Understanding dementia

The key to ensuring that a person living with dementia is receiving the best support is to understand what “dementia” really is.

“Dementia” can be thought of as an umbrella term that includes a range of conditions characterised by cognitive decline, which impact memory, thinking, behaviour, and the ability to perform everyday activities.

The various types of dementia each have different causes, symptoms, prevalence, and treatments.

Let’s a take a look at some of the most common types of dementia.

Alzheimer’s Disease

Alzheimer’s disease is the most common form of dementia, accounting for 60 – 70% of all dementia cases.

It is a progressive disease, and symptoms will worsen over time. A person with Alzheimer’s disease will need increasing support with their daily living needs.

Causes

• The cause for most Alzheimer’s disease cases is still largely unknown.
• Common theories speculate that a build-up of amyloid plaques and tau proteins in the brain cause a gradual loss in cognitive function.
• A very small number of cases (less than 1%), Alzheimer’s disease is caused by a genetic fault.
• Age is the biggest risk factor in getting Alzheimer’s disease, however certain lifestyle choices can increase this risk (such as smoking, alcohol consumption, obesity) as well as the presence of other health conditions (such as diabetes, hypertension, hearing loss, and head injuries).

Symptoms

• Early stages: Short-term memory loss, confusion, difficulty remembering recent events, problems with language, and disorientation.
• Middle stages: Increased memory loss, difficulty recognising family and friends, confusion about time and place, impaired judgement, and mood swings.
• Late stages: Severe memory impairment, loss of ability to communicate or perform daily activities, extensive behavioural changes, and increasing frailty.

Treatment

There is currently no cure for Alzheimer’s disease, therefore treatment strategies are based around management of symptoms.

• Medications: Typical medications used to slow down the progression of the disease or reduce symptoms include donepezil, rivastigmine, and galantamine for early to middle stages of Alzheimer’s. Memantine is prescribed for moderate to severe cases of Alzheimer’s disease, or if other medicines are not being well tolerated by the individual.
• Lifestyle changes: Regular physical activity paired with a healthy and balanced diet, social engagement and cognitive stimulation therapy can ensure the individual maintains their well-being for as long as possible.

• Supportive care:Specially trained professionals can assist an individual to remain independent in their home and continue to maintain their lifestyle. Several organisations exist to provide advice and support to people with dementia and their families. Practical aids and home adaptations can be put in place improve safety and encourage independence as the disease progresses.

Vascular Dementia

Vascular dementia is the second most common form of dementia, making up approximately 20% of all cases.

The progression and experience of vascular dementia can vary significantly from person to person, depending on the areas of the brain affected in that individual.

Causes

• Vascular dementia is the result of impaired blood flow to the brain.
• This can be caused by a stroke, a transient ischemic attack (TIA), or health conditions such as hypertension, heart disease and diabetes.

Symptoms

• Early stages: Short-term memory loss, problems with language, increased confusion and problems concentrating. This stage can last for months or even years.
• Middle stages: Significant changes in mood, personality and behaviour, increasing memory and communication difficulties, problems following a series of steps (e.g. cooking a meal), challenges with decision making, planning or problem solving.

• Late stages: Daily living activities require increased levels of support, including eating, drinking, mobility, personal care and communication.

• Step-wise progression: Vascular dementia progresses at unpredictable rates, with symptoms often remaining stable for a long time, followed by a sharp increase in their severity. This is known as “step-wise progression”.

Treatment

Currently, there are no specific treatments for vascular dementia, the focus is primarily on treating the underlying cause and managing symptoms.

• Medication: Medications may be given for underlying conditions such as diabetes and hypertension to reduce the risk of worsening symptoms of dementia.
• Lifestyle modification: Healthy diets, regular exercise, weight loss and smoking cessation are all examples of changes a person can make to their lifestyle that can contribute to slowing the progression of vascular dementia.
• Rehabilitation: Physical, cognitive and occupational therapies can help to improve function and quality of life. Cognitive Stimulation Therapy can also help with communication, concentration and memory issues.

Dementia with Lewy Bodies

Dementia with Lewy bodies is the third most common type of dementia, and it is estimated that around 10 – 15% of people with dementia have dementia with Lewy bodies.

In early stages, it is often mistaken for Alzheimer’s disease and can be misdiagnosed.

Lewy body dementia is closely related to Parkinson’s Disease.

Causes

• Small clumps of proteins called Lewy bodies appear in the nerve cells of the brain, affecting the way the cells communicate as the proteins accumulate.

• The reason for the development of Lewy bodies in the brain is not yet known.

Symptoms

• Early stages: Sleep disruption, changes in visual perception, mood instability, and unpredictable changes in alertness.
• Middle stages: Hallucinations, loss of mobility, memory loss, acting out of vivid dreams, and difficulty in making decisions or planning.

• Late stages: Parkinsonism, tremors, loss of bodily functions, increase in severity of hallucinations and cognitive disruption.

• Parkinson’s dementia: As Parkinson’s disease is also caused by an accumulation of Lewy bodies, the two diseases share many symptoms. The primary difference is that someone with Parkinson’s dementia will experience Parkinsonian symptoms first, followed by cognitive decline.

