Posted by: ayrshirehealth | February 5, 2014

Dementia – what is it? by @dtbarron

Fear, shock and denial

Dementia, rather like the word cancer, can often stir negative emotions. There can be an element of fear, shock and/or denial when we think about it, the overwhelming thought of losing one’s identity or the impact on someone close to us can create a rising sense of panic. Despite this reaction, the term itself is not well understood. DementiaAlthough it is true to say that dementia will often be an irreversible, progressive and life long condition – that is, once you’ve got it you will always have it, it does not need to be a life limiting condition in the early stages, nor for that matter for some considerable time in most types of dementia.

In short, the earlier a diagnosis is made the better opportunity that exists to slow the progression of some dementias – medication has an important role to play in slowing down some types of dementia. This underlined the importance of early diagnosis and intervention, as well as focusing on several areas of progress. This is more likely to happen when there is an understanding of what is meant by dementia, and what might be the underlying neurological changes.

What is dementia?

The term dementia is slightly misleading as it suggests that dementia is a single ‘thing’ – it isn’t. In general terms dementia is used to indicate a loss of mental abilities or functions.

Loss of memory

These lost abilities, which can impact on how you go about or perform your daily tasks, include loss of memory, which is the most easily understood/recognised symptom. It can also be one of the more difficult ones to talk about either within the family or with the family doctor.

Dementia 1

A survey of British family doctors by the pharmaceutical company Eli Lilley in 2010 found that both GPs and their patients were reluctant to initiate the conversation around a potential diagnosis of dementia. An additional factor in why delays happen in having the conversation is the difficulty in establishing the ‘normal’ process of ageing and abnormal memory loss.

For example there is a difference between normal/occasional forgetfulness i.e. where did I leave my glasses (which most of us have done) or remembering the name of someone you have just met or been introduced to, with more ‘clinical’ loss e.g. disorientation around where you live e.g. which road to take home or the name of a long term friend or even a family member.

In these circumstance it is not unusual for a person and/or their families to adopt strategies to compensate for the loss of memory. In my particular case my father would frequently finish sentences for my mum (she has an Alzheimer type dementia). As this behaviour had been happening over a number of years many family friends never recognised that she had dementia until my dad died and there was no-one taking on the ‘compensation’ role.

Dementia 2In general short term memory loss is more likely to occur in the early stages of dementia, with longer term memory not likely to be affected for longer – in technical terms this is called an anterograde memory impairment, that is, an inability to create ‘new’ memories while retaining older more distant memories.

Loss of reasoning

Other symptoms include a slowing or loss of reasoning i.e. understanding or processing pieces of information, the thought process itself or interruption/difficult with speech/language skills and loss of motor skills (i.e. physical dexterity). The loss of these functions may not be recognised in the very early stages, indeed, as with memory impairment it is important to try and balance ‘normal’ with clinically significant ‘abnormal’.
There is a need to distinguish general clumsiness, with a lost ability to complete smaller finite tasks or frequent ‘accidents’ e.g. bumps and scrapes, unable to judge distances etc.

Categories of dementia?

Dementia can be understood in five broad categories: NB that’s not the same as saying there are only five types of dementia: there are in fact many types of dementia, each with similarities on outcome but different aetiology (or cause).

Disease process type dementia

– Alzheimer type

• Dementia caused by a disease process – you may have heard this called a neurological disease, or a degenerative disorder. The most common type of neurological disease is Alzheimer’s type dementia. As the disease progresses the brain itself is affected as brain cells die. It is generally thought that two proteins are involved in the degenerative process, although the exact process of ‘destruction/change’ is not fully understood.

– Non-Alzheimer Degenerative type

• Dementia caused by a disease process that is not an Alzheimer type dementia include Creutzfeld-Jakob disease (CJD) – unlike Alzheimer’s type CJD is likely to progress more quickly. Dementia with Lewy bodies (associated with Parkinsons dementia) also comes under the broad heading of a disease process dementia – this type of dementia is caused by protein deposits (Lewy bodies) in the nerve cells, these proteins disrupt the messages the brain sends to control various functions.  Picks disease (a term not commonly used now, more usually terms frontal temporaral dementia) comes under this broad heading although the actual pathology of each is different – Picks disease features a wasting of the grey matter (corticol atrophy) that covers the brain with some cells becoming enlarged causing ongoing damage.

Hereditary/chromosomal

• Dementia caused by an hereditary and/or chromosomal disorders e.g. Huntington’s disease or Parkinson’s disease (NB not all cases of Parkinsons are genetic) – in some cases Down’s syndrome can lead to early onset dementia.  It should be noted that not all of these diseases progress inevitably to dementia, however there is a recognised increased risk associated with them.
Vascular (multi-infarct) dementia

Interrupted blood flow

• Dementia caused by interruption of the blood flow and therefore oxygen getting to the brain – you may have heard of this type of dementia called ‘vascular dementia’ or ‘multi-infarct dementia’. In effect the person is having mini strokes which impacts on the circulation of the blood supply to the brain. As with a ‘disease dementia’ (as discussed above) areas of the brain begin to die, the progress however is likely to be more sudden and stepped with each ‘infarct’. Immediately after an ‘infarct’ symptoms can be marked and mimic a stroke, with some functioning slowly returning, although never to the pre infarct level.

Dementia caused by alcohol or drug abuse

• Dementia caused by the toxic effects of substances such as medications or drugs – an example of this may be seen in Korsakoff’s syndrome where an excessive amount of alcohol over a sustained period of time leads to periods of short term memory loss. In most cases the memory loss never returns, although the rate of decline can be slowed with the cessation of alcohol consumption. Other causes of this type of dementia can be illicit drug misuse or glue sniffing.

Traumatic injury dementia

• Dementia caused by trauma – for example a head injury, leading to collection of blood trapped between the outer covering of the brain (called a hematoma). Another example of a trauma induced dementia could be the result of a tumour.
It is relevant to note that the above outline is not a complete list of all types of dementia, it simply tries to put dementia into some more easily understood categories. Other terms you may hear used along with dementia are:
• Frontotemporal dementia, temporal dementia, parietal lobe dementia – these are terms used to describe the area of the brain where the ‘damage’ is thought have occurred.

It is a person who has dementia

Whatever the pathology of the condition the critical thing to remember is that it is a person who has a dementia.

If you were in the same position how might you react? Might you be scared when you don’t know who people are or where you are?
My guiding principle is ‘if it was my mum, how would I want her to be treated’?  What is your guiding principle?

This week’s blog was by @dtbarron (Derek Barron) who is Associate Nurse Director, Mental Health Services in NHS Ayrshire & Arran.

If you would like to speak someone or further information regarding dementia please contact your GP, if you would like more general information and perhaps some local contacts Alzheimer Scotland would be more than happy to help.  Alz ScotNHS Ayrshire & Arran are committed to delivering excellences in person centred services (inpatient and community) to people who have a dementia.  We have an Alzheimer Scotland Dementia Nurse Consultant and over twenty dementia champions – if you would like further information on NHS services please contact (01563 826377).

Patient Opinion

Comments on this blog are also welcomed and can be added by clicking on the link – additionally if you have comments regarding your care/treatment (or a relative who has has dementia) we also welcome comments via Patient Opinion

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Responses

  1. […] Barron’s post for Week 5 on the Ayrshirehealth blog – Dementia – what is it? explained clearly the main different groups of types of dementia. Since dementia is likely to […]

  2. Reblogged this on dtbarron.


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