What is Dementia?
Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships. They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems such as agitation, delusions, and hallucinations. Whilememory lossis a common symptom of dementia, memory loss by itself does not mean that a person has dementia. Doctors diagnose dementia only if two or more brain functions – such as memory, language skills, perception, or cognitive skills including reasoning and judgment – are significantly impaired without loss of consciousness.
Recent statistics indicate that 5.4 million people have dementia in the EU.1 This is set to increase with the ageing population, with a doubling of this figure predicted by 2040 in Western Europe and a trebling in Eastern Europe. AD is the most common form of dementia, accounting for over 60% of all dementia cases.2 Studies show that 1 in 20 people over 65, and 1 in 5 people over 85, have AD.2
Types of Dementia
Dementing disorders can be classified many different ways. These classification schemes attempt to group disorders that have particular features in common, such as whether they are progressive or what parts of the brain are affected. Some forms of dementia are classified as either primary or secondary dementia. Examples of primary dementia include:
- Alzheimer’s disease
- Vascular dementia
- Lewy body dementia
- HIV-associated dementia
- Huntington’s disease
- Creutzfeldt-Jacob disease and more
Examples of secondary dementia include:
- Progressive supranuclear palsy
- Multiple sclerosis
- ALS dementia
- Normal pressure dementia
Alzheimer
Alzheimer’s disease is the most common cause of dementia in people over age 65 with cause possibly related to amyloid plaques and neurofibrillary tangles; almost all brain functions, including memory, movement, language, judgment, behavior, and abstract thinking, are eventually affected.
The impact of dementia in the patient
Alzheimer Disease can have a catastrophic impact. As the disease progresses patients change from being healthy, autonomous members of society to being completely dependent on others, both physically and mentally.
AD is much more than loss of memory. It is a progressive neurodegenerative disease, causing deterioration in all areas of mental ability, accompanied by changes in behavior and personality. Symptoms of AD include inability to perform previously routine and daily tasks (function), impaired memory (cognition), difficulty with language, including remembering or finding words (communication), as well as personality and mood changes such as agitation and aggression (behavior).
Disturbances in behavior are especially troublesome. They most commonly occur in the moderate and severe stages of the disease and often result in patients moving from home care to a nursing home. Within the first year of diagnosis, up to 70% of patients can experience agitation and/or irritability.
The impact of dementia in the carer
Between 50% and 80% of patients with AD are cared for at home, according to figures from Europe and Canada. These data are consistent with the results of this survey, which found that 84% of patients were cared for at home.
People with AD lose the ability to carry out routine daily activities including dressing, undressing, using the lavatory, travelling and handling money. As a result, many require a high level of care.15 This is often provided by an elderly relative, whose own health and quality of life are likely to be seriously affected by the burden of care provision.
Carers show considerable psychological and physical illness compared to agematched controls, with higher levels of anxiety and depression. A survey by the UK Alzheimer’s Society indicated that nearly 60% of carers reported suffering ill health or nervous problems as a result of direct caring. Further research has shown that up to half of caregivers become depressed.17 In this survey almost half of carers spent more than 10 hours per day caring for someone with dementia. As the patient’s function deteriorates, the burden on caregivers increases.7 Caring for someone with AD is costly financially, including:
- lost earnings for carers or the person with dementia
- extra medical and care costs
In some European countries, AD care takes approximately 10-25% of a family’s average net annual income.
Treatment options
There is no cure for either vascular dementia or Alzheimer’ s disease, but there are some medications that may help slow the progression of the disease. It is important for both the person with dementia and the person’ s caregiver to have a strong support system in place to deal with the emotional challenges of the disease.
Treatments are aimed at lessening the symptoms and slowing the progression of the disease. Treatment may include a combination of drug and psychiatric or behavioral therapies. If you are elderly, your doctor may pay close attention to the medications you take, because some drugs may cause confusion or delirium in older people. Exercise, both physical and mental, can slow the progress of dementia.
Drug Therapies
The following drugs have been approved to treat Alzheimer’ s disease. They are also often used to treat vascular dementia. However, not everyone responds to these medications. Research is continuing to find better drugs to treat Alzheimer’ s and other forms of dementia.
Cholinesterase inhibitors — These drugs increase the amount of a brain chemical called acetylcholine, a messenger chemical that is involved in memory and judgment. Side effects can include nausea, fatigue, and diarrhea. This class of drugs includes:
- Donepezil (Aricept)
- Rivastigmine (Excelon)
- Galantamine (Razadyne)
Memantine (Namenda) — This drug works by regulating a chemical messenger called glutamate, which is involved in information storage and retrieval in the brain. Side effects can include headache, constipation, confusion, and dizziness.
Complementary and Alternative Therapies
Alternative therapies may help treat dementia. If you are deficient in some nutrients, taking a supplement or getting more of that nutrient in your diet may help slow the progression of the disease. Many of the nutrients and herbs listed are used due to their supposed effects of increasing blood flow to the brain. Not surprisingly, many of them have a blood thinning effect and therefore can interfere or accentuate the effects of blood thinning medications. Dementia therapies, pharmaceutical or natural, should be used under the supervision of a qualified physician.
What can we do to face dementia problem
Dementia carers want to keep on caring for their loved ones, but they need information and support to help them achieve this. It is time for action – to include carers in national plans and services for the management of dementia.
The Alzheimer’s organizations taking part in the Carers’ Survey call on national governments in EU countries to develop national plans for dementia that include ensuring that carers receive the help and support they need. These should include:
- Provision of comprehensive information for carers on dementia, its treatment and relevant support services, when the person they care for is diagnosed
- Systematic information at the time of diagnosis about the existence of Alzheimer’s associations and the services they provide to carers and people with dementia
- Support for Alzheimer associations and the essential services they provide
- Access to services and treatments that help address behavioural and functional problems in addition to cognitive symptoms
- Development of comprehensive and flexible services adapted to the changing needs of people with dementia
- Provision of appropriate training to equip carers to carry out their caring role
Resourses
Who cares? The state of Dementia in EU, http://www.alzheimer-europe.org