Dementia is a decline in mental ability which affects memory, thinking, problem-solving, concentration and perception. Dementia occurs as a result of the death of brain cells or damage in parts of the brain that deal with our thought processes.
Some forms of dementia, such as Alzheimer’s disease, are degenerative. That is, they get worse over time. Other forms of dementia, such as vascular dementia, may be non-degenerative and may not get worse over time.
People with dementia can become confused. Some people also become restless or display repetitive behaviour. They may also seem irritable, tearful or agitated. This can be very distressing for both the person with dementia and their family and friends. Some people with dementia also develop other problems such as depression, disturbed sleep, aggression, inappropriate sexual behaviour and incontinence, although the latter issues tend to be associated with more advanced dementia.
Rates of dementia vary between men and women and between age groups. Dementia is almost invariably a disease of ageing. Dementia in people under 65 is known as early onset or pre-senile dementia and is rare.
What causes dementia?
Dementia occurs as a result of the death of brain cells or damage in parts of the brain that deal with our thought processes. This may follow other problems like:
- lack of blood/oxygen supply to these brain areas
- head injury e.g. from boxing or whip lash after a car crash
- pressure on the brain e.g. from a tumour
- hydrocephalus (fluid build-up between the brain and the brain lining)
- neurological disease e.g. Parkinson’s disease, Creutzfeld Jakob disease (CJD)
- infection e.g. AIDS
- vitamin deficiency
- a long period of excessive alcohol intake
The most common form of dementia is Alzheimer’s disease. We do not know what causes Alzheimer’s disease but we do know that ageing is the main factor. The second most common type of dementia is vascular or multi-infarct dementia. This is caused by mini strokes that constrict blood flow and oxygen to the brain.
Is there a cure?
Unfortunately, most types of dementia cannot be cured. The exceptions are those dementias related to vitamin deficiency (which can be treated with supplements) and head injury (which can be treated through surgery).
There are some psychological treatments and drugs that can help people in the early stages of dementia. It is very important to get a proper assessment from a medical practitioner as early as possible.
Some lifestyle changes are thought to help prevent dementia. A healthy diet, regular exercise and keeping your mind active by, for example, doing crosswords, computer games or puzzles may help.
Drugs such as Aricept and Reminyl may delay the progression of symptoms of the disease in people with mild to moderate dementia. Medical researchers are currently looking at other medical treatments including anti-oxidants, brain stem cell therapy and a vaccination to stop the build up of plaques in the brain (a hallmark of Alzheimer’s disease). Another drug option, memantine (Ebixa) – approved by NICE to treat moderate Alzheimer’s disease in patients who cannot tolerate the other classes of drugs (Acetylcholinesterase inhibitors) – is also a licensed and approved drug treatment for the severe form of the disease.
Non-medical interventions such as cognitive stimulation therapy (CST) can help people with mild to moderate dementia maintain mental functioning, and alternative therapies such as music therapy, aromatherapy and reminiscence therapy can be of benefit too. Environmental adaptations can also help people with dementia cope better with daily life. For example, people with dementia may have difficulty distinguishing particular colours, and problems with perception. Adapting care home environments can make a big difference to the person’s independence and support their ability to feed and care for themselves for longer. Designing care homes and gardens so people with dementia can wander safely can also help reduce frustration and difficult behaviours.
Dementia and depression
The relationship between dementia and depression is complex. The symptoms of dementia and depression – including withdrawal from social activities and general apathy – are very similar. An elderly person with severe depression may occasionally be misdiagnosed as having dementia. A person with dementia may also become depressed. More about Depression.
Caring for someone with dementia
If you are looking after someone with dementia you may be entitled to specialist help. You can find out details of local support services from your local social services or GP or www.yourmentalhealth.ie
If you are out during the day you may want to think about using a day centre. These provide care and activities (such as reminiscence therapy) for people with dementia. They are run by local health authorities, social services, voluntary organisations and some nursing and residential homes. Transport to them is often provided.
You may also need to consider residential or nursing care for the person you are looking after.
Residential homes provide meals and activities and help residents with washing, dressing, baths etc. However, people with dementia who also have physical problems or whose behaviour cannot be managed by non-professional staff will need the care offered in a nursing home. How much you pay for residential care will depend on your situation and varies from area to area.
Social services can provide help, including aids and adaptations to the home, meals on wheels, home care, respite care, day care, and residential and nursing care. Some social services provide more help than others and you may have to pay for some of the services, depending on how much money you have.
Where people have control over the the social care and support they receive, this is known as self-directed support.
Many people with dementia are not entitled to local authority social services because their needs may not be assessed to be severe enough or because they have too much in savings or income. These people have to arrange their own social care, for example help at home, assistance with shopping or daily tasks.
People with dementia who are entitled to local authority social services should be offered the option of having a personal budget. This allows them to have a say in what the money that has been allocated to meet their care needs is spent on. Some people may like to receive this as a direct payment. This means that they control the money and how it is spent themselves.
People with dementia who may have difficulties making decisions are still entitled to receive self-directed support from a local authority. But this may be managed by a person appointed to make money decisions on their behalf, for example a trusted family member.
Looking after yourself
You also need to think about your own needs. Looking after someone with dementia can be emotionally and physically exhausting, especially if you are on your own. You will need practical and emotional support for yourself as well as regular breaks and holidays. You may want to think about respite care, when the person you care for goes to stay in a hospital or care home for a short while, perhaps a few days or weeks. Alternatively you may be able to arrange for an alternative carer to come and stay in your house while you are away.