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Dementia | Mate wareware

Key points about dementia

Dementia (mate wareware) is a group of symptoms which happen when brain function declines.
It includes problems with memory, thinking, behaviour and the ability to perform daily tasks.
Dementia is more common in people over 65 years of age, but it's not a normal part of ageing.
If you're becoming more and more forgetful, especially if you're over 65, talk to your healthcare provider about the early signs of dementia.
Getting a diagnosis can help you to plan for the future and get the right support and advice.

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Dementia is a group of related symptoms caused by an ongoing decline of your brain. It’s different from occasionally losing your keys or forgetting a name.

It may include problems with:

memory
thinking
language and understanding
mood
behaviour.

As these symptoms get worse, they can make it difficult for you to carry out your normal daily activities.

Dementia happens because of damage to brain cells. Which symptoms you get depends on which areas of your brain have been damaged. It's progressive, meaning the symptoms gradually get worse over time.

Dementia is more common in people over 65 years of age, but it's not a normal part of ageing. More than 70,000 people in Aotearoa New Zealand have dementia. It’s getting more common as we live longer.

There are different types of dementia. The most common is Alzheimer's disease, which affects about 60% of people with dementia. Other types of dementia are vascular dementia, Lewy body dementia, frontotemporal dementia and alcohol related dementia. You can also have ‘mixed’ dementia – a mixture of Alzheimer's disease and vascular dementia.

Early onset dementia (or young onset dementia) describes dementia that occurs in people under 65 years of age. About 5% of people who develop dementia have early onset dementia.

Video: Dementia educational video

(Alzheimers New Zealand, 2016)

Dementia is due to damage and eventual death of cells in the brain. This can be caused by head injury, damage to your brain's blood vessels from diabetes, smoking or a stroke (vascular dementia), or damage from toxins such as alcohol. In Alzheimer’s disease the exact cause of the damage is not known. Once cells die, they're not replaced.

Most dementia is not inherited. However, in rarer types of dementia such as frontotemporal dementia, there may be a strong genetic link. These make up only a tiny proportion of overall cases of dementia.

The older you are, the greater your chance of getting dementia. Most people are over 65 years of age when they're diagnosed.

There are some groups of people who are known to have a higher risk of developing dementia. These include people with:

Māori and Pacific ancestry
risk factors for cardiovascular disease (eg, angina, heart attack, stroke and peripheral arterial disease)
Down syndrome
Parkinson's disease
a history of drinking too much alcohol
a family history of dementia
a history of a head injury
mental health conditions, such as schizophrenia or severe depression
low physical activity levels.

Image credit: Alzheimers NZ

Recent research has added 2 more risk factors for dementia to the 12 in the image above. The 2 new ones are high LDL cholesterol and vision loss. It's suggested that almost half of dementia worldwide could be prevented or delayed if these risk factors were addressed.

Dementia symptoms affect 3 main areas:

mental ability
mood, personality and behaviour
day-to-day activities.

Symptoms can include:

forgetting things that happened recently (things that happened a long time ago are usually remembered better)
repeating questions
not remembering appointments
often forgetting people’s names, or the names of things around the house
not being able to plan the steps to do everyday tasks, eg, making a meal or getting dressed
disorientation – not knowing what time of day it is, or what is appropriate for that time of day
not being able to start or carry on a conversation, or get started on something you once enjoyed
moods changing very quickly for no apparent reason
problems with abstract thinking – trouble understanding ideas or concepts.

If you, or someone you care for, are becoming increasingly forgetful, it may be a good idea to talk to your healthcare provider about the early signs of dementia. It’s a good idea to take someone who knows you well to your appointment. Your healthcare provider will talk with you about what you've been experiencing, and what your whānau and friends have noticed. They will guide you through a memory test.

