Dementia: what it is and how to give you and

Dementia: what it is and
how to give you and
your family the best
chance of avoiding it.
Presented by: Ethna Parker
The information for this presentation was taken
principally from the following websites:
National Institute for Clinical Excellence (NICE)
The Alzheimer’s Research UK
The Alzheimer’s Society
The Department of Health
A definition of dementia
The term ‘dementia’ is used to describe a syndrome
which may be caused by a number of illnesses in
which there is progressive decline in multiple areas of
function, including decline in memory, reasoning,
communication skills and the ability to carry out daily
Alongside this decline, individuals may develop
behavioural and psychological symptoms such as
depression, psychosis, aggression and wandering,
which cause problems in themselves, which
complicate care, and which can occur at any stage
of the illness.
(DH, 2009) Living well with dementia. A national strategy, p15.
It is estimated that dementia affects 840,000 people in the UK.
However, it is likely that the actual figure is much higher as only
31% of people with dementia are registered on GP lists.
Some fact and figures about dementia
The proportion of deaths attributable to dementia
increases steadily from 2% at age 65 to a peak of 18% at
age 85–89 in men, and from 1% at age 65 to a peak of
23% at age 85–89 in women.
Overall, 10% of deaths in men over 65 years, and 15% of
deaths in women over 65 years may be attributable to
The majority of these deaths occurred among those
aged 80–95 years. Delaying the onset of dementia by five
years would halve the number of UK deaths due to
dementia to 30,000 a year.
Alzheimer’s Society (2007), Dementia UK
Which % range do you want to be in?
10% or 90%
15% or 85%
Every year…
• 59,685 people die earlier than
they should because they
have dementia. The National
Dementia Strategy hopes to
half that number. But, even
half that number is still
equivalent to a near capacity
stadium at the Boro.
The Boro vs Steaua Bucharest
2006, in front of a capacity crowd of 35,100
The economic cost of dementia is
calculated at £23 billion every year.
Over 55% (£12 billion) of these total
costs was due to informal care,
representing 1.5 billion hours of
unpaid care provided by relatives
and friends of people dementia
with dementia.
Dementia 2010 by Alzheimer’s Research UK
Prevalence in the UK
Alzheimer’s Society (2007), Dementia UK, p3.
Alzheimer’s Society (2007), Dementia UK, p4.
Some possible causes of dementia
• Medical conditions such as strokes
• Poor nutrition, dehydration, and certain
substances, including drugs and
• Single trauma or repeated injuries to
the brain.
• Infection, illness or disease that affects
the central nervous system, including
Creutzfeldt Jakob Disease (CJD) and
Pseudo dementia
Some conditions have the signs and symptoms
of dementia but are treatable, for example:
Liver or kidney disease
Depression induced pseudodementia
Operable brain tumors
Severe vitamin deficiencies (B12)
Extremely underactive thyroid – however,
needs to be treated in the first two years
• Delirium
Alzheimer’s disease
Alzheimer’s is the most common type of dementia and
affects 60% of people diagnosed with dementia.
Common symptoms of mild Alzheimer's disease include:
Poor memory and forgetfulness
Mood swings
Speech problems
As Alzheimer's disease develops into the
moderate stage, it can also cause:
• Hallucinations: where you hear or see things
that are not there
• Delusions: where you believe things that are
• Obsessive or repetitive behaviour
• A belief that you have done or experienced
something that never happened
• Disturbed sleep
• Incontinence: where you unintentionally
pass urine (urinary incontinence) or stools
(faecal or bowel incontinence)
As Alzheimer's disease becomes severe, it can
also cause a number of other symptoms such
• More frequent hallucinations and delusions.
• Difficulty swallowing.
• Difficulty changing position or moving from
place to place without assistance.
• Weight loss or a loss of appetite.
• Increased vulnerability to infection.
• Complete loss of short-term and long-term
Vascular dementia
Vascular dementia is the second
most common type of dementia.
There are two main types of
vascular dementia: one caused by
stroke and one caused by small
vessel disease. A third type is a
mixture of the two. There are many
variations of vascular dementia.
Vascular dementia
Small vessel disease-related dementia
This type of dementia, also known as
sub-cortical vascular dementia or, in a
severe form, Binswanger's disease, is
caused by damage to tiny blood vessels
that lie deep in the brain. The symptoms
develop more gradually and are often
accompanied by walking problems.
Vascular dementia
The symptoms of vascular dementia can
develop suddenly and quickly worsen, or they
can develop gradually over many months.
