What is dementia?

The word dementia describes a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language. Dementia is caused when the brain is damaged by diseases, such as Alzheimer’s disease or a series of strokes. Dementia is progressive, which means the symptoms will gradually get worse.

What are the type of dementia?

Here are many different types of dementia although some are far more common than others. They are often named according to the condition that has caused the dementia. Some of the more common types are outlined below.

Alzheimer’s disease
This is the most common cause of dementia. During the course of the disease, the chemistry and structure of the brain changes, leading to the death of brain cells.

Vascular dementia
If the oxygen supply to the brain fails, brain cells may die. The symptoms of vascular dementia can occur either suddenly, following a stroke, or over time, through a series of small strokes.

What are the symptoms?

Common symptoms of Alzheimer’s disease and other forms of dementia include:
memory loss, especially problems with memory for recent events, such as forgetting messages, remembering routes or names, and asking questions repetitively
increasing difficulties with tasks and activities that require organization and planning
becoming confused in unfamiliar environments
difficulty finding the right words
difficulty with numbers and/or handling money in shops
changes in personality and mood
depression
Early symptoms of dementia are often mild and may get worse only very gradually. This means that the person with dementia and those around them may not notice these signs or take them seriously for some time. Also, people with dementia sometimes do not recognize that they have any symptoms.

Dementia is progressive. This means that the person’s brain will become more damaged and will work less well over time, and their symptoms will tend to change and become more severe.

What does dementia diagnosed?

If some one is forgetful, it doesn’t mean that have dementia. Memory problems can also be caused by depression, stress, drug side effects, or other health problems. Your doctor will be able to run through some simple checks and either reassure you, give you a diagnosis or refer you to a specialist for further tests.
A diagnosis of dementia affects both the person with the condition and those close to them. An early diagnosis gives you both the best chance to prepare and plan for the future, as well as receive any treatment that may be possible. With treatment and support, many people are able to lead active, fulfilling lives.

What to expect when you see your doctor about dementia?

Your doctor will ask about your symptoms and other aspects of your health, and will give you a physical examination. The doctor will organize some blood tests and ask about any medication you are taking, as these can sometimes cause symptoms similar to dementia.
You will also be asked some questions or given some mental exercises to measure any problems with your memory or your ability to think clearly.

Dementia can be difficult to diagnose, especially if your symptoms are only mild. If your doctor is unsure about your diagnosis, they will refer you to a specialist such as a neurologist (an expert in treating conditions that affect the brain and nervous system), an elderly care physician, or a psychiatrist with experience of treating dementia.

The specialist may be based in a memory clinic alongside other professionals who are experts in diagnosing, caring for and advising people with dementia and their families.

What are the tests for dementia?

Tests for diagnosing dementia

A range of tests and diagnostic procedures is needed to diagnose dementia. The following are the most commonly used.
Assessing mental abilities to diagnose dementia
Questionnaires are often used to help test the mental abilities of the person with symptoms of dementia, and how severe they are. One widely used test is the mini mental state examination (MMSE). The MMSE assesses a number of different mental abilities, including:
short- and long-term memory
attention span
concentration
language and communication skills
ability to plan
ability to understand instructions
The MMSE is not a test to diagnose dementia. However, it is useful for assessing the level of mental impairment that a person with dementia may have.
Test scores may be influenced by a person’s level of education. For example, someone who cannot read or write very well may have a lower score, but they may not have dementia. Similarly, someone with a higher level of education may achieve a higher score but still have dementia.
Blood tests for dementia

A person with suspected dementia may have blood tests to check their overall level of health and to rule out other conditions that may be responsible for their symptoms, such as thyroid hormones and vitamin B12 levels.

Dementia brain scans

Brain scans are usually used for diagnosing dementia. They are needed to check for evidence of other possible problems that could explain a person’s symptoms, such as a major stroke or a brain tumour.

