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

Reminiscence groups for people with dementia and their family carers: REMCARE trial


Elizabeth Collier writes her debut blog on the REMCARE randomised controlled trial of reminiscence groups for people with dementia and their family carers.

[read the full story...]

Bipolar disorder in older men linked to increased risk of dementia


Elena Marcus presents a recent study that shows how older Australian men with bipolar disorder have an increased risk of dementia and early death.

[read the full story...]

It’s a jungle out there: the natural history of behavioural and psychological symptoms of dementia


Caroline Struthers scrutinises a systematic review on the longitudinal course of behavioural and psychological symptoms of dementia.

[read the full story...]

Dementia in Down syndrome: Are we ready for a clinical trial?


Leen Vereenooghe summarises the TOP-COG study (Towards Onset Prevention of COGnitive decline in adults with Down syndrome). This pilot RCT highlights the need to educate people with learning disabilities and their carers about the importance of research participation.

[read the full story...]

Acupuncture for mild cognitive impairment: rubbish in, rubbish out


Edzard Ernst shines a light on the unfounded claims presented in a meta-analysis published today on acupuncture for amnestic mild cognitive impairment.

[read the full story...]

Long-term care placement for people with dementia

Mother and son

Clarissa Giebel reports on a systematic review and meta-analysis of factors predicting care placement of dementia sufferers into long-term care facilities.

[read the full story...]

Proton-pump inhibitors and risk of dementia


Caroline Struthers reports on a recent prospective cohort study which finds a strong association between the use of proton pump inhibitors and a significantly increased risk of dementia.

[read the full story...]

Impact of functional alterations on quality of life in Alzheimer disease

An older woman out shopping

Clarissa Giebel analyses a qualitative study of how functional alterations impact quality of life in Alzheimer disease.

[read the full story...]