To check for other causes of your symptoms you will need to have a blood test. A small number of people will need to have a CT scan. It may take a few appointments to get a good understanding of what is going on for you. Usually your own healthcare provider will be able to diagnose dementia, but if it's not clear they may refer you to a health professional who specialises in dementia for further assessment.

Although there's no cure for dementia, there are many things you can do yourself and with your whānau and friends to continue to enjoy your life. These include:

getting support – contacting a dementia support organization as soon as you know you or your family member has dementia is one of the most helpful things you can do.
making lifestyle changes
doing mind and memory-based activities.
cognitive stimulation therapy.

Lifestyle changes

It isn't possible to prevent dementia gradually worsening, but there are things you can do to keep your brain cells as healthy as you can:

Get some exercise most days
Avoid smoking, alcohol and other substance use. If that’s not possible, cut down.
Eat a healthy diet
Get enough sleep.

Mind and memory-based activities

These could include:

keeping up your social activities – they’re good brain exercise, and loneliness makes brain function worse. If you have hearing loss, this might mean getting a hearing aid.
cognitive rehabilitation, where a health professional helps you achieve a goal, eg, learning to use a mobile phone
life story work, where you use a scrapbook, photo album or electronic app to remember and record details of your life
music and creative arts therapies to keep your brain active and help you express your emotions
sensory stimulation such as aromatherapy, massage or bright light stimulation – discuss these with your healthcare provider beforehand
doing brain exercises such as puzzles, and practicing memory strategies.

Cognitive stimulation therapy

Cognitive stimulation therapy (CST) is a structured group treatment developed for people with mild to moderate dementia. It consists of 14 sessions with a range of activities and discussions aimed at improving your mental and social functioning. The sessions actively engage people with dementia, providing a good learning environment and the social benefits of being part of a group. CST has been found to be helpful for older people with a clinical diagnosis of mild to moderate dementia.

Arrange a care planning meeting

Plan ahead so that you have more say in your future. Arrange a meeting (or get someone else to do it) with all the people involved in your care. This may include your carer, whānau members, or your doctor or nurse.

Agree on a care plan to support you to stay as well as possible for as long as possible. This might include:

having a driving assessment
arranging enduring power of attorney
writing or updating your will
developing an advance care plan
accessing services to help you stay independent for as long as possible
learning about your condition.

Apps reviewed by Healthify

You may find it useful to look at some dementia apps, exercise apps for older adults, and carer support apps.

Treating heart risk factors

Management of heart risk factors may benefit all types of dementia. Generally, what's good for your heart is good for your brain. Read about heart risk assessment.

Medicines

There are medicines that can help some people with the symptoms of forgetfulness and improve their ability to think more clearly in the earlier stages. Medicines don’t cure dementia and they may only work for some people. The aims of treatment are to promote independence, maintain function and treat symptoms. These medicines fall into 2 categories:

cholinesterase inhibitors (eg, donepezil, rivastigmine and galantamine)
memantine.

These work by enhancing the levels of a chemical in the brain (called acetylcholine), that's involved in memory and judgment. Read more about medicines for dementia.

Your healthcare provider will also review any other medicines you are taking to check that they're not contributing to any symptoms similar to those of dementia.

Find your local Alzheimer's branch(external link) NZ
Dementia NZ(external link)

For other support services for people with dementia, their carers and for healthcare providers see the dementia support page.

You may have dementia for years before it's recognized, and every person with dementia is different. Some people live for decades with dementia, but the average lifespan after diagnosis is 5 to 12 years depending on the type.

Usually in the first few years you’re able to live at home with support and enjoy most of the things you used to. It’s important that your whānau are cared for as well. Read more about dementia for carers and carers need care too.

As time goes by more care is needed. Your healthcare provider can co-ordinate practical supports for you – such as occupational therapy – and financial supports for your caregiver if you’re eligible.

In the later stages of dementia you may have problems with speech, eating, mobility and continence. This may mean you need residential care. Dementia does shorten your life span, but often it's another health problem that's the cause of death, eg a chest infection.