Dementia care: What we all need to know.

To ensure accuracy we have referenced the NHS site, where you will find greater detail and many links to other, useful websites, depending on your particular needs.

www.nhs.uk/conditions/dementia/about

How dementia affects people

People with dementia tend to lose the ability to remember events or fully understand their environment or situations.

They may lose interest in their usual activities and struggle with their emotions, often finding social situations challenging. Some aspects of their personality may change; for instance, they may lose their natural empathy with other people and their situations. Some people with the condition also see or hear things that others do not.

As dementia affects a person's mental abilities, they may find planning and organising difficult. Staying independent becomes more of a challenge too, so a person with dementia will increasingly need support from friends or relatives, including help with making decisions, as they become increasingly confused.

How can I spot the symptoms of dementia?

It may surprise you to know that dementia is not a disease itself but a collection of symptoms that result from damage to the brain caused by different diseases, such as Alzheimer's.

There are many different types of dementia and the symptoms of each vary according to the part of the brain that is damaged.

However, there are some common early symptoms that may appear some time before a diagnosis of dementia, such as:

• difficulty concentrating
• loss of memory - particularly short-term
• struggling with familiar daily tasks
• hesitancy when looking for the right word or phrase  
• being confused about time and place
• noticeable mood swings

These symptoms are often mild and may develop only very gradually.

What is “Mild cognitive impairment?"

Mild cognitive impairment (MCI) is the term used for this condition where the symptoms are not severe enough to be diagnosed as dementia. It may be that you don’t notice the symptoms initially and neither do your family or friends, and in some people, they will remain the same and not worsen. But others with MCI will go on to develop dementia.

Dementia is not a natural part of ageing and should not be dismissed as such, which is why you should talk to your GP sooner rather than later if you're at all worried about memory problems or other symptoms. If possible, someone who knows you well should be with you when you seek help as they can help describe any changes or problems they have noticed.

If it is someone else you are worried about, encourage them to make an appointment and perhaps suggest that you go along with them.

Debbie Harris, the founder of Autumna.co.uk, gives her top tip when looking for a dementia care home.

For more detail on the following types of dementia, and others, you can visit:    Dementia UK  or  Age UK-Dementia                           

1. Alzheimer's Disease

The most common cause of dementia is Alzheimer's disease. Though not yet fully understood, scientists know that it begins many years before the symptoms become evident. Its development is driven by the abnormal build-up of deposits from two particular proteins: Amyloid which forms plaques around the brain cells, and Tau which forms tangles within the brain cells.

As brain cells become affected, there's also a decrease in chemical messengers (called neurotransmitters) involved in sending messages, or signals, between brain cells.

Over time, different areas of the brain shrink. The first areas usually affected are responsible for memories. Alzheimer's disease is a progressive condition, meaning the symptoms develop gradually over many years and eventually become more severe. It affects multiple brain functions.

Early symptoms of Alzheimer's disease include:

• memory problems – increasingly forgetting recent events, names and faces
• asking questions repetitively
• struggling to find the right words
• difficulty with numbers and/or handling money in shops  
• increasing difficulties with tasks and activities that require organisation and planning
• becoming confused in unfamiliar environments 
• becoming more withdrawn or anxious

Numerous factors are thought to increase our risk of developing Alzheimer's disease. These include:

• advancing age
• a family history of the condition
• untreated depression - although depression can also be one of the symptoms of Alzheimer's disease
• lifestyle factors and conditions linked to cardiovascular disease

2. Vascular dementia

Vascular dementia is a common type of dementia, and affects around 150,000 people in the UK. It is caused by reduced blood flow to the brain. Nerve cells in the brain need oxygen and nutrients from blood to survive so when the blood supply to the brain is reduced, the nerve cells cannot function properly and eventually die.

Reduced blood flow to the brain can be caused by:

• narrowing of the small blood vessels deep inside the brain. This is the main cause of vascular dementia and is more common in people who smoke, or have high blood pressure or diabetes
• a stroke (where the blood supply to part of the brain is suddenly cut off, usually as a result of a blood clot) – this is called post-stroke dementia
• Several 'mini strokes' that may go unnoticed, but cause widespread damage to the brain – known as multi-infarct dementia

The main symptoms of vascular dementia include:

• stroke-like symptoms: including muscle weakness or temporary paralysis on one side of the body
• mobility problems: difficulty with walking or loss of balance
• thinking problems: having difficulty with attention, planning and reasoning; slowness of thought
• mood changes: depression and a tendency to become more emotional
• disorientation and confusion

3. Lewy Body

Lewy body disease is caused by tiny clumps of a protein called alpha-synuclein developing inside brain cells. They affect the way the cells work and communicate with each other, and the cells eventually die.

Dementia with Lewy bodies is closely related to, and has some of the same symptoms as Parkinson's disease, including difficulty with movement and a higher risk of falls.

It also has many of the features of Alzheimer's disease.

The obvious symptoms of Lewy Body disease include:

• periods of being alert or drowsy
• fluctuating levels of confusion
• visual hallucinations
• slower physical movements, stiff limbs and tremors
• repeated falls and fainting
• sleep disturbances, often with violent movements and shouting out
• problems with understanding, thinking, memory and judgement 

These problems make daily activities increasingly difficult.

4. Frontotemporal dementia

Although Alzheimer's disease is still the most common type of dementia in people under 65, a higher percentage of people in this age group may develop frontotemporal dementia than older people. Most cases are diagnosed in people aged between 45 and 65.

Frontotemporal dementia is caused by an abnormal clumping of proteins, including tau, in the frontal and temporal lobes at the front and sides of the brain. These proteins damage the nerve cells causing brain cells to die, which in turn leads to these areas of the brain shrinking.

Frontotemporal dementia is more likely to run in families and have a genetic link than other, more common causes of dementia.

Early symptoms of frontotemporal dementia may include:

• personality changes: reduced sensitivity to others' feelings
• lack of social awareness: making inappropriate jokes or showing a lack of tact
• becoming withdrawn and apathetic
• language problems: difficulty finding the right words or understanding them
• obsessive tendencies: developing fads for unusual foods, overeating and drinking

The most common symptoms of advanced dementia include:

• Advanced memory problems: people may not recognise close family and friends, or remember where they live or where they are.
• Communication issues: some people may eventually lose the ability to speak altogether. Using non-verbal means of communication, such as facial expressions, touch and gestures, can help. 
• Compromised mobility:  many people become less able to move about unaided. Some may eventually become unable to walk and require a wheelchair or be confined to bed.
• Behavioural challenges: a significant number of people will develop what are known as "behavioural and psychological symptoms of dementia". These may include increased agitation, depressive symptoms, anxiety, wandering, aggression or sometimes hallucinations.
• Incontinence
• Appetite and weight loss:  both common in advanced dementia, often due to difficulty eating or swallowing - which can also lead to other problems.