worsen, the progressive symptoms are often viewed as a three-stage process.
- Early stage. Having problems remembering recent events is one of the first symptoms. You may have difficulty with daily tasks or finding the right words. Your emotions may be up and down. You may be able to continue with activities such as driving, but might get lost more easily.
- Intermediate stage. Your symptoms cause increased memory issues. You may have difficulty with daily self-care tasks or easily lose track of the time or where you are. You might have problems recognising people and objects, and your behaviour may change too.
- Late stage. As your dementia progresses, your short- and long-term memory will decline. You may find it hard to understand conversations or recognise family. At this stage, you will need extensive care.
Whatever stage your dementia is at, it's important to get support from social services, your GP, friends and family.
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may ask you to have blood and urine tests. This is to rule out the possibility of other conditions that could cause symptoms similar to dementia.
You may also have a mental test to assess your memory and thinking. There are several different tests that your GP may use to help find out if you have dementia. One that is often used is the Mini Mental State Examination (MMSE). In this test, your GP will ask you some questions and test your attention and ability to remember words. How you score in this test indicates how severe your condition is.
If you have signs of dementia, your GP will refer you to a specialist or memory assessment service for more detailed tests. This will help to determine what type of dementia you have. You may also be asked to have a brain scan, such as a CT scan or MRI scan.
There are a number of treatment options for dementia as described below. There isn't a cure for dementia. However, there are some medicines that can help with the symptoms. Which treatments you are offered will depend on your personal circumstances. Your doctor will discuss these with you to help you make a decision that’s right for you. Your decision will be based on your doctor’s expert opinion and your own personal values and preferences.
Your doctor may offer you a type of medicine known as an acetylcholinesterase inhibitor if you have mild or moderate Alzheimer's disease. These medicines, such as donepezil, galantamine and rivastigmine, work by increasing the level of an important chemical in your brain. They can help to slow the progression of dementia.
If you have severe dementia, or you have mild or moderate Alzheimer’s disease but can’t take acetylcholinesterase inhibitors, your doctor may offer you another medicine. This is called memantine.
If you have dementia with Lewy bodies, you may be offered an acetylcholinesterase inhibitor.
There is limited evidence that medicines such as acetylcholinesterase inhibitors are effective for symptoms of vascular dementia. However, you may be offered them if you also have Alzheimer’s disease. If you have vascular dementia, your treatment will be aimed at helping your cardiovascular symptoms. For example, your GP may prescribe you medicines to reduce your risk of having a stroke.
Your GP may also offer you other medicines if you have depression or anxiety. If you have depression, you will usually be offered antidepressant medicines called selective serotonin re-uptake inhibitors (SSRIs) or a selective noradrenaline re-uptake inhibitor.
Cognitive stimulation therapies
Depending on its availability, your GP may suggest trying cognitive stimulation therapy. This treatment aims to stimulate and engage people with dementia. It’s recommended by the National Institute for Health and Care Excellence (NICE) for people with mild-to-moderate dementia. It usually involves 14 sessions of themed activities, which run over a seven-week period.
In addition to conventional medicine, you may find complementary therapies help. These may include acupuncture, aromatherapy, massage or music therapy. However, there is no evidence to support these approaches to treating dementia.
There are many different conditions and diseases that can lead to dementia. The following are some of the most common.
- Alzheimer's disease. This is the most common cause of dementia and develops as a result of changes in the structure of your brain.
- Vascular dementia. This is the second most common cause of dementia. It happens when your blood vessels become blocked in your brain, usually because of a stroke or a series of strokes.
- Mixed dementia. This is caused by more than one disease at the same time. A common combination is Alzheimer's disease and vascular dementia.
- Dementia with Lewy bodies. This is caused if you have an abnormal build-up of a particular protein in your brain.
- Frontotemporal dementia (also known as Pick’s disease). This is caused by progressive cell degeneration in your brain. It affects the areas of your brain behind your forehead and ears, which is different to the areas affected by Alzheimer’s disease. This type of dementia is now considered more common than previously thought.
There are also other diseases that can lead to dementia, but they are much rarer causes. They include the following.
- Creutzfeld-Jakob disease (CJD). This is a very rare disease that causes severe brain damage.
- Parkinson's disease. This disease affects the way your brain co-ordinates body movements. It happens when there is a shortage of a chemical called dopamine in your brain.
- AIDS (acquired immune deficiency syndrome). This term describes the point at which your immune system has been weakened so much by HIV that it can't fight certain infections and illnesses.
Sometimes, you might have an unrecognised medical condition that causes the symptoms of dementia. An underactive thyroid gland, vitamin B1 and B12 deficiencies, and a build-up of pressure in the fluid that surrounds your brain can all cause dementia. If these problems are caught early enough, it’s usually possible to stop and reverse the progression of dementia.
Some studies suggest that the risk of dementia could be reduced by longer years in education and being physically active. Eating a healthy diet, not smoking and getting your blood pressure and cholesterol checked regularly may also help.
