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

Performing arts for dementia carers: feasibility and acceptability of a new multi-modal intervention

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Alice Potter reviews a study of a new multi-modal performing arts intervention programme for carers of people with dementia, which suggests this approach is feasible and acceptable.

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Inequalities in accessing dementia care and support during COVID-19

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Catherine Talbot reviews a recent qualitative study on accessing post-diagnostic dementia care before and since COVID-19, which highlights the need to reduce inequalities in dementia care.

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Periodontal disease: Does it increase risk of Alzheimer’s disease and mild cognitive impairment?

Participants who reported higher levels of depression and social isolation had greater risk of loneliness, along with people living alone with dementia.

This blog on a review evaluating the association between periodontal disease (PD), Alzheimer’s disease (AD) and mild cognitive impairment (MCI) was written by the Scottish Special Care StRs following a critical appraisal workshop. The review included 13 studies and suggests a link between PD and AD/MCI, but the evidence is limited.

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Are ethnic minorities under-represented in memory services?

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Harmony Jiang reviews a study exploring the representation of Black, Asian and minority ethnic people in memory services in Leicester and Leicestershire.

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Are changes in blood pressure and weight linked to later dementia?

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Meenakshi Shukla summarises a systematic review exploring the trajectory of blood pressure, body mass index, cholesterol and incident dementia.

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New review suggests that PTSD may be a modifiable risk factor for dementia

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Anjuli Kaul blogs about a new systematic review and meta-analysis of longitudinal cohort studies, which explores the relationship between PTSD and all-cause dementia.

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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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