dementia

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Introduction

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

References

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]

Acknowledgement

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

Our dementia Blogs

Cognitive stimulation therapy for dementia

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Clarissa Giebel summarises a multicentre RCT that assesses the clinical effectiveness and cost-effectiveness of individual cognitive stimulation therapy for dementia.

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Cognitive tests for dementia: MMSE, Mini-Cog and ACE-R

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Akshay Nair explores the results of a systematic review of cognitive tests for dementia and mild cognitive impairment, which focuses on the MMSE, Mini-Cog, ACE-R and MoCA instruments. Along the way he explains how diagnostic tests work and how sensitivity and specificity are useful measures to get your head around.

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Donepezil, nursing home placement and Alzheimer’s Disease

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Caroline Struthers reports on the findings of a follow-up paper of the DOMINO-AD trial, which compares Donepezil and Memantine for Moderate to Severe Alzheimer’s Disease, and looks at the effects these two drugs have on nursing home placement.

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Do house calls benefit older adults with dementia?

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Clarissa Giebel looks at a US study on the impact of ‘house calls’ on health and social service use by people with dementia, and asks some critical questions of the research.

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Reducing antipsychotic use in people with dementia living in nursing homes

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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.

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Can higher educational attainment help lower dementia risk?

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

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Decision making among male carers of people with dementia

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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.

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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.

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

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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.

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