With dementia being a common condition among the older generation, it’s important to know the facts surrounding the disease

What is dementia?
Dementia is a decline of the brain and its abilities. This can affect memory, thinking, language, understanding and judgement. People with dementia are also likely to become apathetic, which causes them to lose control of their emotions or behaviour in social situations.

What is Alzheimer’s disease?
Alzheimer’s is the most common form of dementia. The condition attacks the nerves, brain cells and neurotransmitters, which are the chemicals that carry messages to and from the brain. Alzheimer’s is a progressive condition, so as it develops the symptoms worsen.

What are the symptoms?
There are varying types of dementia, each with a different set of symptoms: vascular dementia, which involves problems with blood circulation, includes symptoms such as memory loss, depression, difficulty concentrating, low attention span, mental confusion, changes in personality, urinary incontinence, stroke-like symptoms, visual hallucinations, wandering during the night and slow/unsteady gait; dementia in Lewy bodies, abnormal structures, experience some of the same symptoms as above as well as delusions, muscle stiffness, difficulty planning ahead, slower movement, shaking and trembling of limbs, problems sleeping, shuffling while walking and loss of facial expression; fronto-temporal dementia, where the two parts of the brain begin shrinking and usually develops in people under 65, experience symptoms such as aggression, compulsive behaviour, being easily distracted, an increasing lack of interest in hygiene and personality changes. The severity of Alzheimer’s varies in different people because each person reacts differently to the condition. The three stages include mild, moderate and severe: mild symptoms can include confusion, poor memory, mood swings and speech problems; moderate symptoms include hallucinations, delusions, obsessive or repetitive behaviour, a belief in an experience that never actually happened, disturbed sleep and incontinence; severe symptoms include difficulty swallowing, difficulty changing position or moving, weight loss, increased vulnerability to infection and complete loss of short-term and long-term memory.

What are the causes of the disease?
Most cases of dementia are caused by damage to the structure of the brain. However, there are some other risk factors, which can trigger the disease, such as diabetes, obesity, smoking, drinking excessive alcohol, lack of exercise and a high-fat diet. Other, less common, risk factors include repeated head injuries, brain infections such as meningitis, Huntington’s disease, Creutzfeldt-Jakob disease, an overactive or underactive thyroid gland, dehydration, lack of vitamin B, poisoning – for example lead or pesticides – a brain tumour or certain lung or heart conditions that interrupt blood and oxygen flow to the brain.   Alzheimer’s is caused by parts of the brain wasting away. This is known as atrophy. Atrophy affects the cerebral cortex, which is the grey matter over the brain that is responsible for thought process. As the cerebral cortex deteriorates, clumps of protein begin to form. These are known as plaques and tangles, and they make the condition worse by destroying brain cells. It is not known what the main cause of the disease is, but there are certain risk factors which contribute. Age is the main contributor; the likelihood of contracting Alzheimer’s doubles every five years after the age of 65. Alzheimer’s can be hereditary if there is a history of it in the family. If there are family members with the disease and it’s passed down on generations then symptoms can begin at an earlier age, between 35 and 60. People with Down’s syndrome have a higher chance of developing Alzheimer’s because they have an extra copy of chromosome 21, which contains a particular protein in the brain that’s high among those with Alzheimer’s. A severe head injury or whiplash can also develop into Alzheimer’s, as can too much aluminium in the body. This natural occurring substance can be detected in food and plants, but is also added to pans, packaging and medicines. Usually only a minimal amount of aluminium is absorbed by the body and is passed out through urine, but plaques and tangles have been found to contain higher levels of the substance. Research is still ongoing as to whether there is a direct link.

What treatments are available?
There are medications available for the varying levels of dementia and Alzheimer’s.Donepezil, galantamine  and rivastigmine are often prescribed to people with moderate symptoms of Alzheimer’s. They work by preventing the chemical breakdown in the brain and slowing the process of brain deterioration. These have the potential of triggering side effects such as nausea, vomiting, diarrhoea, headache, fatigue, insomnia and muscle cramps. For more severe cases of Alzheimer’s memantine is usually prescribed. This acts as a block to harmful chemicals that are released in large amounts in the brain. As dementia develops, health and social care will need to be supported. There are healthcare professionals who can provide the level of support needed, such as GPs or psychiatrists. There are also social care services available, normally provided by the local council working in conjunction with the NHS. Care assessments will usually consist of whether it is safe for the patient to drive, care for themselves with tasks such as washing, feeding and dressing, check whether there is a support network in place i.e. family and friends, and whether they are financially secure.  There are psychological treatments used as coping mechanisms for dementia. Cognitive stimulation is a series of activities and exercises designed to help improve a person’s memory, problem-solving skills and language ability. Reality orientation therapy helps reduce the feelings of mental disorientation, memory loss and confusion, which simultaneously improves self-esteem. By repeating tasks set for them in a classroom, the memory will be strengthened. Behavioural therapy is used to help the problems that arise with dementia such as aggression, depression and delusional thinking. This kind of therapy is most often provided by a carer and supervised by a health professional.

By James Massoud

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