Living with
Dementia

What is dementia?

Dementia is a descriptive term for a collection of symptoms that can be caused by a number of brain disorders. It is a progressive, degenerative brain syndrome that affects memory, thinking, behaviour and emotion.
Dementia is NOT a part of normal ageing.

What are the signs and symptoms of dementia?

Symptoms of dementia vary considerably and depend on the individual and the underlying cause. Usually the first sign of dementia is short-term memory loss.
Other symptoms include mood changes, communication problems and feeling sad, frightened or angry.

Early warning signs include:

• Recent memory loss
• Disorientation of time and place
• Difficulty in performing familiar tasks
• Changes in mood or behaviour
• Problems with language (trouble naming familiar objects)
• Poor judgment
• Loss of initiative
• Misplacing things
• Problems with abstract thinking
• Personality changes.

As time passes and dementia grows worse, signs become more obvious and include:

• Difficulty performing basic tasks such as driving, preparing meals and reading or writing.
• Forgetting detail about current events.
• Poor judgment and loss of ability to recognise danger.
• Delusions, hallucinations, depression and/or agitation.
• Changes in sleeping patterns, such as often waking up at night.
• Social withdrawal.
• Speaking in confusing sentences and using words incorrectly.
• Having arguments and displaying other violent behaviour.

Those with severe dementia may be unable to perform basic activities of daily living, recognise family members or understand language.

What are the different types and causes of dementia?

The causes of dementia may include certain medical conditions, post-substance abuse or a combination of both.
In developed countries Alzheimer’s disease accounts for about half of all cases of dementia.

The different types of dementia include:

• Alzheimer’s disease: In this condition, a biochemical change occurs in the brain, eventually resulting in loss of brain tissue. The onset may be slow initially, but then it is followed by steady acceleration to a rapid deterioration. Alzheimer’s disease is not reversible, but some medications can improve symptoms.
• Vascular dementia: Here, the brain develops multiple small areas of dead tissue as a result of blockages in small brain arteries. This is more common amongst those with a history of high blood pressure, stroke, smoking or alcohol abuse. Treating these conditions can slow the progress of vascular dementia.
• Alcohol-induced dementia: Brain damage can be caused by chronic, prolonged alcohol abuse. Treatment requires sobriety, vitamin replacement, correction of medical problems and management of behaviour problems.

Other types of dementia include those caused by Huntington’s disease, Parkinson’s disease, Lewy body dementia, Creutzfeldt-Jakob disease, Pick’s disease and HIV/AIDS.

How is dementia diagnosed?

Because there is no one test to determine if someone has dementia, doctors have to use a careful combination of medical history taking, a physical examination, laboratory tests and assessments of cognition (thinking), mood and function.

The symptoms and brain changes of different dementias can overlap, making it hard to determine the type of dementia though. Therefore, in some cases, a doctor may diagnose just “dementia” and not a specific type.
Your doctor may ask for referral to specialists like geriatricians, neurologists, psychiatrists and psychologists to help make a diagnosis.

Types of test involved in the diagnosis of dementia include:

• Physical and neurological examination: Measuring vital signs like blood pressure may help the doctor detect vascular conditions that may be treatable.
  Therefore, your doctor may also look for signs of underlying vascular disease and alcohol abuse that may indicate the type dementia that the affected person has.
  The tremors of Parkinson’s or Huntington’s disease and signs of nutritional deficiencies are also visible to a doctor on physical examination if they are present.
  Neurological examination is specifically designed to test balance, sensory responses, eye movements, reflexes and other cognitive functions to help diagnose any neurological conditions that the affected person may have.
• Laboratory tests (blood tests and genetic testing): Blood samples can be taken to measure the levels of hormones or vitamins; for example, to determine whether the affected person has thyroid disease or a vitamin D deficiency that can play an important role in the development of Alzheimer’s disease and other forms of dementia.
  Blood samples can also be used to extract DNA to test whether the affected person has any genes predisposing them to conditions that may cause dementia.
• Cognitive tests: Your doctor will test for memory, orientation, reasoning and judgment and attention, as well as for language, writing and counting skills, in the affected person.
• Brain scans: Computerised tomography (CT) and magnetic resonance imaging (MRI) scans can be used to check for brain masses or for bleeding in the brain such as caused by haemorrhagic stroke; whereas PET scans can show patterns of brain activity and whether there are deposits in the brain of amyloid protein, a hallmark of Alzheimer’s disease.
• Psychiatric exam: A psychiatrist or psychologist can help determine whether the affected person has underlying depression or another mental health condition.
  They may want to also talk to the family or caregivers to determine the affected person’s everyday functioning.

How can you prevent the development of dementia?

While most causes of dementia are not preventable, ways to help prevent vascular dementia include:

• Quitting smoking and managing underlying conditions such as high blood pressure and diabetes.
• A healthy lifestyle, balanced diet and regular exercise.

What treatment is available for dementia?

The treatment of dementia depends on its cause.
Treatment will focus on delaying the onset of the disease and slowing the progress. Developing new treatments for Alzheimer’s disease is an active area of research.

The management of dementia involves a quadrangle: namely the doctor, patient, caregiver and the community. The quality of life of the caregiver, to a large extent, determines the quality of life of the patient. Caregivers must be aware of ways to manage their emotions by learning as much as possible about the disease.

Non-pharmacological treatment should be implemented prior to attempting drug treatment. This involves psycho-education and support of the caregiver, establishing a safe and familiar routine for the patient, helping the patient with daily activities and keeping him/her occupied.

Medications to specifically treat Alzheimer’s disease are now available. Available medications will not cure the disease or reverse existing brain damage, but they can improve symptoms and slow the progression of the disease. This may improve a person’s quality of life, and delay admission to a nursing home. It may also be beneficial to caregivers as it will ease their burden.

Living and managing

You may need to work with a social worker or occupational therapist to modify the living environment and to simplify tasks for a person living with dementia.

Special focus should be placed on:

• Enhancing communication: When talking to someone living with dementia, speak slowly and maintain eye contact. Only talk about a single concept or idea at a time; give simple and clear instructions. You can also use hand gestures, such as pointing to objects or people, to enhance meaning.
• Encouraging exercise and engagement in activity: Exercise can be helpful in managing symptoms such as restlessness in people living with dementia.
  Exercise will also improve strength, balance and cardiovascular health.
  Moreover, there is growing evidence that regular exercise protects the brain from aging processes and dementia, especially when combined with a healthy diet.
  The person living with dementia should stay engaged in social activities they enjoy, like gardening, reading, singing or cooking. Socialisation and listening to soothing music, as well as art therapy focused on a process of creativity rather than outcomes, may all improve the person’s quality of life and help manage their symptoms.
• Create a night-time ritual: Symptoms of dementia are often worse at night. Creating and sticking to soothing bedtime rituals, which include avoiding the television or loud noises, can help. Leaving a soft light on in bathrooms or hallways, or using a sleep lamp, may help reduce the affected person’s feelings of disorientation during the night.
• Keep a calendar: This can help the person living with dementia remember important dates or appointments.
• Develop a plan for the future with the affected person as far as possible: This can include identifying future management strategies, support groups and other people who can help. You will need to consider financial and support resources available.
  Find out more about dementia on Let’s Talk. You can find resources that you may find useful in helping caregivers to manage stress and stay positive. You can also find out about where to get help if you are struggling to cope and need someone to talk to.

When should you contact your healthcare provider about a loved one’s dementia?

• When a sudden change in mental status occurs in the person living with dementia.
• You are unable to care for a person with dementia at home.