Dementia

Common symptoms of Alzheimer’s disease and other forms of dementia include:

• memory loss, especially problems with memory for recent events, such as forgetting messages, remembering routes or names, and asking questions repetitively
• increasing difficulties with tasks and activities that require organisation and planning
• becoming confused in unfamiliar environments
• difficulty finding the right words
• difficulty with numbers and/or handling money in shops
• changes in personality and mood
• depression

Early symptoms of dementia are often mild and may get worse only very gradually. This means that the person with dementia and those around them may not notice these signs or take them seriously for some time. Also, people with dementia sometimes do not recognise that they have any symptoms.

Dementia is progressive. This means that the person’s brain will become more damaged and will work less well over time, and their symptoms will tend to change and become more severe.

For this reason, it is important to talk to your GP sooner rather than later if you are worried that you may have problems with your memory.

The speed at which symptoms get worse and the way that they develop will depend on the cause of the person’s dementia, their overall health and their circumstances. This means that the symptoms and experience of dementia can vary greatly from person to person.

Some people may also have more than one condition – for example, they may have Alzheimer’s disease and vascular dementia at the same time.

The symptoms listed above are common in all forms of dementia. However, some types of dementia have other distinctive features. These are explained below.

Vascular dementia is caused by reduced blood flow to the brain because there is a problem with the blood vessels that supply it. Parts of the brain become damaged and eventually die from a lack of oxygen and nutrients.

However, unlike other forms of dementia, many cases of vascular dementia can be prevented.

The symptoms of vascular dementia can sometimes develop suddenly and quickly get worse, although they can also develop gradually over many months or years. People with vascular dementia may also experience stroke-like symptoms, including muscle weakness or paralysis on one side of their body.

Persistent high blood pressure is thought to play a role and may worsen the disease.

Because of the influence of high blood pressure, vascular dementia may be partly preventable. Managing high blood pressure, losing excess weight and stopping smoking may reduce your risk of developing the disease, or at least slow its progression.

In dementia with Lewy bodies, tiny clumps of abnormal protein – called Lewy bodies – form in the brain. These are also present in the brains of people with Parkinson’s disease. Symptoms usually develop gradually and become more severe over the course of many years.

Dementia with Lewy bodies shares many of the symptoms of Alzheimer’s disease and people with the condition typically also experience the following:

• periods of alertness and drowsiness or fluctuating levels of confusion
• visual hallucinations
• becoming slower in their physical movements

They tend to swing from a state of alertness to drowsiness or staring into space. These extreme changes may be unpredictable and happen from hour to hour or day to day.

Frontotemporal dementia is a rare type of dementia caused by a build-up of abnormal proteins in the brain. The affected areas of the brain gradually function less well and shrink.It tends to affect the frontal and temporal lobes of the brain (the front and sides) in particular, and often starts at a younger age than usually seen in Alzheimer’s disease.

Early symptoms of frontotemporal dementia typically include changes in emotion, personality and behaviour. For example, someone with this type of dementia may become less sensitive to other people’s emotions, perhaps making them seem cold and unfeeling. They may also lose some of their inhibitions, leading to behaviour that is out of character, such as making tactless or inappropriate comments.

Some people with frontotemporal dementia also have language problems. This may include not speaking, speaking less than usual or having problems finding the right words.

As dementia progresses, memory loss and difficulties with communication often become very severe. In the later stages, the person is likely to neglect their own health and require constant care and attention.

Memory symptoms
People with advanced dementia may not recognise close family and friends, they may not remember where they live or know where they are. They may find it impossible to understand simple pieces of information, carry out basic tasks or follow instructions.

Communication problems
It is common for people with dementia to have increasing difficulty speaking and they may eventually lose the ability to speak altogether. It is important to keep trying to communicate with them and to recognise and use other, non-verbal means of communication, such as expression, touch and gestures.

Problems with mobility
Many people with dementia gradually become less able to move about unaided and may appear increasingly clumsy when carrying out everyday tasks. Some people may eventually be unable to walk and may become bedbound.

Incontinence
Bladder incontinence is common in the later stages of dementia and some people will also experience bowel incontinence.

Eating, appetite and weight loss
Loss of appetite and weight loss are common in the later stages of dementia. It’s important that people with dementia get help at mealtimes to ensure they eat enough. Many people have trouble eating or swallowing and this can lead to choking, chest infections and other problems.

