What is dementia?

Dementia is a term used to describe a range of symptoms that reduce memory, thinking and social skills to levels that make daily life difficult. It‘s caused by nerve cells and connections in the brain becoming lost or damaged, often progressively over time. The symptoms and changes a person with dementia experiences will typically depend on the condition that is causing it and what part of the brain is affected.

How to recognise possible signs of dementia

One of the challenges of recognising dementia in its early stages is that the symptoms may be similar to those associated with normal ageing. Sometimes the onset is relatively slow and the changes are only noticed by people who haven’t seen you in a while.

The main difference between dementia and normal ageing is the degree of change. When it comes to memory loss, for example, it’s normal to forget where you put your car keys, but less normal to forget what your car looks like or that you even have one. Anyone can forget what they ate for lunch a couple of days ago, but it’s not so normal to forget what you ate half an hour ago. We all repeat stories from time to time, but most people don’t repeat the same story several times to someone over a single day.

Dementia is not always recognised through memory loss. Other symptoms include delusions and hallucinations, such as completely believing something happened when it didn’t. Becoming disoriented is another potential symptom and so is a rise in verbal and physical aggression. Other symptoms, like confusion and becoming less able to care for yourself, often don’t come to the fore until the death of a partner who has been compensating for the person with dementia by gradually doing more and more for them over time.

What are the main causes of dementia?

While there are several types of dementia, they can be difficult to accurately diagnose. Many share similar symptoms and people can have more than one type.

Alzheimer’s disease, the most common cause of dementia, creates tangles and plaques in the brain that are believed to damage neurons and their connections. Symptoms often begin with a loss of commonly used words and a decline in the ability to hold a conversation. A person might, for example, start describing leaves as the green things on trees, because they can’t remember what they are called.

Vascular dementia, the second most common type, results from damaged blood vessels to the brain. It is frequently caused by stroke or multiple strokes. The symptoms of vascular dementia are often less about memory loss and more about slower thinking, reduced problem-solving abilities and a lack of focus or organisational skills. Unpredictable emotions and behaviours can also occur, along with swearing and ranting in a way that may not reflect their true feelings. People with vascular dementia are usually much more aware of their condition than those with Alzheimer’s.

Lewy body dementia (LBD) is caused by abnormal protein balls in the brain, which are difficult to confirm until an autopsy is performed. Common signs of LBD include seeing things that don’t exist, acting out dreams while sleeping and not staying focussed on things. Physical signs include slow or uncoordinated movement, rigidity and tremors. Many of these physical symptoms are similar to those of Parkinson’s disease. LBD tends to progress in stages with periods of little change in between.

Frontotemporal dementia (FTD) has several forms, all of which involve the deterioration of nerve cells and their connections in the brain’s frontal and temporal lobes. Symptoms vary depending on the particular type of FTD. One affects language and speaking skills, another affects movement and a third will alter personality and behaviour. Someone with FTD may lose empathy and say or do completely inappropriate things. They may not see their behaviours as unusual,; even if they do, they may not be able to stop them. Because of the wide ranging symptoms, FTD is very hard to diagnose accurately and may initially be mistaken for deep depression, bipolar disorder or Alzheimer’s.

While the above types of dementia are progressive and unable to be reversed, some conditions that have similar symptoms to dementia can be reversed. These include infections, immune disorders, thyroid problems, an imbalance in minerals or vitamin B-12, dehydration and vitamin deficiencies, medication side effects, poisoning, brain tumours and conditions that cause a lack of oxygen to organs.

Several other non-dementia disorders - such as traumatic brain injury, Huntington’s disease and Parkinson’s disease - have recognised links with dementia.

How can you lower your risk of getting dementia?

Many things can contribute to dementia over time. While a few cannot be changed, most are potential risk factors you might be able to control.

As you get older, your risk of developing dementia increases, but dementia is not simply part of ageing and it can affect relatively young people. A family history of dementia also increases your risk to some degree, but it’s far from a certain thing either way. People with Down syndrome often develop early Alzheimer’s disease.

While there is no certain way to prevent dementia, here are some of the possible risk factors you might be able to monitor, control or talk to your doctor about:

• An unhealthy diet that lacks fresh produce, whole grains, nuts and seeds
• A lack of exercise
• Not challenging your brain
• Drinking too much alcohol
• Cardiovascular problems, such as obesity, high blood pressure, high cholesterol and fat deposits on artery walls
• Depression
• Diabetes
• Smoking
• Sleep apnoea from regular loud snoring or stopping breathing while you sleep
• Vitamin deficiencies

What to do if you have concerns

If you think you or someone close to you may be developing signs of dementia, discussing your concerns with your doctor can help to avoid a lot of unnecessary doubt, worry and stress. While there is no cure, yet, for the continuous decline caused by dementia, there are often ways to reduce its effects or sometimes slow its progress. Most people who finally receive a dementia diagnosis say that while it was devastating news, it was also a huge relief to know what was causing the changes and how best to manage and prepare for the future.

To learn more

If you’d like to know more about understanding and caring for someone with dementia, look for the very practical New Zealand book, Dealing Daily with Dementia by Angela Caughey.

Other useful sources of information and support include:

• dementia.nz
• alzheimers.org.nz

FACT SOURCE: Dealing Daily with Dementia by Angela Caughey, dementia.nz, alzheimers.org.nz