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

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


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.

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


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.

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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.

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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.

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


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

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Antidepressants for depression in Alzheimer’s Disease


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.

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NICE guidelines: mental health problems in people with learning disabilities


Rachel Allan and Tom Crossland present the recent NICE guidance on mental health problems in people with learning disabilities, and comment on how useful these new recommendations are for people with learning disabilities and their care givers.

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Oral Health in people with dementia

This study is the first of its kind from an RCT perspective which clearly shows that treating major depression in older adults using interventions in primary care settings can extend life

This review of oral health in older people with dementia included 37 mainly observational studies of limited quality. The findings suggest that oral health was generally poorer in those with dementia.

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