What Are The Symptoms Of Dementia?

The symptoms of all types of dementia are similar and include the following.

MEMORY LOSS. As a rule, the most recent events are the first forgotten. For example, a person with early stages of dementia might go to the shops and then cannot remember what they wanted. It is common to misplace objects. However, events of the past are often remembered well until the dementia is severe. Many people with dementia can talk about their childhood and early life. As things progress, sometimes memory loss for recent events is severe and the person may appear to be 'living in the past'. They may think of themselves as young and not recognise their true age.

DISORIENTATION. New surroundings and new people may confuse a person with dementia. However, in familiar places, and with old routines, the person may function well. This is why some people with mild dementia cope well in their own home. Losing track of time is also typical. For example, not knowing if it is morning or afternoon, or what day it is.

POOR CONCENTRATION. Not being able to settle to anything.

FAILING INTELLECT. Even clever people cannot grasp new ideas or learn new skills. For example, how to use a new household gadget.

PERSONALITY CHANGES. At first, being easily irritable or moody may be noticed by family or friends. In some cases, over time, a person with dementia may become quite disinhibited. This means that he or she may say or do things quite out of character. This is often difficult for families and friends to cope with.

SELF CARE. Without help, some people may not pay much attention to personal hygiene. They may forget to wash or change their clothes.

MOOD. Some people with early dementia recognise that they are failing and become depressed. However, many people with dementia are not aware that they are ill. They may remain cheerful. The distress is often felt more by relatives who may find it difficult to cope.

SEVERE DEMENTIA. Speech may be lost. Severe physical problems may develop in the later stages of dementia. such as immobility, incontinence, and general frailty.

Can Medication Help People With Dementia?

There is no medicine that will reverse dementia. The following are some medicines that may be used to help.

CHOLINESTERASE INHIBITORS These include Donepezil, Rivastigmine And Galantamine. They work by increasing the level of acetylcholine. This is a chemical in the brain that is low in people with Alzheimer's disease. These medicines do not affect the brain changes, and are not a cure. However, they may slow down the progression of some of the symptoms in some people with Alzheimer's disease.

There is debate as to how much these medicines actually help in the wellbeing and day-to-day care of a person with Alzheimer's Disease. Some doctors feel that these medicines give only limited benefit which is not worthwhile. However, some people may benefit more than others.

In the autumn of 2006 the National Institute for Health and Clinical Excellence (NICE) issued national guidance on the use of these medicines. NICE recommended that "Donepezil, Galantamine and Rivastigmine should only be considered as options in the treatment of people with moderate Alzheimer's disease." This was a controversial decision as some people feel that these medicines should be available to people in the mild, early stages of Alzheimer's disease. If one of these medicines is started it is usual to review the situation after three months to see if it has made any difference. The best length of time to stay on medication is not known. Side-effects such as feeling sick, cramps and diarrhoea may occur.

MEMANTINE This medicine is a relatively new medicine. It works by reducing the amount of calcium that gets into certain brain and nerve cells. This may help to slow down the damage to cells affected by Alzheimer's disease. Like the medicines above, this is not a cure.

Research studies show that it seems to slow down the progression of the symptoms in some cases. As it is relatively new, the role of memantine is not yet fully established. It is not routinely prescribed. In the same guidance as for the cholinesterase inhibitor medicines (above) NICE issued advice for the prescribing of memantine. The advice states that "memantine is only recommended as part of clinical studies for people with moderately-severe to severe Alzheimer's disease."

Other Medication

Ginkgo biloba is a herbal treatment. There is some evidence that this delays the progression of symptoms of dementia in some people. More research is needed.

A tranquilliser is sometimes prescribed as a last resort for people with dementia who become easily agitated.

An antidepressant may be advised if depression is suspected. Depression is common in people with dementia and may be overlooked.

Aspirin and other medicines to treat the 'risk factors' for stroke and heart disease may be appropriate for some people. Especially those with vascular dementia.

Sleeping tablets are sometimes needed if difficulty sleeping is a persistent problem.

Support And Care Is The Most Important Part Of Treatment

Most people with dementia are cared for in the community. Often the main carer is a family member. It is important that carers get the full support and advice, which is locally available. Support and advice may be needed from one or more of the following, depending on the severity of the dementia and individual circumstances.

• District nurses who can advise on day to day nursing care.
• Community Psychiatric Nurses who can advise on caring for people with mental illness.
• Specialist psychiatric assessment. A GP can advise if this is needed.
• Social Services who can advise on local facilities such as day care centres, benefits, help with care in the home, sitting services, respite care, etc.
• Voluntary organisations. If you care for a person with dementia it is well worth getting information about the help that is available in your local area. In most areas of the UK there are organisations that provide support and advice for carers of people with dementia. The local library or citizen's advice bureau will often have local contact details.

The level of care and support needed often changes in time. For example, some people with mild dementia can cope well in their own familiar home. Some may live with a family member who does most of the caring. If things become worse, a place in a residential or nursing home may be best. The situation can be reviewed from time to time to make sure the appropriate level of care and support is provided.

Many carers struggle on beyond the point that is appropriate. If you are a carer, you can ask a GP or district nurse to assess a person with dementia if you feel that you need a greater level of support.