First Steps to living with Dementia

Simon Atkins

• Publisher: Lion Books
• Year: 2013
• ISBN:
  9780745957210
• Topic: Medicine
• Subtopic: Diseases & Allergies

What is dementia? Is it the same as Alzheimer's? What symptoms should you look out for? Where can you go to find help? What treatments are available? In this short but comprehensive introduction, Dr Simon Atkins clears away the myths, and sets out the facts about this increasingly common condition. Whether you are concerned for yourself or someone else, First Steps to living with Dementia will advise you about how it is diagnosed, conventional medical treatments and alternative remedies, the social and financial support available, and the lifestyle changes that can help prevent it.

1

What is dementia?

Dementia is caused by a number of different illnesses which each lead to progressive and irreversible damage to the brain. Symptoms caused by this damage can include loss of memory, confusion, disorientation, problems with language and judgment, lack of insight, mood changes, hallucinations and delusions, and, as a result, the gradual loss of the ability to carry out even the most basic tasks of daily living.

It is a condition of adults that can affect both men and women and becomes more common with increasing age, although 2 per cent of those diagnosed are younger than 65. Once picked up, symptoms can be stable for up to five years and the average survival rate is around ten years (although this depends on age at diagnosis). This reduced survival compared to the rest of the population is likely to be due to the incapacity caused by dementia, which increases the risk of falls as well as susceptibility to picking up infections such as pneumonia.

Mythbuster

All old people get dementia.

Dementia is not a normal part of ageing, and although one in three people over 65 will develop it, that means that a massive two-thirds of the elderly population will not.

The most common cause of dementia is Alzheimer’s disease, with vascular disease, frontal lobe dementia (or Pick’s disease), and Lewy body disease being the next most common causes. Age distribution for causes of dementia is shaped like a funnel – wide at the top and much narrower at the bottom – because in younger people any of the diseases can be responsible, whereas in the over-75s it’s almost exclusively down to Alzheimer’s.

In order to understand what goes wrong inside our brain when we develop any type of dementia, it can help to have some idea about how the brain works when it’s doing its job properly. Go to Appendix A to find out more.

Alzheimer’s disease

This is the most frequent cause of dementia, which, because we are all living longer, is predicted to affect over 80 million people across the globe by 2040. That’s a whopping four times the number affected now.

First described by a German doctor called Alois Alzheimer in 1906, it is a physical disease that causes protein plaques and tangles to form in brain cells. These cause damage to the cells, which stops them working properly and eventually leads to cell death. As time goes on, the disease spreads to more and more parts of the brain, making the symptoms worse.

There is no single cause of Alzheimer’s disease, but there is thought to be an inherited (genetic) risk, with lifestyle factors such as smoking and poor diet also being significant risk factors. By far the biggest risk factor is age, with 99 per cent of cases occurring in people over the age of 65.

Vascular dementia

This is the second most common form of dementia. It is not in itself a single disease but is caused by damage to small blood vessels in the brain either by atherosclerosis (furring of the arteries) or by small haemorrhages. It can also be caused by the effects of poor circulation due to heart failure.

Strokes are the biggest culprits, with 25 per cent of people who have had a stroke developing symptoms of dementia within one year.

The risk factors for this type of dementia are diabetes, high blood pressure, raised cholesterol levels, smoking, poor diet, and lack of exercise.

Mixed dementia

Given that, like Alzheimer’s disease, the risk of vascular dementia goes up with age, it’s very common to find people whose dementia symptoms are caused by a mixture of the two conditions.

Lewy body disease

This disease, like Alzheimer’s, bears the name of the doctor who first described it. In this case it was Frederic Lewy, working in 1912, who first noted abnormal, spherical protein deposits in the midbrain and cortex. These deposits are also found in the midbrains of people who have Parkinson’s disease and so, in Lewy body disease, sufferers not only have the symptoms of dementia but tend to have Parkinson’s symptoms too (see Chapter 2 for more detail on symptoms).

Alongside the Lewy body proteins, the brains of people with this type of dementia are also often damaged by the presence of plaques and tangles.

