What is Dementia?

Dementia is a serious cognitive disorder. It may be static, the result of a unique global brain injury or progressive, resulting in long-term decline in cognitive function due to damage or disease in the body beyond what might be expected from normal aging. Although dementia is far more common in the geriatric population, it may occur in any stage of adulthood. This age cutoff is defining, as similar sets of symptoms due to organic brain syndrome or dysfunction, are given different names in populations younger than adult.

Dementia is a non-specific illness syndrome (set of signs and symptoms) in which affected areas of cognition may be memory, attention, language, and problem solving. It is normally required to be present for at least 6 months to be diagnosed; cognitive dysfunction that has been seen only over shorter times, in particular less than weeks, must be termed ‘delirium’. In all types of general cognitive dysfunction, higher mental functions are affected first in the process. Especially in the later stages of the condition, affected persons may be disoriented in time (not knowing what day of the week, day of the month, or even what year it is), in place (not knowing where they are), and in person (not knowing who they are or others around them). Dementia, though often treatable to some degree, is usually due to causes that are progressive and incurable. Dementia is progressive – which means the symptoms will gradually get worse.

Symptoms of dementia can be classified as either reversible or irreversible, depending upon the etiology of the disease. Less than 10 percent of cases of dementia are due to causes that may presently be reversed with treatment. Causes include many different specific disease processes, in the same way that symptoms of organ dysfunction such as shortness of breath, jaundice, or pain are attributable to many etiologies. Without careful assessment of history, the short-term syndrome of delirium (often lasting days to weeks) can easily be confused with dementia, because they have all symptoms in common, save duration, and the fact that delirium is often associated with over-activity of the sympathetic nervous system. Some mental illnesses, including depression and psychosis, may also produce symptoms that must be differentiated from both delirium and dementia. Chronic use of substances such as alcohol as well as chronic sleep deprivation can also predispose the patient to cognitive changes suggestive of dementia. (http://en.wikipedia.org/wiki/Dementia)

The word dementia is used to describe a set of symptoms. Symptoms of the different forms of dementia can vary a great deal and can include memory loss, confusion, and mood and behaviour changes.

Dementia can be caused by a number of different diseases, with Alzheimer’s disease the most common. Other diseases that cause dementia include vascular dementia, dementia with Lewy bodies and frontotemporal dementia. In some cases, dementia is thought to be caused by both Alzheimer’s disease and either vascular dementia or dementia with Lewy bodies. You might hear this called mixed dementia. You can contact us for more information about the different causes of dementia.

Your brain ages along with the rest of your body. As a natural part of the aging process, you will lose some of your mental ability. This normal decline in mental functioning should not interfere with your ability to function in your daily life. Any drastic change in memory functioning may be indicative of an underlying disease. If this occurs, immediate contact must be made by with a doctor, psychiatrist, or geriatrician for a professional evaluation. The assessment will focus on any significant change in memory, personality, behaviour, language and analytical skills.

Most of us forget things every day, like people’s names or where we put our keys, but this is a normal part of life and not necessarily a sign of Alzheimer’s or dementia. In dementia, memory loss is more serious than forgetting things occasionally – it is memory loss that starts to interfere with everyday life. There are many reasons why people become forgetful. Some medicines and drugs can affect memory. Depression, anxiety, vitamin deficiency and thyroid problems can also cause forgetfulness, so it’s important to get the right diagnosis. If you are worried about your memory, if it’s getting worse, or interfering with everyday life, then you should talk to your GP.

As dementia becomes more common as people get older, many of us will have a relative living with the condition – but this does not mean we will inherit it. Most of the time the genes we inherit from our parents will only have a small effect on our risk of developing dementia. In most cases our likelihood of developing dementia will depend on our age and lifestyle, as well as the genes we have.

In rare cases, someone may inherit a faulty gene that causes a specific form of dementia. Some rare forms of early-onset Alzheimer’s and frontotemporal dementia are caused by faulty genes and can run in families. Symptoms of these often start in an individual’s 30s, 40s or 50s.

No, but most people with dementia are over the age of 65. In the UK over 40,000 people with dementia are under 65, around 5% of the total. Many of these people are likely to be in their 50s or early 60s, but some rare forms of dementia can affect people even younger.

Yes. In the UK 61% of people with dementia are female and 39% are male. This is mostly because women tend to live longer than men and as dementia becomes more common as we age, there are more women to develop the condition. Some studies have suggested that other factors may affect the number of women and men with dementia , but there is no firm evidence that women are more likely than men to develop dementia at a particular age.

At the moment, screening the general population for dementia is not recommended. This is for several reasons. Firstly there is no simple and accurate way to identify people with early dementia. Also, there is not enough evidence yet to suggest that screening people who don’t have concerns about their memory is beneficial in the long term. Research is ongoing in this area.

The one thing that is certain with dementia is that it is heterogenic, which means that there is no one way the disease progresses in all people. There is a tremendous variability in the speed with which the disease and brain pathology progresses in individuals, and this variability very likely is important in understanding the basis for dementia in the elderly. It is important to point out that the progression of dementia in even the same person can vary over time. For example, it is known that people with late stage dementia can have “good days” or “better days”, and often do better in the morning and afternoon as compared to the late evening hours. A focus of the Institute is to understand the basis by which “good days” occur and to develop interventions which increase the number and duration of “good days” in individuals with dementia as an important means of treating dementia in the elderly.

Scientists have known for a long time that depression and dementia are linked. Especially during the 1970s, when there was a lot of emphasis on so-called “reversible dementia,” it was often held that depression had to be “ruled out” (including by a trial of antidepressants) before dementia could be diagnosed. Now, however, although the jury is still out, many experts feel that being depressed can increase the risk of dementia.

Depression can also exist together with Alzheimer’s disease, including in people who become depressed for the first time when they are diagnosed. It seems two issues are at work here. One is that for some people, the diagnosis of such an illness is enough to trigger depression. The other is that the disease appears to affect brain chemicals causing depression. Exactly how to treat depression in someone who also has Alzheimer’s disease is not clear, but in general, drugs that depress the amount of the brain chemical acetyl choline should be avoided.