Dementia is not an ordinary part of ageing. Dementia has now replaced ischemic heart disease as the leading cause of death in the UK and represents the growing problem linked to our ageing population. There are over 850,000 people with the condition in the UK alone. This means that more and more of us are affected by dementia either as someone with the condition or someone with friends or family with the condition. Although dementia is caused through specific physiological changes to the brain that are increasingly well understood, there is not yet a cure for the condition. This means that managing the condition and enabling people to live well with the symptoms is very important.

What is the difference between dementia and Alzheimers disease?

Dementia is an umbrella term that describes a variety of conditions. The four most common types of dementia are Alzheimers disease, Vascular, Lewy body and Frontotemporal dementia. There are also many other less prevalent types, as well as mixed dementias.

When people think of dementia they mostly think of a loss of short term memory, but dementia is more than that and the symptoms affect many aspects linked to how people manage their everyday lives. The specific symptoms of the various types of dementia are related to the areas of the brain that are affected.

Alzheimers disease is the most common form of dementia. It is caused through the build-up of protein plaques which inhibit the path of neurotransmitters within the cerebral cortex (grey matter). The cerebral cortex is responsible for storing and retrieving memories (hippocampus), calculation, spelling, planning and organising (frontal lobe). As the disease progresses, more areas of the brain become affected.

Therefore the symptoms of Alzheimers are linked closely to the functions of these areas of the brain:

Problems with short term memory and an inability to recall people, places and events

Organisation and planning become increasingly difficult

Becoming confused in unfamiliar environments

Word finding difficulty

Increasing difficulty with numbers for example handling money in shops

Changes in personality and mood

Depression and withdrawal

Difficulties with perception and depth perception (right parietal lobe)

Inability to recognise people or objects (temporal lobe)

Vascular dementia

Dementia can also be caused by reduced blood flow to an area of the brain which causes cell and tissue death. Although dementia can result from a stroke, it more commonly has a stepped onset caused by multiple small blockages, ruptures or constrictions (known as infarcts) in the brain, which may be too small to notice individually but can cause problems if they affect area linked to memory and processing.

Sub-cortical dementia is caused through multiple small changes to small blood vessels deep within the brain and once again may not be noticed individually but may have a cumulative effect.

Symptoms of Vascular dementia can be more varied than in other types as the damage to the brain can occur in a variety of lobes within the brain depending on where the infarcts occur.

Dementia with Lewy bodies

This type of dementia is closely linked with Parkinsons Disease. It is the third most common type affecting 15% of those with dementia.

In both Parkinsons disease and Dementia with Lewy bodies, proteins build up into lumps (called Lewy bodies) which interfere with transmission along nerves. Lewy body dementia specifically affects nerves in the areas which control thinking, memory and movement (cerebral cortex, limbic system and brain stem).

Frontotemporal dementia: Most commonly found in people 45-64 but only accounts for 5% of the total dementia cases in the UK. It affects the frontal and temporal lobes of the brain and the symptoms are linked to the functions of these two areas:

Frontal lobes regulate our personality, emotions and behaviour, as well as reasoning, planning and decision-making

Temporal lobes are involved in the understanding and production of language

The death of brain cells in these regions is again caused through a build-up of specific proteins, however the build-up of proteins is not fully understood.

For all types of dementia, the later stages also cause difficulties communicating, walking and eating and drinking. However, less affected are skills and memories acquired a long time ago which is why people with dementia are often able to recall things from their childhood in great detail but not something that occurred earlier that day.

The future of dementia research

For many years, investment in dementia research has lagged behind that of other conditions. However, an increase in the older population has led to a recent increase in dementia and made it a priority for investment. In 2015 the government increased its dementia research spending to £66 million. This represented a doubling of its funding from 2010. Dementia charities have also contributed an extra £20 million research funding. It is worth noting that cancer receives seven times this amount (from combined government and charity).

Currently dementia remains a life limiting, ultimately fatal condition and the functional and physiological effects of the condition are wide ranging. This requires dementia research to be equally wide ranging and diverse in its priorities.

Research into dementia falls into five broad areas:

1. The impact of causal factors such as lifestyle and genetics

Being able to identify these factors may delay to the onset of dementia. According to Alzheimers Research UK if the onset of dementia were delayed by five years there would be 469,000 fewer people with dementia within 10 years, which would save the UK economy £14.1billion a year; therefore research is focussing on both identifying genetic mutations and longitudinal studies looking at aspects such as exercise, diet and smoking to identify causal factors for dementia.

2. Research to improve rates and timing of diagnosis.

There are similarities in the external symptoms of different forms of dementia, however different types of dementia can have differing responses to medication. Increasing the accuracy of scans to differentiate between types of dementia will serve to reduce errors in diagnosis and ensure appropriate treatments are used.

3. Possible treatments to delay or halt the progression of the disease

Using stem cells to produce new nerve cells which may be used to repair the damage caused in dementia. Clinical trials are taking place looking at how medications used to treat other conditions may be able to delay the progress and ease the symptoms of dementia.

4. Ways of living well with the condition and improving quality of life for people with dementia.

Finding ways of improving community infrastructures to assist people with dementia in their day to day lives and enable them to keep their independence. Two thirds of people with dementia live in their own homes and the majority of people affected by dementia want to remain living at home for as long as possible. However individuals often find that they require residential care to meet their needs as their condition progresses. Research to help this may be:

Enabling people with dementia to stay in their own homes by creating an enabling environment and designing equipment and care services to respond to individuals needs. Using design to focus on how to design homelike residential homes and a good physical environment which can promote well-being for people with dementia who move to residential care.

New technology offers the potential to promote independence, safety and meaningful activities for people with dementia. GPS tracking, monitoring systems, avatars and multimedia interaction to promote reminiscence and communication are being designed specifically with dementia in mind.

Exploring and developing new ways of supporting those who care for people with dementia.

There are an estimated 670,000 people caring for loved ones with dementia in the UK which costs the economy an estimated £11.6 billion per annum. Research is investigating new and effective ways to support carers in looking after loved ones with dementia through education and improved support services.

What does this mean?

Many of the research outcomes are linked to an improved quality of life for people living with the condition. Earlier diagnosis, coupled with better treatment should lead to more people living well with the condition for longer. Life with dementia will be influenced by improving education, living environments, support and symptom management. In this way, there is hope that dementia will become a less troubling statistic.

First published on 25th January 2017.