Dementia / Major Neurocognitive Disorder
Dementia is not a normal part of ageing. It is caused by diseases that damage brain cells and lead to a decline in multiple areas of brain function.
The likelihood of developing dementia increases with age. It is estimated to affect approximately one in ten people aged 70 or above and one in three people aged 85 or above.
In addition to memory loss, other cognitive abilities may gradually decline, including language, judgement, planning, calculation and decision-making. These changes can affect a person’s daily functioning, behaviour and emotions.
People with dementia may become increasingly forgetful and quickly forget what they have just been told. They may find it difficult to absorb new information and require repeated reminders to remember even everyday matters. For example, they may:
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Frequently misplace their wallet or keys
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Have difficulty remembering telephone numbers
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Struggle with calculations when buying or selling items
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Forget the time or location of appointments
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Forget to switch off the cooker
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Be unable to recall what they have just eaten
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Have difficulty finding their way back to their table after using the toilet in a restaurant
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Repeat the same statements or questions frequently
Main Symptoms of Dementia
Cognitive Difficulties
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Decline in memory, judgement, learning, calculation and language abilities
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Disorientation and an increased risk of becoming lost
Behavioural and Emotional Changes
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Agitation
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Unusual behaviour
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Apathy
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Delusions
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Hallucinations
Decline in Self-Care Abilities
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Requires assistance from family members with activities such as dressing, bathing and making telephone calls
Risk Factors for Dementia
Factors associated with an increased likelihood of developing dementia include:
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Older age
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A family history of dementia
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Cardiovascular disease
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High blood pressure, diabetes or high cholesterol
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Smoking or excessive alcohol consumption
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Lower educational attainment
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Other neurological conditions, such as Parkinson’s disease
Ten Warning Signs of Dementia
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Decline in short-term memory
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Difficulty performing familiar tasks
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Frequently misplacing items
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Loss of initiative
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Poor judgement or reduced awareness
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Changes in mood or behaviour
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Difficulty expressing or understanding language
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Changes in personality
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Difficulty with calculations or abstract thinking
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Confusion about time, place or people
Stages of Dementia
Dementia is commonly described in early, middle and late stages. Mild cognitive impairment (MCI) may precede dementia, although not everyone with MCI will go on to develop the condition.
Mild Cognitive Impairment
People with MCI have measurable cognitive difficulties, with memory or other thinking abilities below what would be expected for their age and level of education. Symptoms are relatively mild and do not significantly interfere with daily life. Studies suggest that approximately 10% to 15% of people with MCI develop dementia each year.
Early-Stage Dementia
The person may become increasingly forgetful and experience difficulties with short-term memory. They may find it harder to process new information or learn new things, repeatedly ask the same questions, or frequently forget where they have placed items.
They can usually continue to manage basic self-care but may have difficulty with more complex activities, such as managing finances.
Middle-Stage Dementia
Memory decline becomes more noticeable, and the person may have difficulty retaining new experiences or information. They may become disorientated regarding time and place, get lost easily, or wander.
Difficulties with expressing themselves and understanding others may also develop. Increasing assistance and guidance may be required for daily activities.
Late-Stage Dementia
The person may become unable to care for themselves and require extensive assistance with daily activities. Their speech may become difficult to understand, and their sleep–wake cycle may become reversed. Urinary or faecal incontinence may also occur.
Types of Dementia
Dementia can broadly be divided into primary and secondary dementia.
Primary Dementia
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Alzheimer’s disease
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Vascular Dementia
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Dementia with Lewy bodies
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Fronto-temporal dementia
Secondary Dementia
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Secondary dementia may result from various medical conditions that adversely affect brain cells and cause symptoms of cognitive decline.
How Is Dementia Diagnosed?
The doctor will take a detailed medical history and may carry out a physical examination, cognitive assessments, blood tests and brain imaging. These evaluations help identify the possible cause of the symptoms and rule out other medical conditions that may cause cognitive decline.
Treatment for Dementia
Treatment depends mainly on the type and severity of dementia. The primary aims are to manage symptoms, slow the progression of cognitive decline where possible, help the person maintain independence and self-care abilities for as long as possible, and reduce the burden on caregivers.