Twenty years ago, if you thought about the way you’d choose not to die - if that choice was yours to make - you’d probably have answered with the single word, ‘cancer’. Today, that word seems to have been cast into the shades by another that is even more frightening. Dementia. This thief of our mind and our memories seems to have crept up on us almost unawares and has an annihilating effect on the lives of its victims and of their families.
A diagnosis of cancer is devastating. But at the very least cancer is a known adversary. We understand what it is and what it will do, and we have strategies to deal with it that are frequently successful.
Dementia is another thing entirely. It is an invisible invader, like something from science fiction, that gradually breaks down your brain, stealing your memories, your history, your relationships and eventually your very self.
We know very little about why it develops, and even less about what to do about it. And most difficult of all is the fact that once you start to exhibit its symptoms there is currently no way of halting the ultimate progression of the disease. At the moment, there simply is no cure at all.
The good news, though, is that you can, with careful management, delay that progression.
First, the facts.
What is dementia?
Cancer and dementia are both words that collectively describe a range of diagnoses with similar symptoms. Cancer is an umbrella word that covers over 100 different variations of the disease, each with different characteristics and prognoses. The term ‘dementia’ describes the collection of different disorders that cause the brain to deteriorate and stop working properly.
Saying someone has dementia is like saying someone has cancer. You then need to ask which type?
* In 2013, there were more than 800,000 people with dementia in the U.K.
* The majority of these (773,502) were 65 years or older.
* Dementia currently affects 1 in 14 of us over the age of 65.
* 1 in 6 people over the age of 80 have dementia.
* Numbers are increasing every year and are estimated to double every 20 years. By 2025 those numbers are forecast to grow to more than 1 million, hitting 2 million by 2051.
* 225,000 of us will develop dementia this year: that’s one every three minutes.
* Dementia can affect people as young as 30.
* 70% of people in care homes have dementia or severe memory problems.
* Globally, around 46 million people are currently affected.
* Another 7.7 million people will develop dementia around the world every year.
Types of dementia in the UK
There are 4 main types of dementia, making up the majority of diagnoses.
Alzheimer's disease: 62%
Vascular dementia: 17%
Mixed dementia: 10%
Lewy-body dementia: 7.5%
Fronto-temporal dementia: 2%
Parkinson's dementia: 2%
Symptoms of dementia
Each type of dementia has similar symptoms, which include memory loss, mood changes, confusion and problems with speech and understanding. The disease worsens over the course of just a few years.
Alzheimer’s is the most commonly diagnosed form of dementia and it usually develops slowly over several years. It is a brain disease that causes a slow decline in memory, thinking and reasoning skills. To start with, symptoms are very similar to the mild forgetfulness of older age, but they rapidly get worse over time.
Initial symptoms may include:
•Forgetting people’s names and faces, or familiar places and recent events
•Becoming increasingly repetitive
•Losing things - or putting them in odd places.
•Not being sure of the date or the time of day.
•Losing track of where you live; getting lost
•Difficulty in finding the right words.
•Getting anxious or irritable, losing self-confidence
•Losing interest in day to day matters
As Alzheimer’s progresses:
•The ability to remember, think and make decisions worsens.
•Communication and language become more difficult.
•Recognising household objects or familiar faces becomes harder.
•Day-to-day tasks becomes confusing - using a TV remote control, phone or kitchen appliance.
•Changes in sleep patterns often occur.
•Anxieties are common and people may seek extra reassurance or become fearful or suspicious or sad, depressed and overwhelmed by the challenges of the disease.
•People may experience hallucinations, where they may see things or people that aren’t there.
•Increasing unsteadiness and at greater risk of falling.
•Getting dressed, eating and going to the bathroom becomes more difficult
What's the cost of Alzheimer's?
* Alzheimer’s currently costs the UK around £23 billion each year, which is more than the costs of cancer, heart and stroke combined.
* Two thirds of the cost of dementia is paid by people with dementia and their families.
* Unpaid carers supporting someone with dementia save the economy £11 billion a year.
