Let's Talk About Dementia

By Dr. Judith Martin

Dementia is an umbrella term for a cluster of symptoms that affect cognition, behaviour, and functioning.

Most people feel that dementia is synonymous with Alzheimer’s disease, but this is not the case. Whilst Alzheimer’s disease is the leading cause of dementia, there are a number of other causes that are also significantly represented.

What is dementia?

First, let’s take a step back. So, what is dementia? Dementia is primarily a cognitive disorder that must be acquired and represents a decline from a person’s usual level of functioning.  

As we age, dementia becomes more prevalent in the community. It is rare to be diagnosed with dementia before the age of 65.

According to the current guidelines, dementia, or major neurocognitive disorder as it is now known in the Diagnostic and Statistical Manual of Mental Disorders V, is represented by a change in a number of domains:

• Complex attention – being able to maintain attention and process information as quickly as usual 
• Executive function – planning, organisation, inhibition (i.e. social graces)
• Learning and memory
• Language – object naming, word finding, understanding
• Perceptual motor function – being able to see and understand the world around you and move within it effectively
• Social cognition – recognition of emotion, insight

From time to time we can all experience any one of these symptoms. Who hasn’t walked into a room and been unable to recall why they are there?

The difference between this experience and dementia is that in dementia, the changes are sustained and impairing, leading to a loss of independence or functioning in activities of daily life.

Types of dementia

Now, back to the other subtypes of dementia. The most commonly seen subtypes include:

Lewy Body Dementia - which can present with visual hallucinations and motor changes like those seen in Parkinson’s disease;

Fronto-temporal dementia - which can be indicated by changes in personality, mood, and behaviour; and,

Vascular dementia - where changes occur due to impaired blood flow in the brain.

However, dementia can develop from many other conditions such as HIV, Parkinson’s disease, Huntington’s disease, chronic excessive alcohol intake, and a number of other neurological conditions.

Can we prevent dementia?

Dementia is caused by many different diseases but there are some over-riding principles in improving our brain health. Alzheimer’s Australia recommends the following:

• Look after your cardiovascular system – maintain a healthy weight, stop smoking, avoid or manage type 2 diabetes, lower your cholesterol, and maintain a healthy blood pressure.
• Exercise! Both aerobic exercise and strength training are important for overall health, including that of your brain. You don’t have to run a marathon but moving your body several times a week in moderate intensity along with a couple of days of strength training is what you are aiming for
• Eat well and avoid excessive amounts of alcohol.
• Keep learning and trying new things!
• Remain socially active. In fact, why not combine your exercise and social activity. A great study showed that when dementia-prone rats were put on a treadmill this delayed the onset of their dementia. When you throw two rats on the treadmill the onset was delayed even more. So be the social exercising rats!

Dementia treatment

Treatment of dementia relates largely to slowing cognitive decline rather than reversal of any deficits that are already seen.

We have a number of medications for this purpose. We also treat any conditions that occur as dementia progresses such as depression, anxiety, or psychosis. Support for patients and their carers is paramount.

It’s important to remember that if you or someone you know is experiencing any cognitive changes, the cause may NOT be dementia. These changes must be investigated as there are a number of other conditions that can mimic the changes of mild cognitive impairment.

These include, severe depressive episodes, vitamin deficiencies, other neurological conditions, and even certain medications. A great starting point, as always, is your general practitioner, who can kick off the process of investigation of any cognitive change.

Dr Martin is a consultant psychiatrist with a sub-speciality interest in geriatric psychiatry. Dr Martin works in the private sector, providing mental health care to both younger and older adults. She also provides psychiatric care to residents at a number of Brisbane nursing homes.