The cause of this condition is still a mystery despite a lot of research.

Frontal lobe dementia

This type of dementia was originally known as Pick’s disease after Arnold Pick, a psychiatrist working in Prague, who first recorded it in 1892. It has since been rebranded as frontal lobe or frontotemporal dementia to include other conditions, such as motor neurone disease, which can cause dementia affecting these areas of the brain (the frontal and temporal lobes).

The cause is again unknown and its symptoms are mentioned in Chapter 2.

Other causes

A large number of other diseases can cause damage to the brain and lead to symptoms of dementia. Some of these are conditions that affect the brain directly, but disturbances in levels of the body’s chemicals and hormones, along with various infections, can also cause dementia-like symptoms. Many of these are treatable (urinary infections, for example) and not chronic and progressive illnesses like the diseases we’ve just looked at.

Neurological causes

Parkinson’s disease (PD)

People with this condition have a higher risk than average of developing dementia and make up 2 per cent of all people suffering with dementia. People with PD-related dementia have similar symptoms to those with Lewy body disease, and there may be a link between the two. In addition to the common symptoms of dementia, they suffer with visual hallucinations and may also have mood swings and episodes of irritability. Unfortunately, some of the drugs used to treat their PD may make their dementia symptoms worse.

Multiple sclerosis (MS)

It’s reckoned that a high percentage of people with MS have some sort of cognitive problems. They are particularly susceptible if their MS affects the cortex of the brain.

Normal pressure hydrocephalus (NPH)

It can be difficult to tell the difference between NPH, Alzheimer’s, and PD because the symptoms overlap. In NPH there is an accumulation of fluid in the brain which causes the ventricles to enlarge. This stretches the brain tissue, causing the symptoms of dementia, walking difficulties, and incontinence of urine. It affects people over the age of 55 and has to be treated by brain surgeons, who put a shunt into the brain to drain the fluid.

Creutzfeldt–Jakob disease (CJD)

This rare brain disease has four types, the best known of which is vCJD, which was once thought to be linked to so-called “Mad Cow” disease. Although no link was proven, it is believed that this type of CJD may be contagious, whereas the others are more commonly either sporadic or genetic. Dementia is only one small feature of this awful disease, which causes multiple neurological symptoms such as unsteadiness, slurred speech, loss of bladder control, and blindness.

Huntington’s disease

This is a hereditary disease caused by a faulty gene on chromosome 4. If one parent has the disease, then there is a fifty-fifty chance of a child inheriting it. Symptoms begin in middle age (30–50 years) and progress relentlessly until death. Alongside dementia, symptoms include loss of movement control and mood changes. Huntington’s disease eventually leads to the complete inability of sufferers to look after themselves.

Hormonal and nutritional causes

Addison’s disease and Cushing’s disease

In these diseases there is either too little (Addison’s) or too much (Cushing’s) of a hormone called cortisol. This leads to imbalances in mineral levels in the blood, such as sodium and potassium, which, among other things, can cause mental confusion. Treatment of the underlying triggers can help alleviate these symptoms.

Diabetes

Low blood-sugar levels can cause confusion and disorientation similar to that seen in dementia. Correcting the level of sugar by simply giving some chocolate can solve the problem in the short term. It can be prevented by good diabetes control.

Thyroid disease

The thyroid gland produces hormones that help control metabolism. An over- or underactive thyroid gland can cause symptoms of confusion and upset thought processes because of the abnormal levels of these hormones. Again, treating the thyroid disease will cure these symptoms.

Hyperparathyroidism

The parathyroid glands make a hormone that controls the body’s levels of calcium, phosphorus, and vitamin D. Overproduction of the hormone will put the blood level of calcium up too high. This can cause changes in personality, altered levels of consciousness, disorientation, and even coma.

Vitamin B12 deficiency

One of the jobs of this B vitamin is to ensure normal function of the nervous system. It is found in various foods and absorbed through the digestive system. Unfortunately, some people are unable to absorb it and as a result can end up with damage to nerves in their arms, legs, and brain. Injections are available to sort out the deficiency, but if it has taken a while to diagnose, it may...