Alzheimer’s Disease and Other Dementias

What is dementia?

Dementia is a condition characterised by the loss of previously acquired mental function without any loss of consciousness. The most common type is called Alzheimer’s disease. Dementia is not a normal part of getting old, but affects older people more commonly.

Alzheimer's disease brain comparison.jpg Comparison of a normal aged brain (left) and the brain of a person with Alzheimer’s (right). Characteristics that separate the two are pointed out.

What are the symptoms?

The symptoms of dementia usually come on gradually, although they can start very suddenly in people who have had a stroke. A person with dementia may complain of any of the following:

• Getting lost or confused easily.

• Forgetting how to do important, everyday things, such as cooking meals, getting dressed, or using the toilet.

• Having trouble sleeping.

• Not being able to recognise even close family members.

These symptoms may make it seem as if the person’s personality has changed. For example:

• They may become agitated or moody, pace about, or wander off.

• They may have trouble talking to or understanding you.

• Some people imagine that things are happening to them (delusions) or see things that aren’t really there (hallucinations), or become aggressive.

What treatment options are available?

Rarely, a treatable cause of dementia, such as hypothyroidism, is found.

Management is usually supportive for other untreatable causes. When someone is first diagnosed they should be referred to a social worker or a mental-health professional, so that they get the right emotional and psychological support. There are also community services that can help.

Some evidence suggests that participation in cognitively demanding activities in later life may protect against or delay the onset of dementia.

Drug Treatments

Cognitive enhancers. They have a modest symptomatic benefit in Alzheimer’s disease but do not slow or prevent progression. Whilst there is dispute about the place for these drugs – all are costly – they contribute in some cases to patients being able to prolong independence and remain at home for longer than might otherwise be the case.

Cholinesterase inhibitors. These maybe helpful in some types of dementia but not others.

Memantine is an NMDA receptor antagonist. It is used in moderate or severe AD or where cholinesterase inhibitors are not tolerated. There is some evidence that combination of Memantine and cholinesterase inhibitors is better than either used alone.

Antidepressants and Antipsychotics. Depression is common in dementia and may be difficult to distinguish from dementia symptoms such as apathy and worsening cognitive function.

Non-drug treatment

Some people try a herbal remedy called Ginkgo biloba for dementia symptoms. It doesn’t have many side effects. However, people who take Ginkgo should tell their doctor. That’s because it can be harmful if taken with some medicines, especially drugs to prevent blood clots (such as aspirin or warfarin). Get good quality ginkgo products from here:

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Getting the most out of life

To help people with dementia get the most out of life, therapists often encourage them to be as independent as possible and to do things they enjoy.

Cognitive stimulation, which involves things like word or number games, or looking at pictures of famous faces, may help people with dementia. They may also be encouraged to talk about people in family photographs or play games. A large calendar or a blackboard can be used to remind them about daily happenings (reality orientation).

Music therapy may also help demented people feel happier and more relaxed. Occupational therapy aims to help people stay independent.

What will happen?

There’s no cure for Alzheimer’s disease and most other kinds of dementia. The treatments given are usually only supportive and does not alter the progression of the disease, although they may slow it down. It’s difficult to predict how quickly this progression occurs, and while some people may stay the same for a long time, others may swing between good and bad days. Eventually, most people with dementia need help with everyday things, like getting washed and dressed.