Dementia

What is Dementia

Dementia is a syndrome (a group of related symptoms) associated with an ongoing decline of brain functioning. This may include problems with:

memory loss
thinking speed
mental sharpness and quickness
language
understanding
judgement
mood
movement
difficulties carrying out daily activities

There are many different causes of dementia. People often get confused about the difference between Alzheimer's disease and dementia.

Signs & Symptoms

memory loss
difficulty concentrating
finding it hard to carry out familiar daily tasks, such as getting confused over the correct change when shopping
struggling to follow a conversation or find the right word
being confused about time and place
mood changes

Treatment

Most of the medications available are used to treat Alzheimer's disease as this is the most common form of dementia. They can help to temporarily reduce symptoms.

The main medicines are:

Acetylcholinesterase inhibitors

These medicines prevent an enzyme from breaking down a substance called acetylcholine in the brain, which helps nerve cells communicate with each other.

Donepezil (also known as Aricept), rivastigmine (Exelon) and galantamine (Reminyl) are used to treat the symptoms of mild to moderate Alzheimer's disease. Donepezil is also used to treat more severe Alzheimer's disease.

There is evidence that these medicines can also help treat dementia with Lewy bodies and Parkinson's disease dementia, as well as people who have a mixed dementia diagnosis of Alzheimer's disease with vascular dementia.

There is little difference between these medicines in their effectiveness. However, rivastigmine may be preferred if hallucinations are one of the main symptoms.

Side effects can include nausea and loss of appetite. These usually get better after two weeks of taking the medication.

Challenging Behaviour

Medicines to treat challenging behaviour

In the later stages of dementia, a significant number of people will develop what is known as "behavioural and psychological symptoms of dementia (BPSD)". The symptoms of BPSD can include:
increased agitation
anxiety
wandering
aggression
delusions
hallucinations
These changes in behaviour can be very distressing, both for the person with dementia and for the person caring for them. However, there are coping strategies that can help.
If coping strategies don't work, antipsychotic medicines such as risperidone or haloperidol may be prescribed for those showing persistent aggression or extreme distress.
These are the only medicines licensed for people with moderate to severe Alzheimer's disease (risperidone and haloperidol) and vascular dementia (just haloperidol) where there is a risk of harm to themselves or others.
Risperidone should be used at the lowest dose and for the shortest time possible (up to 6 weeks) as it has serious side effects. Haloperidol can be used only if other treatments have not helped.
The decision to prescribe a medicine should be taken by a consultant psychiatrist.
Antidepressants may sometimes be given if depression is suspected as an underlying cause of anxiety.

Find out More:

One of the main dementia charities is Alzheimer's Society. Its website has information on all diseases that cause dementia, not just Alzheimer's disease, including how to live well with dementia and how to find help and support near you.

It also runs the National Dementia Helpline on 0300 222 11 22 for information and advice about dementia.

Dementia UK is a national charity that aims to improve the quality of life for people with dementia. It offers advice and support to families who are living with dementia through its Admiral Nurses, who are registered nurses and dementia experts.

Alzheimer's Research UK carries out dementia research but also answers questions about dementia and dementia research, including how you and your family and friends can get involved. The charity's infoline – on 0300 111 5 111 – can provide help and guidance.

Age UK has advice on a range of topics, including advance care planning, benefits and choosing a care home, as well as information on local activities and services for those with dementia. It runs a free national helpline on 0800 055 6112.

The Carers Trust provides information and advice on its website for carers, including how to get support for yourself.

Carers UK is a national charity for carers, providing information and advice from benefits to practical support.

Find out More:

Emergency Action plan:

Try not to assume they can’t remember things. As mentioned dementia is progressive, they may be at the very start of their condition and their memory is barely effected and you as not a family member wouldn’t even notice anything was wrong, or they could have another form of dementia that doesn’t effect their memory yet at all.

Just because they’re a little confused doesn’t mean they can’t consent to treatment. Always explain to them what you would like to do, and if necessary repeat it. They may forget how to perform simple tasks such as using an inhaler or using a phone and need help to do so.

Make sure that if a carer or loved one is with them, that they stay there with you whilst you are providing treatment. This is in case the patient with dementia does struggle to remember things, or has difficulty communicating. Patients with severe dementia can get agitated and frustrated with their condition so having someone who knows them with you can help.

If you are concerned, call for help. If they are one their own and you are worried about their well being, or someone seems confused and you don’t know for definite it’s dementia, call for help. There are other illness that can cause confusion such as head injuries, strokes or severe infections.

Try to be patient relaxed. Patients suffering from dementia can feel very frightened and scared if they are confused. Keep the environment around them calming, removing loud noises. Don’t pressure them or draw attention to the fact they can’t remember something. Anxiety can make their confusion worse. Instead move on to talk about something else and ask them again later.