Dementia, and the difficulties it causes, is one of the most feared health conditions. People with dementia and their families are sometimes reluctant to seek advice when concerned about memory or other problems. But there are many potential benefits to getting medical advice if you’re worried. Being diagnosed early is important for many reasons. It helps you to get the right treatments and to find the best sources of support, as well as to make decisions about the future.

It may not be clear why someone has problems with memory or has a change in behaviour. These problems may be because of dementia, or down to other reasons such as poor sleep, low mood, medications or other medical conditions. This uncertainty can be distressing for both the person experiencing difficulties, and their family and friends. While a diagnosis of dementia can be devastating news, an explanation of what the problem is and what can be done about it can help people feel empowered and reduce some of the worry caused by uncertainty. Some people find it helpful to discuss with doctors and nurses how the dementia may affect them or their loved one in the future, and there is advice available about how to stay independent and live well with dementia.

Dementia is not a single condition – it refers to difficulties with thinking and memory that may be caused by several different underlying diseases. This is one reason why not everyone with dementia experiences the same problems.

Identifying that there is a problem, and then diagnosing the underlying cause is important for guiding treatment and accessing services. Some causes of dementia are treatable and reversible (either partially or fully, depending on the nature of the problem). Conditions such as anxiety and depression, some vitamin deficiencies, side effects of medications and certain brain tumours fall into this category. Alzheimer’s disease and dementia with Lewy bodies are neurodegenerative conditions, which means they gradually damage the brain.

Cholinesterase inhibitor medications have been shown to have benefit in Alzheimer’s disease and dementia with Lewy bodies.

These treatments (donepezil, rivastigmine and galantamine) improve symptoms by making the remaining brain cells work a bit harder.

Memantine is another medication that can help in Alzheimer’s disease. Although not a cure, these medications can make a significant difference to day-to-day living and functioning.

Treating high blood pressure, high cholesterol and poorly controlled diabetes is also important, as is stopping smoking and keeping to a healthy weight. These factors (known as risk factors) all contribute strongly to vascular dementia, and may make Alzheimer’s disease worse. Your GP will be able to assess your risk factors, advise if treatment is needed and monitor you.

In addition to medication, treatment for Alzheimer’s disease involves a wide range of other measures and treatments to help people with dementia live as independently as possible.

For example:

• an occupational therapist can identify problem areas in your everyday life, such as dressing yourself, and help you work out practical solutions
• grab bars and handrails can be added around your home – for example, to help you get in and out of the bath
• psychological treatments, such as cognitive stimulation, may be offered to help improve your memory, problem-solving skills and language ability

Medication, other psychological therapies, such as cognitive behavioural therapy, and relaxation therapies may also be offered to help reduce any depression, anxiety, agitation, hallucinations, delusions and challenging behaviour that often feature with Alzheimer’s disease.

Whether or not there are specific treatments for the cause of the dementia affecting you, having the correct diagnosis is important for getting the right advice and support. There is a lot of help and information available both for people with dementia and their friends, relatives and carers.

Other things which might help:

• If you need urgent support click ‘urgent help’ on this website, which is on the side of the screen on desktops and the bottom of the screen on mobiles.
• Search for support on this website: we have information on mental health friendly services, groups, and websites.
• Have a look at our activities section, where we’ve listed workshops, groups and courses which are all mental health friendly, and free or low cost.
• Our wellbeing section also includes helpful tips.
• Go to the Sheffield IAPT website, where you can find information on self-help resources, IAPT support services and health and wellbeing.
• Check out the different support options at Sheffield Mind.
• Find out about other activities, which you might find beneficial, on the Sheffield Directory.
• Read stories about other people living with mental health issues on the Sheffield Flourish website.

The Sheffield Mental Health Guide has information about support groups, counselling services and other organisations in the Directory of Services. To search the Directory for services and resources about dementia, click here.

Dementia Carer is a website that has been developed in Sheffield with the NHS and the Local Authority for carers of people with dementia.

The Sheffield Directory has information about local support groups, services and activity groups that may be able to help you. To visit the Sheffield Directory website click here.

More information on conditions and issues relating to mental health:

• Mind has an excellent A-Z of mental health, which is written in a friendly and informal style.
• For a more medicalised approach, NHS Choices regularly reviews its information on mental disorders.
• The Royal College of Psychiatrists has information on problems and disorders.
• The Mental Health Foundation also has an A-Z  of mental health problems.

Source: NHS Choices Website