Dementia is a syndrome resulting from brain disease, characterised by a global cognitive decline, which may include disturbances of thinking, memory, comprehension and orientation.

Symptoms can vary, depending on the cause, but memory difficulties are often the first problem to be noticed. There is sometimes a change in personality with alterations in behaviour, termed ‘BPSD’ (behavioural and psychological symptoms of dementia).

There are several types of dementia. We could talk about each in much greater detail, but in summary the most prevalent types are:

  • Alzheimer’s disease (most common form of dementia)
  • Lewy body dementia
  • Vascular dementia
  • Frontotemporal dementia
  • Rarer causes e.g. HIV, vitamin B12 deficiency, etc

What we already know

Screening and diagnosis of dementia has much improved over the last few years, with many areas of the country having a specific ‘memory clinic’ service, although controversy remains about which instrument to use to diagnose dementia.

The management of dementia includes both pharmacological treatment and non-pharmacological considerations (e.g. ensuring the environment is appropriate, providing activity and stimulation and addressing communication needs).

The use of acetylcholinesterase inhibitors has become much more widespread over recent years and, although it is no wonder drug or cure, for some people with Alzheimer’s, it can slow the progression of the disease. NICE guidelines recommend the use of Donepezil, Galantamine or Rivastigmine for mild-moderate Alzheimer’s disease. Mematine is recommended as an option for those with moderate Alzheimer’s disease who cannot tolerate acetylcholinesterase inhibitors, or for those with severe Alzheimer’s disease.

Areas of uncertainty

What actually causes dementia? We know lots of factors and even some genetic changes that are associated with dementia but we know little about the actual direct causes of dementia.

There is also uncertainty about the reason that some people progress from Mild Cognitive Impairment (memory impairment that does not meet diagnostic threshold of dementia) to dementia and how to predict who this will happen to.

What’s in the pipeline

Media reports often hint at a progression towards finding a cure for dementia. In practice we may not be that close, but there are several areas that researchers are working on:

  • Gene therapy
  • A vaccine for dementia
  • The use of stem cells to develop replacement cells lost in dementia


Giebel, C. M., Sutcliffe, C., Stolt, M., Karlsson, S., Renom-Guiteras, A., Soto, M., … Challis, D. (2014). Deterioration of basic activities of daily living and their impact on quality of life across different cognitive stages of dementia: a European study. International Psychogeriatrics / IPA, 26(8), 1283–93. doi:10.1017/S1041610214000775 [Abstract]

NICE guidelines CG42 (2015) “Dementia: Supporting people with dementia and their carers in health and social care” [PDF]

Semple, D. and Smyth, R. (eds.) (2013) Oxford Handbook of Psychiatry. 3rd ed. Oxford: Oxford University Press. [Publisher]


Written by: Josephine Neale
Reviewed by:
Last updated: Sep 2015
Review due: Sep 2016

Our dementia Blogs

Reducing antipsychotic use in people with dementia living in nursing homes


Clarissa Giebel highlights a recent RCT, which concludes that antipsychotic use by people with dementia in nursing homes can be effectively reduced through the use of a review protocol, which includes regular scrutiny of prescriptions and targeted education for physicians and nurses.

[read the full story...]

Can higher educational attainment help lower dementia risk?


Raluca Lucacel summarises a recent meta-analysis of prospective cohort studies, which investigates the dose-response between education and the risk of dementia.

[read the full story...]

Decision making among male carers of people with dementia


Jeanne Carlin explores a study on decision making in male carers of people with dementia and reflects on her own experiences in interpreting the findings.

[read the full story...]

Psychotherapies for depression and anxiety in dementia

The study highlighted a lack of evidence about what CMHT services work for older people.

Clarissa Giebel summarises a recent systematic review that investigates the effectiveness of various psychotherapies (CBT, interpersonal therapy, counselling) for depression and anxiety in people with dementia or mild cognitive impairment.

[read the full story...]

Dementia day programmes: how can we tell if they are effective?


Caroline Struthers looks at a study on the effectiveness of a NZ dementia day programme but wonders about the use of outcomes measures in the research.

[read the full story...]

Impacts of special care unit for older adults with learning disabilities and dementia evaluated over three years


People with learning disability may be more likely to develop dementia than other people.

Here Ros Hithersay looks at the findings of a three year evaluation of a special care unit for people with dementia.

[read the full story...]

Care worker experiences of dementia care in nursing and residential settings


Jo Moriarty examines research on care worker experiences of supporting people with dementia in residential settings and discovers the value of relationships in a task centred working environment.

[read the full story...]

Rivastigmine for Alzheimer’s: is a small cognitive ‘improvement’ worth the risk of feeling physically unwell?

This trial suggests that antipsychotic use can be effectively reduced in nursing homes by using a review protocol.

Rosalyn Nelson presents the latest Cochrane systematic review of Rivastigmine for Alzheimer’s disease, which brings together the results of 7 industry sponsored or funded trials, and concludes that Rivastigmine may be of benefit to people with Alzheimer’s disease.

[read the full story...]

Living positively with dementia: findings from a qualitative systematic review


Clarissa Giebel finds a lot to discuss in a recent qualitative systematic review about living positively with dementia.

[read the full story...]

German lessons for dementia care mapping in England?


Clarissa Giebel assesses a study from her native Germany into the effectiveness of dementia care mapping for improving quality of life in nursing homes.

[read the full story...]