Treatment

As with the previously mentioned dementias, there is currently no cure for dementia with Lewy bodies. Treatments are again focused on managing symptoms and helping the individual live as well as possible.

It is important to get an accurate diagnosis to ensure suitable treatment. A combination of assessing the person’s detailed symptoms and having a scan called a Single Photon Emission Computed Tomography (SPECT) can help to support a Lewy body dementia diagnosis.

• Medications: Finding suitable medications can be challenging, as some people with Lewy body dementia can be especially sensitive to medicines used to treat hallucinations. Drugs used to treat Alzheimer’s disease (donepezil, rivastigmine, galantamine, and memantine) have been shown to help improve some symptoms of Lewy body dementia in the early or middle stages, but they are not an effective treatment for all people. Parkinson’s disease medication such as levodopa can help with Parkinsonian symptoms, but they are used with caution as they can make hallucinations worse.
• Non-drug interventions: Social interaction, Cognitive Behavioural Therapy (CBT), creative activities such as singing, music and art, exercise and maintaining daily routines have all been shown to have a positive effect when managing dementia with Lewy bodies.

• Home support and adaptations: Effective home care and the use of aids and home modifications can help to keep an individual with Lewy body dementia safe and independent in their own home.

Frontotemporal Dementia (FTD)

Frontotemporal Dementia (FTD) is an umbrella term for a rare group of dementias, accounting for less than 5% of all dementia cases.

As the name suggests, FTD primarily affects the frontal and temporal lobes of the brain, which are responsible for personality, behaviour, and language.

There are two broad types of FTD, behavioural variant FTD (bvFTD) and primary progressive aphasia (PPA).

Causes

• An abnormal build-up of tau proteins, TDP-43 proteins, and FET proteins in the frontal and temporal lobes damages brain cells. As the damage spreads, symptoms of FTD will worsen.

• The reason for the build-up of these proteins is not yet know.

• FTD is most common in people aged 40 – 60.

• There appears to be a significant genetic link in cases of FTD. Around 10 – 15% of individuals with FTD have a single faulty gene that causes FTD, known as “familial FTD”. People with family members who have FTD can be tested to see if they are carrying this gene via their local NHS genetics service.

Symptoms

• Behavioural variant FTD: Lack of motivation and interest, inappropriate behaviour and loss of inhibitions, difficulty focusing and decision-making, and repetitive behaviours.
• Primary progressive aphasia (PPA): PPA has two main subtypes, semantic variant PPA and non-fluent variant PPA. Semantic variant PPA will cause a person to lose their vocabulary over time, and forget the names or purposes of familiar objections. Non-fluent variant PPA will cause a person to speak differently, use incorrect words or word order, use shorter sentences, or say the opposite of what they mean.
• Late stages: Difference between the types of FTD become less obvious, the person may eventually lose the ability to speak, have drastic changes in their personality, experience memory loss, aggression, delusions and hallucinations. Eventually, the person will require full-time care to meet their daily needs.

Treatment

There is currently no known cure for FTD, and unfortunately the progression of FTD cannot be slowed down.

Drugs used for other types of dementia can actually make FTD symptoms worse.

• Medications: Some behavioural symptoms can be managed by antidepressants or antipsychotics, however these are not suitable for everyone.
• Therapies: Occupational, speech and cognitive behavioural therapists can provide support in managing symptoms and maintain independence for as long as possible. Physiotherapy can also help with physical or mobility issues.
• Supportive care: Counselling and support groups can be useful for providing advice and emotional support, and professional home care can enable a person to remain safe and independent in their home for as long as possible.

Mixed Dementia

A person can have more than one type of dementia, and this condition is called “mixed dementia”.

At least 10% of dementia diagnoses are of “mixed dementia”.

The most common type of mixed dementia is Alzheimer’s disease and vascular dementia, followed by Alzheimer’s disease and dementia with Lewy bodies.

There are no fixed causes, symptoms or treatments for mixed dementia, because these depend on the relative contributions of each type of dementia a person has.

How Home Instead can help

Home Instead is a specialist dementia care provider. Our Care Professionals are highly trained to support individuals living with dementia, and they are carefully chosen for their kindness, empathy, and warmth.

We take time to learn what is important to the individual and their family, so our support is tailored to their needs.

We make sure the same Care Professionals visit each time, which is especially important to help those with memory issues to recognise familiar faces and build trusting relationships.

Home Instead Canary Wharf has been rated as Outstanding by the CQC and our person-centred philosophy of care is focused on providing the highest quality service possible.

Our Care Professionals help to enhance the quality of life of individuals living with dementia, by allowing them to maintain a sense of dignity and independence for as long as possible.

We also support families and family carers to navigate the difficulties that arise when their loved ones are living with dementia, by alleviating the emotional and physical burdens family carers face. Our Care Professionals can allow family members to have time for themselves and to enjoy time with their loved ones without the anxiety and stress of also having to provide constant support.

To have a chat about how we might be able to help you or someone you care about, call our friendly team today on 0203 713 3161, or send us a message and someone will get back to you within 24 hours.