dementia

shutterstock_189857270

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

Traumatic brain injury increases the long-term risk of dementia #DAW18

american-football-1416221_1280

Eleanor Kennedy summarises a Danish observational cohort study, which looks at the long-term risk of dementia among people with traumatic brain injury.

[read the full story...]

Moderate and heavy alcohol consumption: what impact on later life brain and cognition?

willian-west-342225-unsplash

Sally Adams summarises a recent clinical review in Evidence Based Mental Health on the effects of drinking alcohol on late-life brain and cognition.

Follow #EBMHchat today from 3pm for an expert Google Hangout on this paper.

[read the full story...]

Alcohol is the number one modifiable risk factor for dementia

huy-phan-587849-unsplash

Marie Crabbe looks at a recent retrospective cohort study in The Lancet Public Health which explores the contribution of alcohol use disorders to the burden of dementia in France.

[read the full story...]

Person-centred care for dementia: impact on quality of life, agitation and antipsychotic use

4084079896_8eb54c3e0c_o

Hilary Shepherd reports on a recent paper from the WHELD trial on the impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes.

[read the full story...]

Improving health related quality of life for people with dementia in care homes

mikhail-rakityanskiy-415620

Hilary Shepherd writes her debut blog on a new paper from the WHELD cluster RCT, which looks at the impact of antipsychotic review and psychosocial intervention on health-related quality of life in people with dementia living in care homes.

[read the full story...]

Dementia and oral health

we need to ensure even more so that care staff feel capable and happy in doing what can be a stressful and demanding, as well as rewarding job, so that the residents with dementia are also well looked after and happy

This review of the oral health status of dementia patients included 36 observational studies and highlights the high levels of plaque and many soft tissue related oral health problems suffered by this group of patients.

[read the full story...]

Dementia and oral health status

Caring for a loved one with dementia can be stressful at times.

28 observational studies were included in this review of the oral health status of people with dementia. The findings suggest that compared with people without dementia those with dementia have poorer oral health.

[read the full story...]

Dementia care in hospital: training, leadership and culture change needed

granny-2347552_1280

Caroline Struthers explores a recent realist review of dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals.

[read the full story...]

Antidepressants for depression in Alzheimer’s Disease

mental-health-2211184_1280

The EQUATOR Publication School #EQPubSchool group summarise a systematic review and meta-analysis on the efficacy of antidepressants for depression in Alzheimer’s Disease, which finds no statistical difference between antidepressants and placebo.

[read the full story...]