It's important for you to get the help and support you need. As well as family and friends, emotional and practical support is available from a range of services including:
- your GP
- charities, such as Alzheimer’s Society
- Admiral nurses (specialist dementia nurses)
- local voluntary groups
Health and social care staff can help you to maintain your independence. They can offer you advice on daily living, and how to adapt and develop the skills you need to help you live with dementia.
You may be able to have a personal dementia adviser. He or she will help you to find the right information, care, support and advice. Ask your GP for more information about this service.
It's important that partners and children also receive plenty of help and support. Respite care, to give your family a break, can be an important part of looking after you, particularly as the disease progresses.
How likely is it that I will develop dementia if one of my parents has it?
Having close relatives with dementia doesn't necessarily mean you will get it. A small number of people can inherit genetic factors, which may make them more at risk, but for most there aren’t any particular genes that cause it.
The majority of people who develop dementia don't get it as a result of genetic factors. For people who may be at risk of dementia, it's possible to test for some inherited types, such as early-onset Alzheimer’s disease. This is usually observed when people are in their 40s or even younger.
However, the psychological impact of knowing you may be at an increased risk could make you feel anxious. You should consider what you will gain from being tested and if you can cope with the knowledge of being at an increased risk. You may find it helpful to discuss this with your GP.
It’s important to remember that the greatest risk factor for dementia is age – the older you get, the more likely you are to develop the disease. One in five people over the age of 80 and one in three people over 95 have some degree of dementia.
Are there things that can be done to help someone who has dementia?
Dementia affects everyone differently. For this reason, people who have the disease will need different levels of support. This will depend on their personality, family circumstances and how severe their dementia is.
If you have recently been diagnosed with dementia, one of the best ways that people around you can help is by being understanding and supportive. There are also practical things that can help. Making notes and lists, keeping a diary and using a calendar can all serve as reminders. For example, a large, prominent calendar hung on your wall may help you to remember appointments or occasions.
It may be helpful to establish new routines in the early stages of dementia. Also, splitting a new activity into stages can help you to understand things, and make them less overwhelming or frustrating. It can sometimes be difficult to pick from different options, so use activities that don't revolve around making lots of choices. Having a specific place for everything may also be helpful, such as where you put your keys and important paperwork.
If you have friends and relatives that you have known for a long time, you could try talking together about the past. This may help to comfort, reassure and calm you. But as the disease progresses, you may not be able to recognise familiar things, people or places. As this happens, those close to you can help by jogging your memory so you don’t get too distressed.
Can ginkgo biloba help to prevent dementia?
There is no medical evidence to show that gingko biloba can help prevent dementia.
Ginkgo biloba is an extract of the leaves from the maidenhair tree. It's used in Chinese medicine for a number of disorders, including memory and concentration problems, confusion, depression and anxiety.
However, there is no medical evidence that proves it can help prevent dementia and taking high doses may result in side effects. The Alzheimer's Society also supports this view.
- What is dementia? Alzheimer’s Society. www.alzheimers.org.uk, published March 2012
- Dementia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2010
- Dementia. The Merck Manuals. www.merckmanuals.com, published February 2008
- Living well with dementia: a national dementia strategy. Department of Health. www.dh.gov.uk, published 3 February 2009
- Depression and anxiety. Alzheimer’s Society. www.alzheimers.org.uk, published February 2012
- Drugs used to relieve behavioural and psychological symptoms in dementia. Alzheimer’s Society. www.alzheimers.org.uk, published January 2012
- Vascular dementia. Medscape. www.emedicine.medscape.com, published 13 June 2012
- The mini mental state examination (MMSE). Alzheimer's Society. www.alzheimers.org.uk, published January 2012
- Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease. Review of NICE technology appraisal guidance 111. National Institute for Health and Care Excellence (NICE), 2011. www.nice.org.uk
- Vascular dementia. BMJ Best Practice. www.bestpractice.bmj.com, published April 2013
- Complementary and alternative medicine and dementia. Alzheimer's Society. www.alzheimers.org.uk, published July 2011
- Dementia: the NICE–SCIE guideline on supporting people with dementia and their carers in health and social care. National Institute for Health and Care Excellence (NICE), 2007. www.nice.org.uk
- Alzheimer's Society comment on JAMA study that shows Gingko biloba is not an effective remedy for dementia. Alzheimer's Society. www.alzheimers.org.uk, published 21 November 2008
- Genetics and dementia. Alzheimer’s Society. www.alzheimers.org.uk, published July 2012
- Statistics. Alzheimer’s Society. www.alzheimers.org.uk, accessed 15 July 2013
- Frontotemporal dementia. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed November 2010
- Dementia – therapeutic activities. Royal College of Nursing. www.rcn.org.uk, reviewed 13 February 2013
- Brayne C, Ince P, Keage HAD, et al. Education, the brain and dementia: neuroprotection or compensation? Brain 2010; 133(8):2210–2216. doi:10.1093/brain/awq185
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