North East & Yorkshire Healthcare Service

DEMENTIA

Awareness Raising of the Disease

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Introduction
 At this present time 820.000 people are suffering affects of
dementia.
 The information is an overview for those wanting to know
more about Alzheimer’s and dementia. This includes people
living with dementia, their carers, friends and families.
 Alzheimer's disease damages individual brain cells one by one,
so that the brain can't work as well as it used to. A protein
called amyloid builds up in deposits, called plaques, and tiny
filaments in the brain cell form tangles

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 We all forget things every day, where we have put something, people’s
names, and we will say “ have I got Alzheimer’s” well the answer is
probably not.

 There are many reasons why we forget things and become forgetful. The
medication we may be taken can effect memory. Depression, anxiety,
vitamin deficiency and thyroid problems can also cause forgetfulness.

 Our working lives and the pressures we are put under also have an adverse
affect on us.

 But for some people, Forgetfulness has a greater impact on them.

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Dementia Types

Alzheimer’s
Vascular dementia
Dementia with Lewy bodies
Frontotemporal dementia

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 Other diseases that cause dementia are vascular dementia

which includes multi-infarct dementia and Binswanger's
disease, Lewy Body disease also known as dementia with Lewy
Bodies, and fronto-temporal dementia which includes Pick's
disease and primary progressive aphasia.
 It is not uncommon for people to have more than one form of
dementia; for example, some people with vascular dementia
also have Alzheimer's disease.
 Senile dementia is a more precise term that specifically refers
to dementia in people over 65. Dementia in people under this
age is much rarer and is often referred to as early onset
dementia.

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 Faulty genes may cause the build up of the amyloid protein.

Recent research seems to show that there may also be a
genetic factor in other cases of Alzheimer's disease. However,
this does not mean that someone whose parent had
Alzheimer's will automatically develop the disease.
 "Is Alzheimer's and dementia the same thing?
 " The answer is both yes and no.
 Alzheimer's disease is one cause of dementia, but several
other diseases can cause it too. Alzheimer's disease is the most
common cause of dementia, accounting for around two thirds
of cases in the elderly.

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What Happens?
The early stages of Alzheimer's disease and other dementias
can be difficult to diagnose because many of the symptoms are
initially subtle or common to other illnesses. Symptoms also
vary among individuals and between the various diseases that
cause dementia.
As people get older, they start to forget little things, like the names
of acquaintances and where they put the car keys. This needn't be a
sign of dementia and in a lot of cases it's just that we are growing
old and our brains are no longer at their peak.
However, there are some less subtle signs of confusion that
may be possible warning signs. These symptoms aren't
necessarily signs of dementia.

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 The symptoms are caused by nerve cells dying in certain areas of the
brain and the degeneration of millions of connections between
affected nerve cells. The loss of connections in the part of the brain
dealing with memory usually causes the first symptoms.

The disease progresses and spreads, gradually affecting cells in

other parts of the brain. More research is needed to find out what
causes the nerve cells to die. Different types of protein deposits,
known as amyloid plaques and tau tangles, accumulate in the brains
of Alzheimer's patients, but it is not yet known whether these
actually cause the disease or are a symptom of it.

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Alzheimer's disease
Regularly misplacing everyday items, or putting things in odd places - and
then forgetting or even denying having done so.
Problems with everyday tasks; for example preparing a meal, putting it on
the table, but forgetting to eat it and then preparing it all over again.
General disorientation, such as failing to recognise familiar streets and
frequently becoming confused about the time of day.
Difficulty finding words or using inappropriate words.
Diminished judgement, for example dressing inappropriately for the
weather or being unaware of dangerous situations.
Mood or behavioural problems which may resemble depression; usually a
mixture of agitation, irritability, apathy and lack of care with personal
hygiene.

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Vascular dementia

 -Also including multi-infarct dementia and Binswanger's disease

 Generally, the early symptoms are similar to those of

Alzheimer's, but the decline often happens in distinct steps
rather than gradually.

