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  • David Price

To forget or not to forget


Unfortunately for the majority of us, getting older will usually mean that our bodies are no longer as fit, strong or toned as they once were, and this includes the brain. When the deterioration gets serious, it will usually be categorised as a form of Dementia.


Dementia is the overall term used to describe a range of symptoms that impact our cognitive function - the ability to think, memorise, problem solve and communicate. Changes in emotions and control can often appear too. Over time, this deterioration can become severe enough to interfere with the everyday tasks.


Dementia is more common in the population over the age of 65, where it affects between 5-7% of people. Unfortunately, with age, the statistics increase, with around 25-50% of those 80 or above being affected. The disease doesn’t only affect the elderly though, with early onset of dementia appearing in people as young as 30, though this is very rare. The causes and symptoms of the more commonly known forms of the disease are different, but they often become more similar in the later stages.


Alzheimers disease: Found in 60% of patients. Exact cause unknown but is known that plaques and tangles form in the brain as a result of two proteins, called amyloid and tau. It is thought that the plaques begin to malfunction, creating beta amyloid, a piece of a larger protein which is toxic to the brain. The tau proteins naturally helps brain cells communicate, but as plaques begin to form, this communication is disrupted, triggering inflammation and ultimately leading to the death of brain cells.


Vascular dementia: Affects around 17% of patients and is the second most common type of dementia. Umbrella term used to describe problems with blood circulation to the brain, caused by small blood clots known as Transient Ischaemic Attacks (TIAs) preventing oxygen from reaching the brain. Blood supply damage can cause blocked arteries or bursting of blood vessels (brain haemorrhage). Onset of dementia may come as a result of a stroke.


Dementia with Lewes bodies: Progressive dementia which accounts for 10-15% of cases. Early stages are similar to Alzheimers. The two types of lewes body are:

Dementia with Lewes body: Changes to thought, visual perception (cognitive symptoms), difficulty with movement.

Parkinson’s disease dementia: Difficulty with movement followed by cognitive changes. Not everyone with Parkinson’s will develop dementia, but the risks do increase.

Caused by abnormal clumps of protein (Lewes bodies) gathering in brain cells, particularly in the area responsible for thought, movement, sleep and vision.


Frontotemporal dementia: Common for those under 65, less so above. Condition involved with the death of nerve cells and pathways in frontal and temporal lobes of the brain. Damage linked to normal forming proteins that interfere with brains communication. Progressive condition that affect behaviour and personality leading to inappropriate social behaviour. Can often be confused with anxiety, depression, psychosis or OCD behaviour.



Early signs of Dementia:

Dementia will affect different people in different ways. Initially the changes maybe subtle, steadily getting worse over time. The “mild cognitive impairments” (MCI) won’t necessary mean that dementia will occur, but the likelihood increases if symptoms worsen. Symptoms include:

-Memory loss:

-Difficulty focusing/concentrating

-Difficulty carrying out familiar tasks

-Changes in communication and speech

-Confused about time and place

-Mood changes

-Impaired reasoning and judgement


Diagnosis of dementia: There are several different scales used to measure the progression of dementia, with the most commonly used being the Global Deterioration Scale for Assessment of Primary Degenerative Dementia (GDS) or the Reisberg Scale. Other scales used are Clinical Dementia Rating (CDR) and Functional Assessment Staging Test (TEST). The GDS has seven stages based on the amount of cognitive decline. It is more relevant for people who have Alzheimer’s disease than some other forms of dementia (ie: Frontotemporal dementia) which don't always include memory loss. The GDS suggests there are seven different stages of Alzheimer’s disease correlating with four distinct categories:


No Dementia:

Stage 1; No cognitive decline- normal function, no memory loss.

Stage 2; Very mild cognitive decline - forget names, misplace familiar objects.

Stage 3; Mild cognitive decline - Increase forgetfulness, slight concentration loss, gets lost more frequently, difficulty finding the right words


Early Stage Dementia:

Stage 4; Moderate cognitive decline - difficulty concentrating/completing tasks ,forget recent events, can’t travel alone, socialisation problems


Mid-Stage Dementia:

Stage 5; Moderate severe cognitive decline - major memory problems, needs assistance dressing, bathing, forgets dates, times, locations

Stage 6; Severe cognitive decline (middle dementia) - Forget family names, recent events, lost, difficulty speaking, bladder control issues


Late-Stage Dementia:

Stage 7; Very severe cognitive decline (late dementia) - cannot speak, loss of motor skills, requires 24h care, cannot walk.


Is Dementia hereditary?:

Research suggest that genes can play a role in the development of dementia. However, their effects are complicated and opinion on how and whether dementia is passed down through inheritance differs greatly. The role of genes in frontotemporal dementia appear to be more significant than in vascular dementia. Overall, it is important to understand that genes are only part of the picture in the dementia puzzle. Whatever genes you have inherited, most people can significantly reduce their chances of getting dementia through simple lifestyle choices.


Preventing Dementia:

With no cause for each type of dementia known, you can help reduce your risk of developing dementia by eating a healthy and balanced diet, coupled with regular exercise to maintain a healthy weight. Keeping your alcohol consumption within the recommended limits, keeping an eye on your blood pressure and avoiding smoking are also beneficial.


Conclusion:

The number of people living longer has steadily increase due to the improvements in medical treatment. Although people are now living longer, dementia incidence rates seem to be falling due to the greater adoption of a healthier lifestyle and the greater medical research. Leading a healthier lifestyle, one that is balance will definitely pay off in the long run.


Brett’s view:

I know how frustrating it is when you forget the odd thing and you begin to wonder, is this it, am I going down the rabbit hole…?


David’s view:

Having watched my father go through dementia, which was terrible, I am trying to do as many things as possible to prevent memory loss. I am sure that keeping busy, active, exploring and inquisitive may be the way to delay this disease.

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