Symptoms include:
• Increasing difficulties with tasks and activities
that require concentration and planning
• Memory loss
• Depression
• Changes in personality and mood
Vascular dementia
Periods of mental confusion
Low attention span
Urinary incontinence
Stroke-like symptoms, such as muscle weakness
or paralysis on one side of the body
• Visual hallucinations
• Wandering during the night
• Slow and unsteady gait (the way that you
Certain factors can increase a person's risk of
developing vascular dementia. These include:
• A medical history of stroke, high blood pressure, high
cholesterol, diabetes (particularly type II), heart
problems, or sleep apnea (where breathing stops
during sleep).
• A lack of physical activity, drinking more than
recommended levels of alcohol, smoking, eating a
fatty diet, or leaving conditions such as high blood
pressure or diabetes untreated.
• A family history of stroke or vascular dementia.
• An Indian, Bangladeshi, Pakistani, Sri Lankan or
African-Caribbean ethnic background.
Always consult a doctor if you
experience any sudden symptoms,
such as slurred speech, weakness
on one side of the body, or blurred
vision - even if they are only
temporary. These episodes may be
caused by temporary interruptions
in the blood supply within the brain,
known as transient ischaemic
attacks (TIAs). If left untreated, they
can lead to permanent damage.
Fronto-temporal dementia
Fronto-temporal dementia is caused
by damage to the parts of the brain
that help control emotional responses
and behaviour. Therefore, many of
the initial symptoms of frontotemporal dementia involve changes
in emotion, personality and
behaviour. Symptoms may include:
Fronto-temporal dementia
• People may become less sensitive to other people’s
emotions. This can make them seem cold and
• They may also lose some of their inhibitions. This could
lead to strange behaviour, such as making sexually
suggestive gestures in a public place, being rude to
others or making tactless comments.
• Aggression
• Compulsive behaviour
• Being easily distracted
• An increasing lack of interest in washing themselves
• Personality changes: person who was previously
withdrawn may become very outgoing or vice versa.
Dementia with Lewy bodies
The symptoms of dementia with Lewy bodies usually
develop gradually but get more severe over the course of
many years. Symptoms include:
Memory loss
Low attention span
Visual hallucinations
Periods of mental confusion
Difficulty planning ahead
Muscle stiffness
Slower movement
Shaking and trembling of arms and legs
Shuffling while walking
Problems sleeping
Loss of facial expression.
Mixed dementias
Mixed dementia is a condition in
which Alzheimer's disease and
vascular dementia occur at the same
time. Many experts believe mixed
dementia occurs more often than
was previously realized and that it
becomes increasingly common in
advanced age.
Dementia or memory drugs
The National Institute for Clinical
Excellence (NICE) has published
new guidance on the availability of
Alzheimer's drugs on the NHS in
England and Wales. These are drugs
that are licensed to treat
Alzheimer's disease, but not other
forms of dementia.
Donepezil (Aricept) galantamine
(Reminyl) and rivastigmine (Exelon)are
now recommended as options for
managing mild as well as moderate
Alzheimer’s disease.
Memantine (Ebixa) is now
recommended as an option for
managing moderate Alzheimer’s
disease for people who cannot take
AChE inhibitors, and as an option for
managing severe Alzheimer’s disease.
Can I protect myself from dementia?
YES and NO
Because we are not totally
sure what causes dementia,
it is not possible to state with
absolute certainty what you
can do to avoid it…BUT!
We know that some
things are RELATED in
some way to the onset
of dementia…so here
are some pointers for
protecting yourself.
Physical activity
Do some regular aerobic
activity like:
• Running, walking, or
bicycling, which require
oxygen to produce
energy. Anything that
gets you slightly out of
breath is good.
• Pick activities you like and
do them regularly for at
least 30 minutes a day.
Weight control
People who are obese in
midlife have a threefold
increased risk of developing
Alzheimer's, and those who
are overweight (considered
a BMI between 25 and 30)
have a twofold increased
This could be due partly to
the fact that with added
pounds, fat gets deposited
in the brain and narrows the
blood vessels that deliver
fuel. Over the long term,
brain cells die and vital
connections and volume
are lost.
The Mediterranean diet
• Increase fruit & veg
• Decrease animal-based
• Eat more oily fish
• Eat raw nuts every day
• Oven bake, steam or dry
• Switch to olive or
rapeseed oil and use
• Drink less alcohol and
fizzy pop
• Less processed foods
Work those grey cells…
Did you know that with continued learning you can
generate new brain cells? Here’s how to…
• Go back to school
• Take up a new hobby
• Train that brain with regular ‘brainastics’ e.g. do
games that test your memory, creativity and speed
of reflex*
• Join a debating club, use your local library,
volunteer for something, read ‘War and Peace’
• Karaoke…no kidding, singing is good for you!
