Dementia – Summary

Dementia is a triad of problems: memory loss, decline in some other aspect of cognition, and difficulties with activities of daily living.

More formally, dementia is defined as a syndrome (that is, a distinct pattern of symptoms and signs) that can be caused by many brain disorders, most of which progress gradually over several years.

The symptoms of dementia occur in three groups:

Cognitive dysfunction, resulting in problems with memory, language, attention, thinking, orientation, calculation, and problem-solving.

Psychiatric and behavioural problems, such as changes in personality, emotional control, social behaviour, depression, agitation, hallucinations, and delusions.

Difficulties with activities of daily living, such as driving, shopping, eating, and dressing.

Early-onset (or young-onset) dementia, by convention, is dementia that develops before 65 years of age.

The most common causes of dementia include:

Alzheimer’s disease (about 50%).

Vascular dementia (about 25%).

Dementia with Lewy bodies (DLB) (about 15%).

Frontotemporal dementia (less than 5%).

Screening for dementia is not recommended for the general population.

Dementia should be suspected:

If when you ask the person a simple question, they immediately turn to their partner — the so-called head-turning sign.

When relatives are concerned about the person’s memory or behaviour, but they themselves are not.

Dementia should be suspected when any of the following are reported (by the person or by someone close to them) to be new or deteriorating problems:

Cognitive symptoms: memory problems, misunderstandings, disorientation.

Challenging behaviours, psychiatric symptoms, and personality changes.

Neurological symptoms: gait disturbances, apraxia.

Difficulties with activities of daily life: difficulties with orientation, taking prescribed drugs erratically, neglecting household chores.

Neglecting hygiene or self-care.

Routine investigations should be requested and other conditions excluded, such as normal ageing, mild cognitive impairment, depression, and acute delirium (due to infection, biochemical imbalance, excessive consumption of alcohol, and drugs).

When managing dementia:

Primary care should be coordinated with secondary care and social care.

Information and advice about dementia, its management, and what local support is available should be provided.

People with dementia should have the opportunity to give informed consent to decisions about their care and treatment.

Adults should be assumed to have capacity until proven otherwise despite all available support; assess capacity for each decision; and act in the person’s best interests.

Carers’ needs (which they may be reluctant to express) should be recognized and supported.

A structured follow up and review process should be in place.

Strategies to cope with disabilities should be promoted so the person can be as independent as possible.

Challenging behaviour should be prevented and managed as far as possible with non-drug psychosocial approaches.

Drug treatment for cognitive symptoms of dementia is initiated by a specialist, but may be continued and monitored by a general practitioner under a shared care protocol.

Dr G Mohan.

Do request Drug therapy of Dementia- if needed.