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Dementia

Dementia is a decline in mental ability severe enough to interfere with daily life. It affects memory, language, judgement and behaviour.

Common signs and symptoms

  • Memory loss: forgetting recent conversations, appointments, names.
  • Difficulty communicating: struggling to find words or to follow conversations.
  • Disorientation: getting lost in familiar places, losing track of dates and time.
  • Cognitive decline: trouble planning, organising, managing money or complex tasks.
  • Changes in behaviour: mood swings, apathy, personality shifts, poor judgement.

Main types

  • Alzheimer’s disease: the most common. Caused by abnormal build-ups of protein: amyloid plaques and tau tangles.
  • Vascular dementia: from reduced blood flow to the brain, due to strokes or small-vessel disease.
  • Lewy body dementia: abnormal deposits of the protein alpha-synuclein. It affects thinking, movement and sleep, and causes visual hallucinations. Related to Parkinson’s.
  • Frontotemporal dementia: targets the frontal and temporal lobes. Early changes in personality, behaviour or language.

Diagnosis: rule out reversible causes

Not all memory loss is dementia. These can mimic it: thyroid problems, vitamin B12 deficiency, side effects of medicines, depression, infections.

Common evaluations:

  • Neurological exam: checks reflexes, balance and the senses.
  • CT scan or MRI: looks for a stroke, bleeding, tumours or fluid build-up.
  • PET scan: shows brain activity and amyloid protein deposits.
  • Lab tests: B12 levels, thyroid function, spinal fluid for infection or inflammation.
  • Psychiatric exam: depression often overlaps with, or mimics, the symptoms of dementia.

Treatment and management

  • Medicines:
    • cholinesterase inhibitors like donepezil may improve symptoms for a time;
    • other medicines for depression, sleep problems, hallucinations, agitation, or Parkinson’s-like movements.
  • Occupational therapy: makes the home safer and teaches coping strategies to prevent accidents.
  • Changes to the surroundings: reduce clutter and noise to help focus. Secure dangerous items like knives, car keys and medicines.
  • A care facility: may be needed when behaviour can’t be managed safely at home.

Reducing the risk

  • Avoid head injury, and treat hearing loss.
  • Stop smoking.
  • Eat a Mediterranean-style diet.
  • Exercise regularly.
  • Control diabetes, high blood pressure and high cholesterol.

The saying “what’s good for the heart is good for the brain” holds up. Vascular health and brain health are closely linked.

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