Being sociable is good for
you…even baboons know it!
Be happy ☺
People who have lots of friends showed
less cognitive decline than those with
fewer friends, even though they had the
same number of plagues and tangles
associated with Alzheimer’s disease.
Too much stress over the long term
significantly raises a person's risk of
developing Alzheimer's.
Managing long-term conditions
There are around
15 million people in
England with at
least one long term
condition. Numbers
are expected to
increase, in
particular those
with two or more
Joint disorders
High blood pressure*
Coronary heart disease
Chronic obstructive
pulmonary disease (COPD)
Mental health problems
*Strong association with
Alzheimer’s disease and/or
vascular dementia
In a nutshell then…
• Challenge your MIND
• Give your BODY what it
really needs
What to do if you think someone you know
has dementia
Make an appointment with your GP and discuss the signs
and symptoms you are worried about. Ask for a full physical
examination and blood tests. This will help to rule out other
other medical conditions.
Ask to be referred to your local Community Mental Health
Team (CMHT) for older people for assessment. This is
important even if you are worried about someone who is
younger than 65.
The Consultant will take details of the person’s medical
history, results from their blood-work and physical
examinations and decide whether or not to do an MRI
scan. The Consultant may also perform a cognitive
assessment using the Mini-mental state (MMSE)
At this point the doctor will decide what the best
treatment options are, e.g. drug therapy and/or
psychological counseling. He/she may also make
a referral to a Social Worker, Occupational
Therapist or Speech & Language Therapist and/or
a Physiotherapist.
If prescribed memory drugs, a memory nurse will
monitor the person’s progress every 3 -6 months
and feed back relevant information to the
Do not rely on GPs having the skills to recognise
early signs of dementia. If you are concerned,
insist on an early referral to the CMHT.
Recommended reading
Rare dementias
• Pick’s disease is a rare form of dementia that is similar to
Alzheimer's disease, except that it tends to affect only
certain areas of the brain.
• Binswanger's disease is a rare form of vascular dementia
in which damage occurs to the blood vessels in the
deep white matter of the brain.
• Huntington's disease is a progressive hereditary disease.
It usually becomes apparent in adults in their 30s,
although it can occur earlier or later. There is also a
juvenile type of Huntington's, which affects children. The
course of the disease varies for each person, and
dementia can occur at any stage of the illness.
• Korsakoff's syndrome may result from continual heavy
drinking over a long period. It is caused by lack of
thiamine (vitamin B1). This may be due to poor nutrition,
poor absorption of vitamins resulting from the effects of
alcohol on the stomach lining, or both.
Rare dementias
• Niemann-Pick disease type C is one of a group of rare
inherited disorders. It mainly affects school-age children
but can occur at any time, from early infancy to
adulthood. It is caused by the inability of the body to
deal with cholesterol, and leads to progressive loss of
movement and difficulties with walking and swallowing.
• Normal pressure hydrocephalus (NPH) occurs when an
obstruction in the normal flow of spinal fluid causes
pressure to build up in the tissues of the brain. Symptoms
include difficulties with walking, dementia and urinary
incontinence. People who have had a history of
meningitis, encephalitis or head injury are more likely to
develop NPH. The condition is sometimes treatable.
• People with Parkinson's disease have a higher-thanaverage risk of developing dementia, although the
majority remain unaffected. Symptoms of dementia
associated with Parkinson's disease vary from person to
Rare dementias
• This is a group of rare diseases in which a transmissible
agent known as 'prion protein' accumulates in the brain.
This causes dementia and neurological symptoms
including unsteadiness and jerky movements. Different
prion diseases occur in humans and animals. One of
these, Creutzfeldt-Jakob disease (CJD), has been
identified for some time in a small number of humans.
More recently, a new form of CJD, known as variant
CJD, has been identified.
• Progressive supranuclear palsy (PSP) is a comparatively
rare progressive condition, sometimes known as SteeleRichardson-Osliewski syndrome. It affects the brain stem
and adjacent areas, and some of its early symptoms
resemble those of Parkinson's disease.
Rare dementias
• A grossly underactive thyroid gland (hypothyroidism)
can lead to the symptoms of dementia. Simple tests can
detect this condition. The symptoms include loss of
interest, apathy, slowing down of mental abilities and
poor short-term memory. Treatment involves replacing
the naturally occurring thyroid hormones with synthetic
hormone preparations. This is more likely to be effective
in reversing the dementia if the problem is identified and
treated within two years of its onset.
• Severe vitamin B12 deficiency can cause a dementia
along with weakness, unsteadiness and visual problems.
