Dementia

Dementia has been at the top of the political agenda for many years now as politicians realise that they need to take action to tackle a disease that will soon affect one million people across the country. The Alzheimer's society has been working with authorities to create the worlds first dementia-friendly parliament.

Volunteering at a care home first brought about my interest into this topic, after which I read a book called, 'Contented Dementia'. This book taught me a lot about how you should care for people with dementia. Putting yourself in their shoes is crucial. Although there are common symptoms, it is not a universal disease; we are all individuals and it affects people in different ways.

Dementia is the umbrella term for a chronic or persistent disorder of the mental processes caused by brain disease. It is marked by memory disorders, personality changes and impaired reasoning. There are many forms of dementia and here is a brief overview of the most common forms being, dementia with Lewy bodies, Frontotemporal dementia, vascular dementia and Alzheimers.

Alzheimer's
This is the most common form of dementia and with the ageing population it is becoming an increasing problem and is a condition that healthcare professionals will need to really understand in order to provide good care.
Causes
Researchers are unsure of where the progressive nature of Alzheimer's starts from, however sufferers have been found to have abnormal amounts of amyloid plaques (protein), fibres (tau tangles) and acetyl choline in the brain. This reduces effectiveness of nerve cells and destroys them gradually- that is why it is progressive in nature. Over time it spreads to areas of the brain such as, grey matter (responsible for thought processing) and hippocampus (responsible for memory). In my next post I will delve deeper into amyloid hypothesis.
Symptoms
Whilst there are common symptoms, it's vital to remember that everyone is unique and it will affect each person in different ways. Common symptoms include mood swings, feeling sad, angry, scared frustrated at their increasing memory loss, more withdrawn due to loss of confidence. They have difficulty with everyday activities and will need more and more support as it progresses.


Dementia with Lewy Bodies (DLB)
Causes
Unsurprisingly, this form of dementia is caused by Lewy bodies. Lewy bodies are tiny deposits of proteins in nerve cells. named after the doctor who discovered them. Researchers do not yet understand how they appear in the brain or contribute to dementia. However their presence is linked to low levels of acetyl choline and dopamine (chemical messengers) which leads to a loss of connection in nerve cells. It is progressive and leads to death of nerve cells and brain tissue. Lewy bodies are also the underlying cause of Parkinson's disease, collectively called Lewy body disorders.
Symptoms

This type of dementia shares symptoms with Alzheimer's and Parkinson's disease. Symptoms partly depend on where the Lewy bodies are in the brain. Lewy bodies at the base of the brain are linked to problems with movement (motor symptoms) - the main feature of Parkinson's disease. Lewy bodies on the outer layers of the brain link to problems with mental abilities (cognitive symptoms), characteristic of DBL. These symptoms can both occur together. 1/3 of people with Parkinson's develop dementia, whilst 2/3 of people with DBL develop motor symptoms. 

Symtoms unique to DBL can include convincing visual hallucinations and less common auditory hallucinations, which can be very distressing. Delusions such as ideas that strangers live in the house or that a spouse has been replaced with an identical impostor can be distressing for carers and relatives.

Later stages include problems with speech or swallowing, leading to chest infections and risk of choking. This requires extensive nursing care. On average a person may live eight years after first symptoms.

Who is affected
It is thought that Lewy bodies accounts for 10% of all dementia cases but is under-diagnosed and mistaken for other diseases, so only accounts for 4% of recorded dementia. It is particularly important to have an accurate diagnosis of DBL because sufferers can react well to some medications but badly to others. There is equal chances of both men and women developing dementia and it is more common in people over 65. There are very few risk factors identified to increase chances of developing DBL.


Vascular Dementia 
Causes
Brain cells are killed due to reduced oxygen supply to the brain as blood vessels to the brain narrow or become blocked. This can occur gradually after damage to blood vessels deep in the brain, after a series of small strokes or suddenly after a large stroke. Symptoms overlap with  with the most common form of dementia, that is, Alzheimer's. It is not uncommon for people to have mixed dementia, such as both Alzheimer's and vascular dementia.
Factors that increase risk are the same as those which increase the risk of cardiovascular disease (makes sense). Risk factors are anything which causes damage to the vascular system, including high blood pressure, high cholesterol diabetes and heart problems.
Symptoms
Typically symptoms appear suddenly after a stroke or in a step progression, where it will stay at a constant level then suddenly deteriorate. Symptoms are similar to Alzheimer's but symptoms particular to vascular dementia include problems with concentration, communication, speed of thinking, and memory. Seizures could occur, periods of acute confusion, symptoms of stroke such as weakness of paralysis. Hallucinations, misperceptions, behavioural changes, difficulty walking and unsteadiness can also occur. These, however may not be directly as a consequence of the disease, but other factors play a part. For example behavioural changes could be as a result of care needs not being wholly met.


Frontotemporal Dementia 
Causes 
This is a less common form of dementia but is the significant cause of dementia in under 65s. The cause is not yet known, but it is assumed to be caused by a mixture of genetic and lifestyle factors. It occurs to due death of nerve cells in the frontal and temporal lobes. Frontal lobes situated behind the forehead- on the right side they control behaviour and emotions and language on the left. Temporal lobes on either side of the brain have many roles such as understanding of words on the left side. The death of nerve cells is linked to lumps of abnormal proteins inside cells. These build up and become toxic causing brain cells to die and the lobes to shrink over time. A mutation in the tau gene can cause frontotemporal dementia, leading to a build up of the protein which usually is involved in transporting chemical messengers between nerve cells. It can also be caused by the progranulin gene or a recently discovered gene called c9orf72 that can also cause motor neurone disease.
Symptoms
This is hard to diagnose because it is not associated with memory loss in the early stages. In addition this dementia can occur in middle aged people which is unusual. Brain damage leads to changes in behaviour, personality and difficulty with language.

With dementia becoming so prevalent in society today, more needs to be done amongst us all to create communities which are aware and supports the needs of those living with dementia. This is what the Dementia Friends campaign is all about. Anybody can become a dementia friend and if you are interested, here is a short video about it: https://dementiafriends.org.uk/