Dementia explained

Dementia is the term used to describe the symptoms of a number of illnesses that affect the brain. It is not one specific disease. The most common cause of dementia is Alzheimer’s disease.

Dementia causes a progressive decline in a person’s functioning and affects a person’s thinking, behaviour and ability to perform everyday tasks.

Around 69,000 Victorians had dementia in 2011. This number is projected to increase rapidly as our population ages. In 2011, there were approximately 20,000 new cases of dementia in Victoria. In 2050, there will be an estimated 246,000 Victorians with dementia and the number of new cases per year is predicted to more than quadruple to around 94,000.

Dementia can happen to anybody

The risk of getting dementia increases with age, but it is important to remember that the majority of older people do not get dementia. It is not a normal part of ageing. Dementia can happen to anybody, but it is more common after the age of 65 years.

When people between the age of 40 and 60 do develop dementia, it is called younger-onset dementia.

Early symptoms of dementia

The early symptoms of dementia are subtle and may not be immediately obvious. Common early symptoms of dementia include:

• progressive and frequent memory loss
• confusion
• personality changes and behaviour changes
• apathy and withdrawal
• loss of ability to perform everyday tasks.

Types of dementia

There are many different types of dementia. The most common include:

• Alzheimer’s disease is the most common form of dementia, accounting for between 50 and 70 per cent of all cases.
• Vascular dementia is the broad term for dementia associated with problems of circulation of blood to the brain.
• Lewy body disease is a form of dementia caused by abnormal structures in the brain called Lewy bodies, the symptoms of which can overlap with Parkinson’s disease.
• Frontotemporal dementia is the name given to a group of dementias caused by degeneration in one or both of the frontal or temporal lobes of the brain that often develops in people under the age of 65.
• Alcohol-related dementia is due to excessive alcohol intake, especially when combined with a poor diet low in Vitamin B1 (thiamine).
• Dementia caused by Huntington’s disease is due to the fact that Huntington’s disease is an inherited, degenerative brain disease that affects the brain and body, and causes dementia in the majority of cases.
• Human immunodeficiency virus (HIV)-associated dementia (HAD) is a form of dementia that is very rare.

Diagnosis of dementia

It is important to consult a doctor when symptoms are in the early stages so that a medical assessment can confirm or rule out a diagnosis of dementia.

A diagnosis of dementia will:

• rule out other conditions that can be mistaken for dementia, such as depression, stress, pain or infection
• trigger discussion of treatment options
• allow immediate early planning for the future, while the person affected can still actively participate
• allow support to be arranged that will assist both the person with dementia, and their carers and family.

A local doctor or specialist should conduct a full assessment. Cognitive Dementia and Memory Service (CDAMS) clinics are available throughout Victoria to assist in diagnosis.

If the person will not go to a doctor, or the doctor is unwilling to take your concerns seriously, seek advice on how to deal with this from Dementia Australia.

Conditions that cause symptoms similar to dementia

A number of conditions have symptoms similar to those of dementia. In many cases, treatment of these conditions means that the symptoms will often disappear. These conditions include:

• stroke
• depression
• some vitamin deficiencies and hormone disorders
• alcoholism
• medication clashes or overmedication
• infections
• brain tumour.

It is essential to get an early medical diagnosis, when symptoms first appear, to ensure that a person who has a treatable condition is diagnosed and treated correctly.

Inheritance of dementia

Most cases of dementia are not inherited. Researchers still do not have a lot of information about genes involved in dementia. A number of genes might be associated with different types of dementia, but in most cases, dementia it is not caused by specific changes to a gene.

Familial Alzheimer’s disease does have a clear pattern of inheritance, but it is very rare. Symptoms can appear from the ages of 30 to 60. Researchers have found three genes that are associated with this form of Alzheimer’s disease, but more genes might be found in the future.

Alzheimer’s disease associated with Down syndrome and the familial form of frontotemporal dementia are also caused by genetic changes.

The involvement of any genes in dementia will depend on the cause of the dementia, so it is important to have a firm medical diagnosis. If you have concerns about the risk of inheriting dementia, discuss it with your doctor, or contact Dementia Australia on 1800 100 500 and speak to a counsellor.

Treatment for dementia

At present, there is no prevention or cure for most forms of dementia. Support is vital for people with dementia, and the help of families, friends and carers can make a positive difference to managing the condition. While there is no cure, there are many practical changes that you can make, which will help the person living with dementia, and their family and carers.

Some medications are available that can help to reduce some of the symptoms experienced by people with dementia, including cognitive (memory and thinking) problems and other associated symptoms, such as depression, anxiety and sleeping disturbances.

It is important to remember that all medications have side effects. People with dementia might take a number of medications, and your doctor can help you to understand how the different drugs might interact with each other.

Medications to help cognitive problems in dementia

Medications are available in Australia to help with the cognitive (memory and thinking) problems of dementia for people with Alzheimer’s disease. These medications might also be useful for people with vascular dementia or Lewy body disease.

The two types of medications for cognitive dementia symptoms include:

• Cholinesterase inhibitors increase the levels of a chemical in the brain that is important for memory (acetylcholine), which can help some people.
• Memantine blocks the action of another chemical in the brain (glutamate), which can improve thinking problems in some people.

Medications to help symptoms of depression in dementia

Many people with dementia experience depression. If depression becomes significant, it can begin to further impact on memory and thinking. For this reason, it might be best to treat depression with medication, although it is important to minimise the side effects.

Medications to help symptoms of anxiety in dementia

Anxiety, panic attacks and unreasonable fearfulness can be distressing for a person with dementia, their family and carers. Mild symptoms are often helped by reassurance, adjustments to the environment or an improved daily routine.

More severe anxiety can be caused by underlying depression and so antidepressant medication can help. Other options are antipsychotic or specific anti-anxiety medications, but these can have unwanted side effects and are usually not recommended for anxiety in dementia.

Medications to help sleep disturbances in dementia

Waking at night and wandering can cause problems for both the person with dementia, and their carers and families. Speak to your doctor before using medication to treat sleep disturbance. If these are given during the day to sedate people with dementia, they can cause increased alertness at night.

Getting help early will make a difference

The earlier help is found, the better the family and person with the condition will be able to manage and cope. It is important to:

• plan ahead – while the person can still legally sign documents, get enduring powers of attorney to manage financial affairs, medical decisions and guardianship
• get information – find out about dementia and what lies ahead, so that you will be informed and have more sense of control
• seek support – many people find it helpful to talk through what a diagnosis of dementia means and how they can make adjustments
• organise practical help – organise help in the home, respite care, day trips and stays at day centres, which can all make a positive difference.

Support services for people with dementia and their carers

A wide range of community services is available to help both the person with dementia and their carers. These include:

• support and information groups, for people in the early stages of dementia and their carers
• carer education and training programs
• books, videos and other resources
• counselling and practical advice, for individuals or family groups
• carer support groups
• telephone support programs
• day centres
• respite care, including in-home, out-of-home and flexible care, such as holidays
• home care and Meals on Wheels
• aged care facilities.

Where to get help

• Your GP (doctor)
• Your local council
• Your local community health centre
• National Dementia Helpline, Dementia Australia Tel. 1800 100 500
• Aged Care Assessment Services Tel. 1300 135 090
• My aged care Tel. 1800 200 422
• Cognitive Dementia and Memory Service (CDAMS) clinics
• Carers Victoria Tel. 1800 514 845
• Carer Gateway Tel. 1800 422 737
• Dementia Behaviour Management Advisory Service (DBMAS) Tel. 1800 699 799 – for 24-hour telephone advice for carers and care workers