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

The Care Ecosystem: telephone support to help people with dementia and their carers

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A UCL MSc group of students review a US randomised controlled trial of the ‘Care Ecosystem’; collaborative care for dementia delivered by telephone and internet, which suggests improvements in quality of life and caregiver well-being, and reductions in health service use.

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New evidence on treatments for symptoms of depression in dementia

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Andrew Sommerlad appraises a recent review on the efficacy of interventions for depression in people with dementia, which identified several non-drug treatments that can have a meaningful effect on depressive symptoms in dementia.

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Dementia care during COVID-19: difficult choices for unpaid carers

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In her debut blog, Catherine Talbot reviews a recent qualitative study, which explores the decision-making process for receiving paid home care for people with dementia during COVID-19.

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Advance Care Planning for people with dementia: recognising moral dilemmas faced by physicians

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In his debut blog, Justin Chan appraises a meta-review on the moral barriers and facilitators that physicians encounter when talking about Advance Care Planning for people with dementia.

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What do dementia stakeholders think about Cognitive Stimulation Therapy?

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A group of students from the UCL MSc in Mental Health Studies summarise a review on dementia stakeholders’ perceptions of Cognitive Stimulation Therapy.

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Dementia and loneliness: prevalence and determinants for people living in the UK

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Rosie Mansfield summarises recent findings from the IDEAL programme on the prevalence and determinants of loneliness in people living with dementia.

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Dementia ward inpatients need better protection from COVID-19

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Clarissa Giebel summarises a recent study on the prevalence, management, and outcomes of COVID-19 infections in older people and dementia patients on mental health wards.

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Voices of people living with dementia and their carers on the closure of support services during COVID-19

Voices of people with dementia and their carers on the closure of support services during COVID-19

Caroline Green discusses a qualitative study which considers the effects of COVID-19 on social support services for people with dementia.

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Allowing visitors back into nursing homes during the COVID-19 pandemic

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Clarissa Giebel reviews a mixed-methods Dutch study and accompanying guidance, which recommends a safe way to allow visitors back into nursing homes during the COVID-19 pandemic.

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Dog therapy for dementia: can fluffy friends help with thinking and memory problems?

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Clare Dolan and Sarah Gregory summarise a recent systematic review on the effectiveness of dog therapy for people living with dementia, which suggests that animal assisted therapy may be a useful complementary treatment to help with the behavioural and psychological symptoms of dementia.

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