Vascular dementia is the second most common type of dementia, affecting around 150,000 people in the UK. Brain cells need a constant supply of oxygen and nutrients to be healthy and work properly and this gets delivered through a complex network of blood vessels within the brain (the vascular system). If these get damaged in some way - if they leak or become blocked - then blood cannot reach the brain cells and they will eventually die. This sort of malfunction can also trigger problems with memory, thinking or reasoning and when symptoms become severe, one or a combination of different types of vascular dementia is likely be diagnosed.
Types of vascular dementia
• Stroke-related dementia. Vascular dementia can develop after a stroke (called post-stroke dementia) or after a series of small strokes (called multi-infarct dementia). 20% of people who have a stroke, where large parts of the brain are damaged, go on to develop vascular dementia in the following 6 months.
• Subcortical vascular dementia. This is the most commonly diagnosed form of vascular dementia and it is caused by changes to very small blood vessels deep in the brain.
Symptoms can include:
• slowness of thought.
• difficulty with planning.
• trouble understanding.
• problems with concentration
• mood or behavioural changes.
• problems with memory and language (but these aren't as common as they are in people with Alzheimer's disease)
At least 10% of people are diagnosed with mixed dementia which means that both Alzheimer’s and vascular dementia are thought to have been involved.
What is dementia with Lewy bodies?
Occurs when there is a build up of clumps and proteins in the nerve cells in their brain known as Lewy bodies, damaging the way the nerve cells work and communicate with each other.
* Around 7.5% of people diagnosed with dementia will have dementia with Lewy bodies
* It is the third most common cause of dementia
* Usually affects people over the age of 65 years.
* Over the age of 80 there is a 1 in 6 chance of developing dementia with Lewy bodies.
* Twice as many women over the age of 65 are diagnosed with dementia with Lewy bodies than men.
* In rare cases, dementia with Lewy bodies can be passed from one generation to another. This type of dementia usually affects people under the age of 65.
What are the symptoms of dementia with Lewy bodies?
* Problems with memory, with planning and processing information. Decline in problem solving skills.
* Confusion, fluctuating ability to concentrate or pay attention
* Problems with movement - tremors, stiffness, slowness and difficulty walking. Increased falls.
* Visual hallucinations (seeing things that are not present)
* Sleep disturbance and restlessness.
* Mood changes - depression, apathy, anxiety, agitation, delusions or paranoia
* Changes in autonomic body functions, such as blood pressure control, temperature regulation, and bladder and bowel function.
(Psychol Med.2014 Mar;44(4):673-83. doi: 10.1017/S0033291713000494. Epub 2013 Mar 25.)The prevalence and incidence of dementia with Lewy bodies: a systematic review of population and clinical studies.Vann Jones SA1, O'Brien JT1.
Frontotemporal dementia is one of the less common types of dementia. It is sometimes called Pick’s disease or frontal lobe dementia and is caused by the shrinkage of the frontal lobes of the brain, found behind the forehead, though no one yet understands exactly why it happens.
The frontal lobes of the brain deal with behaviour, language, personality, problem-solving, planning and control of emotions. The left temporal lobe usually deals with the meaning of words and the names of objects. The right temporal lobe is involved in recognising faces. When the brain tissue in the lobes shrink, it therefore affects personality and behaviour and creates difficulties with language. It is usually diagnosed earlier than the other types of dementia, often between the ages of 40 and 45.
The symptoms are different from the memory loss often associated with Alzheimer’s or vascular dementia and may include:
* Dramatic changes to personality - becoming socially inappropriate, emotionally disconnected or lacking in inhibition.
* Repetitive compulsive behaviour
* Decline in personal hygiene
* Overeating, and eating of strange objects
* Difficulty in using and understanding language - inability to find the words for everyday objects, hesitant speech
* Lack of judgement
* Loss of social skills
* No awareness of any of the above
If you notice any of these symptoms in either yourself or anyone close to you, the first thing to do is contact your doctor for screening. Do not ignore it or pretend it will go away because it just won’t. And although you really, really may not want to know, the earlier that you do, the better your hope of keeping the symptoms at bay.
Written by health advocate Sara Davenport, founder of one of the UK's leading breast cancer charities, Breast Cancer Haven. With over twenty years' experience in holistic health, Sara's digital dose of wellness teaches you to listen to your body, tweak your lifestyle and improve your health.
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