It may be caused by pernicious anaemia or conditions
causing very severe problems of absorption of vitamins
from the bowel. It can be detected by blood testing but
nowadays in the developed world the underlying cause
is usually recognised long before dementia begins.
All information on rare dementias was taken from
Hot off the press!
A new study by researchers at the University of California,
San Francisco, has concluded that up to half of
Alzheimer’s cases worldwide and in the US may be
attributable to seven risk factors that are potentially
preventable through simple lifestyle changes, such as
exercising, using your brain, quitting smoking and losing
The new study, by Dr Deborah E Barnes PhD and
colleagues at the University of California, San Francisco,
is published online in the July 19, 2011 issue of The Lancet
Neurology, a British medical journal. It was presented on
July 19 at the Alzheimer’s Association International
Conference in Paris.
The seven risk factors
The seven risk factors isolated by the
researchers include:
• Physical inactivity
• Cognitive Inactivity or Low Educational
• Smoking
• Mid-life Obesity
• Mid-life High Blood Pressure
• Diabetes
• Depression
Hot off the press!
Currently the diagnosis of Alzheimer’s follows the
sequence of family history, information, mental
assessment and the physical exam, focusing on
neurological signs.
Research labs have developed a new diagnostic tool
for Alzheimer’s disease based on a blood test, the first
of its kind. Previously, there was no definitive way to
diagnose the disease during life. The new technique
may have important implications for the ability to
begin treatment early.
Rammouza, G., Lecanua, L., Aisen, P. and Papadopoulos, V. (2011) A Lead Study on
Oxidative Stress-Mediated Dehydroepiandrosterone Formation in Serum: The Biochemical
Basis for a Diagnosis of Alzheimer’s Disease. Journal of Alzheimer’s Disease 24 (2011) 5–16.
Hot off the press!
An existing anti-seizure drug improves memory and brain function in adults
with a form of cognitive impairment that often leads to full-blown
Alzheimer’s disease, a Johns Hopkins University study has found.
The findings raise the possibility that doctors will someday be able to use
the drug, levetiracetam, already approved for use in epilepsy patients, to
slow the abnormal loss of brain function in some aging patients before
their condition becomes Alzheimer’s. The researchers emphasize,
however, that more studies are necessary before any such
recommendation can be made to doctors and patients.
The new study, presented July 20th 2011 at the International Congress on
Alzheimer’s Disease in Paris, also shows that excess brain activity in
patients with a condition known as amnestic mild cognitive impairment,
or aMCI, contributes to brain dysfunction that underlies memory loss.
Previously, it had been thought that this hyperactivity was the brain’s
attempt to “make up” for weakness in its ability to form new memories.
Hot off the press!
Scientists have determined a molecular link between chronic stress
and the progression of Alzheimer’s disease. A newly published
study has found that in a mouse model, stress changes the levels
of a certain protein that regulates the connections between brain
cells, and whose malfunction is linked to Alzheimer’s. Chronic stress
has long been linked with neurodegeneration. Scientists at USC
now think they may know why.
The study, which has tremendous implications for understanding
and treating Alzheimer’s disease, was published in the June 2011
issue of The FASEB Journal (the Journal of the Federation of
American Societies for Experimental Biology).
Researchers examined the brains of rats that had experienced
psychological stresses and found high levels of the RCAN1 gene.
Davies and his colleagues suggest that chronic stress — physical or
mental — causes overexpression of RCAN1, in turn leading to
neurodegenerative disease.
Hot off the press!
Treating a mouse model of Alzheimer’s disease with an extract of
cinnamon is effective at slowing disease progression, new research
suggests. Scientists have found that a particular compound found in the
spice also has antiviral properties.
An extract found in cinnamon bark, called CEppt, contains properties
that can inhibit the development of the disease, according to Prof.
Michael Ovadia of the Department of Zoology at Tel Aviv University. His
research, conducted in collaboration with Prof. Ehud Gazit, Prof. Daniel
Segal and Dr. Dan Frenkel, was recently published in the journal PLoS ONE.
“The discovery is extremely exciting. While there are companies
developing synthetic AD inhibiting substances, our extract would not be a
drug with side effects, but a safe, natural substance that human beings
have been consuming for millennia,” says Prof. Ovadia.
Though it can’t yet be used to fight Alzheimer’s, cinnamon still has its
therapeutic benefits — it can also prevent viral infections when sprinkled
into your morning tea.
Hot off the press!
Scientists at the Gladstone Institutes have identified a
drug candidate that diminishes the effects of both
Alzheimer’s disease and Huntington’s disease in animal
models, offering new hope for patients who currently
lack any medications to halt the progression of these
two debilitating illnesses.