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Vascular dementia describes a number of conditions that are

linked by vascular causes, such as sustained high blood
pressure (hypertension), stroke and atrial fibrillation.
When the condition is caused by a series of repeated small
strokes, it is known as multi-infarct dementia.
During a stroke, parts of the brain are deprived of blood, which
carries oxygen and nutrients, and so they die.
These damaged areas of the brain are known as vascular brain
lesions and can sometimes be seen on a CT scan.

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Lewy Body disease

Confusion or delirium that fluctuates - sometimes so much so

that carers may feel the person is pretending to be confused.
Persistent hallucinations, usually involving an animate object
in the same place - for example of the same person sitting in
the same chair.
Spontaneous Parkinson's disease-type symptoms, such as a
tremor or parts of the body becoming rigid.
Regular falls or a change in the way a person walks.

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Lewy Bodies are small deposits of protein found inside the

nerve cells in the brains of people diagnosed with this disease.
They alter the way the brain functions and in particular the
way chemical messengers work within the brain.
The affected nerve cells are found in an area of the brain
called the cerebral cortex.

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Fronto-temporal dementia including

Pick's disease
A rare condition which typically affects people in their 50s and 60s.
Personality changes, such as a loss of inhibition, rudeness, apathy,
impatience, or inappropriate behaviour of which the person is often
unaware.
Loss of emotional warmth and empathy for others. The person may seem
selfish and unfeeling.
A decline in language abilities. At first patients may have trouble
remembering or understanding less common words and the names of
people.
Overeating or changes in dietary preference, particularly cravings for sweet
food.
Changes in sexual behaviour.
The memory remains intact in the early stages, but the decline in
communication abilities may give the impression of memory problems.
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There are none of the plaques or tangles seen in Alzheimer's disease

and the damage to brain cells is more localised. There are several
different types of fronto-temporal dementia:
Pick's disease symptoms are caused by abnormal and swollen brain
cells, known as Pick's cells, and abnormal protein deposits within
cells, known as Pick bodies. The disease mostly affects the frontal
and temporal lobes of the brain.
Primary progressive aphasia causes a loss of cells in areas of the
brain's frontal lobe that govern speech. It is difficult to distinguish
from Pick's disease in living patients.
Frontal lobe degeneration mainly affects those parts of the brain
that govern social behaviour. The onset of the disease is usually
slow.

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Medications

 There is currently no cure for Alzheimer's disease and other related

dementias, but researchers have developed some treatments that can
temporarily help with some of the symptoms patients’ experience.

 For mild to moderate stages of Alzheimer's, three drugs are sold under the
names Aricept (donepezil), Exelon (rivastigmine), and Reminyl
(galantamine). Around half of patients see modest benefits for a period
including stabilisation of memory loss

 For moderately-severe to severe Alzheimer's, a drug is sold under the name

Ebixa (memantine).

 Depression is common in all forms of dementia. Antidepressants can

improve quality of life and temporarily help with memory loss.

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 Major tranquillisers/ anti-psychotics/ neuroleptics. Short-term low doses are

sometimes used to treat agitation, delusions, anxiety, hallucinations, sleep
disturbance, and aggressive behaviour.

 Although they are used to treat symptoms experienced by some people with
Alzheimer's disease, vascular dementia and fronto-temporal dementia, these
drugs can be dangerous for people with Lewy Body disease and should be
avoided.

 Anti-anxiety drugs/ anxiolytics/ benzodiazepines These drugs can help

patients who are severely anxious, particularly when this hinders an
individual's ability to communicate clearly or carry out normal tasks. They
can also help with the hallucinations experienced by people with Lewy Body
disease.

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What can we do?

Non-drug therapies can be very helpful for people with dementia,

including:

psychological methods to help with behavioural problems;

nutritional improvements; occupational activities, such as music
therapy, massage, aromatherapy or acupuncture.

An activity, hobby or regular exercise can help with the depression

often experienced by people with dementia.

Therapies introduced by a GP or specialist can help with the over-

eating often exhibited in people with fronto-temporal dementia.

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