What is Dementia?
Dementia is a term that covers a wide range of diseases which lead to loss of memory and other thinking abilities, significantly affecting the individual’s working or social life. Main symptoms include loss of memory, difficulty with concentration, and reduced ability to perform complex planning tasks such as managing finances. The main causes of dementia include Alzheimer’s, Vascular, Lewy Body and Frontotemporal dementia. While we know that dementia is related to changes in the brain, the exact processes leading to these specific types of dementia are still under intensive research. Dementia is typically a progressive disease leading to increased impairment over time.
How is Dementia assessed?
Dementia is assessed through patient and family interviews, examination including cognitive assessment, and investigations such as blood tests and imaging of the brain. Cognitive assessment often involves the use of bedside tests such as the Mini Mental Status Examination (MMSE) or the Montreal Cognitive Assessment (MOCA). These help to make an objective assessment of memory, problem solving, orientation, language, attention and other cognitive abilities. It is important to diagnose dementia early in order to facilitate the best treatment of symptoms. Such treatment includes avoiding certain medications which may make dementia worse, utilising medications which may help with overall function such as donepezil or memantine, setting up supports, giving the patient and their family education about the course of the disease, and working with them to plan for the future.
How can I prevent Dementia?
The best evidence we have for preventing dementia is based on findings from the 2022 Lancet Commission. This commission combined research from multiple studies and suggested a range of interventions for dementia prevention based on the concepts of cognitive reserve and healthy brain stimulation. Cognitive reserve describes how using our brains builds neurons throughout life, and healthy stimulation is also thought to be protective in reducing possible damage to the brain. In the Lancet study, 40% of the factors contributing to dementia were found to be potentially modifiable.
Dementia prevention is split into interventions during early, middle, and later life. In early life, childhood education is the most important intervention. In middle life, factors such as treatment of hearing loss, high blood pressure and obesity, along with reduction of alcohol intake, and prevention of brain trauma leads to a decrease in the incidence of dementia.
During later life, dementia prevention could be achieved through smoking cessation, treatment of depression and diabetes, and maintenance of a socially and physically active lifestyle, along with reduced exposure to air pollution.
Reproduced with permission
Dr Jerry Dang, Geriatrician
References
Livingstone G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 2020;396(10248):413-46.