Several types of brain scan can be used to help diagnose dementia:
Computerised tomography (CT) scan

A computerised tomography (CT) scan can be used to check for signs of stroke or a brain tumour. However, unlike an MRI scan, a CT scan cannot provide detailed information about the structure of the brain.
Magnetic resonance imaging (MRI) scan
An MRI scan can provide detailed information about the blood vessel damage that occurs in vascular dementia, plus any shrinking of the brain (atrophy). In Alzheimer’s disease, the whole brain is susceptible to shrinking, whereas in frontotemporal dementia the frontal and temporal lobes are mainly affected by shrinking.
Other scans and procedures

Other types of scan, such as a single photon-emission computed tomography (SPECT) scan or a positron emission tomography (PET) scan, may be recommended if the result of your CT or MRI scan is uncertain. These scans look at how the brain functions and can pick up abnormalities with the blood flow in the brain.
In some cases, an electroencephalogram (EEG) may be taken to record the brain’s electrical signals (brain activity).
A lumbar puncture may also be used to check the protein levels in the brain. This procedure involves taking a sample of spinal fluid from the lower back for testing.

What are the benefits of early dementia diagnosis?

Dementia, and the difficulties it causes, is one of the most feared health conditions. People with dementia and their families are sometimes reluctant to seek advice when concerned about memory or other problems. But there are many potential benefits to getting medical advice if you’re worried. Being diagnosed early is important for many reasons. It helps you to get the right treatments and to find the best sources of support, as well as to make decisions about the future.
Diagnosis can help uncertainty

It may not be clear why someone has problems with memory or has a change in behavior. These problems may be because of dementia, or down to other reasons such as poor sleep, low mood, medications or other medical conditions. This uncertainty can be distressing for both the person experiencing difficulties, and their family and friends. While a diagnosis of dementia can be devastating news, an explanation of what the problem is and what can be done about it can help people feel empowered and reduce some of the worry caused by uncertainty. Some people find it helpful to discuss with doctors and nurses how the dementia may affect them or their loved one in the future, and there is advice available about how to stay independent and live well with dementia.
Accessing treatments

Dementia is not a single condition – it refers to difficulties with thinking and memory that may be caused by several different underlying diseases. This is one reason why not everyone with dementia experiences the same problems.
Identifying that there is a problem, and then diagnosing the underlying cause is important for guiding treatment and accessing services.
Some causes of dementia are treatable and reversible (either partially or fully, depending on the nature of the problem). Conditions such as anxiety and depression, some vitamin deficiencies, side effects of medications and certain brain tumours fall into this category.
Alzheimer’s disease and dementia with Lewy bodies are neurodegenerative conditions, which means they gradually damage the brain. Cholinesterase inhibitor medications have been shown to have benefit in Alzheimer’s disease and dementia with Lewy bodies. These treatments (donepezil, rivastigmine and galantamine) improve symptoms by making the remaining brain cells work a bit harder. Memantine is another medication that can help in Alzheimer’s disease. Although not a cure, these medications can make a significant difference to day-to-day living and functioning.
Treating high blood pressure, high cholesterol and poorly controlled diabetes is also important, as is stopping smoking and keeping to a healthy weight. These factors (known as risk factors) all contribute strongly to vascular dementia, and may make Alzheimer’s disease worse. Your doctor will be able to assess your risk factors, advise if treatment is needed and monitor you.
Medications for other conditions can be reviewed in case they are having a negative effect on cognitive functioning.
Other support

Whether or not there are specific treatments for the cause of the dementia affecting you, having the correct diagnosis is important for getting the right advice and support. There is a lot of help and information available both for people with dementia and their friends, relatives and carers.
This includes:
Information on help available at home or in the community, such as from social services, day centres and respite care, community mental health teams, speech and language therapists, dietitians and occupational therapists.
Advice regarding financial affairs and planning for the future.
Financial benefits and support (such as Disability Living Allowance and Council Tax reduction).
Advice about driving (see Staying independent with dementia).
Advance care planning and help with setting up a Lasting Power of Attorney if the dementia is progressive. This enables a person to be involved in discussions about their future when they are still able to do so effectively.
Information and support groups. There are a number of sources of information and advice that are easier to find if you have a diagnosis (for example, the Alzheimer’s Society and FTD support group). Access to a support group is easier if a diagnosis is clear because support groups can provide secialist information and links to others in similar situations.
Advice and support for other medical conditions

If doctors and nurses are aware that a person has a condition causing dementia, this is also helpful when treating other medical problems. This includes taking extra time to explain things to patients in a way they can understand, setting up safer ways of taking medication (for example, dosette boxes to help people remember when to take tablets), and understanding and offering extra support if someone has to come into hospital as an inpatient for another reason.
Research and planning services

Getting the right diagnosis is also important for research and understanding more about the causes of dementia. Better recognition of how important and common the causes of dementia are is vital for planning services to provide the help and support people need, both locally and nationally.