In mice modeling Alzheimer’s disease, the novel
compound prevented memory deficits and the loss of
synaptic connections between brain cells—both of
which are key features of the human disease. In mice
modeling Huntington’s disease, JM6 prevented brain
inflammation and the loss of synaptic connections
between brain cells, while also extending lifespan.
Hot off the press!
A yet unidentified component of coffee
interacts with the beverage's caffeine, which
could be a surprising reason why daily coffee
intake protects against Alzheimer's disease. A
new Alzheimer's mouse study by researchers
at the University of South Florida found that this
interaction boosts blood levels of a critical
growth factor that seems to fight off the
Alzheimer's disease process.
Chuanhai Cao, Li Wang, Xiaoyang Lin, Malgorzata Mamcarz, Chi Zhang, Ge Bai, Jasson
Nong, Sam Sussman and Gary Arendash. Caffeine Synergizes with Another Coffee
Component to Increase Plasma GCSF: Linkage to Cognitive Benefits in Alzheimer's Mice.
Journal of Alzheimer's Disease, 25(2), June 28, 2011
Hot off the press!
Researchers have
identified a gene that
appears to increase a
person’s risk of
developing late-onset
Alzheimer’s disease, the
most common type of
the disease.
Abbreviated MTHFD1L,
a gene on chromosome
six, was identified in a
association study by a
team of researchers led
by Margaret PericakVance.
Naj AC, Beecham GW, Martin ER, Gallins PJ, Powell
EH, et al. (2010) Dementia Revealed: Novel
Chromosome 6 Locus for Late-Onset Alzheimer Disease
Provides Genetic Evidence for Folate-Pathway
Abnormalities. PLoS Genet 6(9): e1001130.
Some further resources and useful references
Age Concern (2004) How ageist is Britain? London: Age Concern, p7.
Alzheimer’s Society (2007) Dementia UK. A report into the prevalence and cost of dementia.
London: Alzheimer’s Society.
Audit Commission (2000) Forget me not. Developing mental health services for people in
England. London: Audit Commission.
Department of Health (2007) The NHS in England: the Operating Framework for 2008/09. London:
Department of Health (2009) Living well with dementia: a National Dementia Strategy. DH: London. Feb
2009. Download from:
Department of Health (2009) Living well with dementia: a National Dementia Strategy implementation
plan. DH: London. July 2009. Download from:
Great Britain. The Mental Capacity Act 2005: Elizabeth II. Chapter 9. (2005) London: The
Stationery Office.
National Institute for Health and Clinical Excellence/Social Care Institute for Excellence (2006)
Dementia Supporting people with dementia and their carers in health and social care.
NICE/SCIE: London.
The British Psychological Society (2007) Dementia. The NICE/SCIE guideline on supporting
people with dementia and their carers in health and social care. The British Psychological
Society and Gaskell: London. Download from:
Dementia Quiz – info
Dementia Test – fun
The five-minute Alzheimer's Test -
Sheard, D.M. (2009) Our emotions at work in dementia care. London: Alzheimer's
Alzheimer’s Society (2002) Yesterday, today, tomorrow: Providing quality dementia
Care manual,
Alzheimer’s Society (2004), Policy Positions: Demography,
Jones, D.W. (2002) Coping with stigma: the significance of shame and identity, In
Myths, Madness and the family. Hampshire: Macmillan
Keady, J. and Ashton, P. (2004) The older person with dementia or other mental
problems, In Norman, I. and Ryrie, I. (Eds) The art and science of mental health
Berkshire: Open University Press
Kitwood, T (1997) Dementia reconsidered, Buckingham: Open University Press.
Matthews F.E., and Dening, T (2002) Prevalence of dementia in institutional care,
Lancet, 360, (9328), pp.225-226.
Useful references on learning disability and dementia
Cooper, S. A. (1997) High prevalence of dementia amongst people
with learning disabilities not attributed to Down's syndrome.
Psychological Medicine, 27, pp609-616.
Lund, J. (1985) The prevalence of psychiatric morbidity in mentally
retarded adults. Acta Psychiatrica Scandinavica, 72, pp563-570.
Moss, S. and Patel, P. (1993) The prevalence of mental illness in
people with intellectual disability over 50 years of age, and the
diagnostic importance of information from carers. The Irish Journal of
Psychology, 14, pp110-129.
Prasher, V.P. (1995) Age specific prevalence, thyroid dysfunction
and depressive symptomatology in adults with Down's syndrome
and dementia. International Journal of Geriatric Psychiatry, 10,