About dementia

 Find out what dementia is, including what causes it, if it can be prevented and how it's treated. 

What is dementia 

It's normal for your memory to be affected by stress, tiredness, certain illnesses and medicines. But if you're becoming increasingly forgetful, particularly if you're over the age of 65, it's a good idea to talk to a GP about the early signs of dementia.

Memory loss (amnesia) can be annoying if it happens occasionally, but if it's affecting your daily life, or it's worrying you, or someone you know, you should get help from a GP.

Dementia is not only about memory loss. It can also affect the way you speak, think, feel and behave.

It's also important to remember that dementia is not a natural part of ageing.

Dementia is a syndrome (a group of related symptoms) associated with an ongoing decline of brain functioning. There are many different causes of dementia, and many different types. 

People often get confused about the difference between Alzheimer's disease and dementia. Alzheimer's disease is a type of dementia and, together with vascular dementia, makes up the majority of cases.

Symptoms of dementia

Dementia symptoms may include problems with:

• memory loss
• thinking speed
• mental sharpness and quickness
• language, such as using words incorrectly, or trouble speaking
• understanding
• judgement
• mood
• movement
• difficulties doing daily activities

People with dementia can lose interest in their usual activities, and may have problems managing their behaviour or emotions.

They may also find social situations difficult and lose interest in relationships and socialising. 

Aspects of their personality may change, and they may lose empathy (understanding and compassion).

A person with dementia may see or hear things that other people do not (hallucinations and hearing voices).

Because people with dementia may lose the ability to remember events, or not fully understand their environment or situations, it can seem as if they're not telling the truth or are wilfully ignoring problems.

As dementia affects a person's mental abilities, they may find planning and organising difficult. Maintaining their independence may also become a problem.

A person with dementia will usually need help from friends or relatives, including help with making decisions.

The symptoms of dementia usually become worse over time. In the late stage of dementia, people will not be able to take care of themselves and may lose their ability to communicate.

Why it's important to get a diagnosis

Although there is no cure for dementia at the moment, an early diagnosis means its progress can be slowed down in some cases, so the person may be able to maintain their mental function for longer.

A diagnosis helps people with dementia get the right treatment and support. It can also help them, and the people close to them, to prepare for the future.

With treatment and support, many people are able to lead active, fulfilled lives with dementia.

How common is dementia?

In Spain, dementia affects a significant and growing number of people. Recent estimates suggest that around 800,000 people in Spain are living with Alzheimer’s disease, which is the most common cause of dementia, and a large proportion of these are people aged over 65.  

Across the country, prevalence increases with age, and studies indicate that approximately 5–7 % of people aged 65 and older may have some form of dementia.  

Because Spain’s population is ageing rapidly, the number of people affected by dementia is expected to continue rising in the coming decades, placing increasing pressure on health and social care services.

Worried someone has dementia? 

If someone you know is becoming increasingly forgetful, encourage them to see a GP to talk about the early signs of dementia.

There are other reasons why someone might be experiencing memory loss. However, if dementia is found early, its progress can be slowed down in some cases, so the person may be able to maintain their mental function for longer.

Be aware of the signs of dementia

Although dementia is not only about memory loss, that's one of the main signs.

Some of the other signs of dementia include:

• increasing difficulty with tasks and activities that require concentration and planning
• changes in personality and mood
• periods of mental confusion
• difficulty finding the right words or not being able to understand conversations as easily

You may like to suggest you go with your friend or relative to see a GP so you can support them. You'll also be able to help them recall what has been discussed.

A GP will ask how the symptoms have developed over time. They may also do a memory test and physical examination. Blood tests may be done to check if the symptoms are being caused by another condition.

If other causes can be ruled out, the GP may refer your friend or relative to a memory clinic, or other specialist service, where they may have more assessments to confirm whether they have dementia.

How to talk to someone you think has signs of dementia

Talking about memory loss, and the possibility of dementia, can be difficult. Someone who is experiencing these symptoms may be confused, unaware they have any problems, worried, or struggling to accept their condition.

Before starting a conversation with someone you're concerned about, the Alzheimer's Society suggests you ask yourself:

• what could be stopping them from seeing their GP about their memory problems?
• have they mentioned their memory problems?
• do they think their problems are just a natural part of ageing?
• are they scared about what their symptoms could mean for their future?
• do they think there will not be any point in seeking help?
• are you the best person to talk to them about memory problems?
• would they find it reassuring if you offer to go to their GP with them?

When you do talk to them, choose a place that is familiar and not threatening. Also, allow plenty of time so the conversation is not rushed.

If the diagnosis is dementia 

A dementia diagnosis can be a shock, but it's the first step towards getting the information, help and support that's needed to manage their symptoms.

A diagnosis of dementia can also help people with these symptoms, and their families and friends, make plans so they're prepared for the future.

Causes of dementia 

Dementia is a term used to describe the symptoms that occur when there's a decline in brain function.

Dementia is not a single disease. There are different diseases that can cause dementia. Many of these diseases are associated with an abnormal build-up of proteins in the brain.

This build-up causes nerve cells to function less well and ultimately die. As the nerve cells die, different areas of the brain shrink.

Causes of Alzheimer's disease

Alzheimer's disease is the most common type of dementia.

Alzheimer's disease is thought to be caused by the abnormal build-up of 2 proteins called amyloid and tau.

Deposits of amyloid, called plaques, build up around brain cells. Deposits of tau form "tangles" within brain cells.

Researchers do not fully understand how amyloid and tau are involved in the loss of brain cells, but research into this is continuing.

As brain cells become affected in Alzheimer's, there's also a decrease in chemical messengers (called neurotransmitters) involved in sending messages, or signals, between brain cells.

Levels of 1 neurotransmitter, acetylcholine, are particularly low in the brains of people with Alzheimer's disease.

Medicines like donepezil increase levels of acetylcholine, and improve brain function and symptoms.

These treatments are not a cure for Alzheimer's disease, but they do help improve symptoms.

The symptoms that people develop depend on the areas of the brain that have been damaged by the disease.

The hippocampus is often affected early on in Alzheimer's disease. This area of the brain is responsible for laying down new memories. That's why memory problems are one of the earliest symptoms in Alzheimer's.

Unusual forms of Alzheimer's disease can start with problems with vision or with language.

Read more about Alzheimer's disease.

Causes of vascular dementia

Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills brain cells.

This can happen as a result of:

• narrowing and blockage of the small blood vessels inside the brain
• a single stroke, where the blood supply to part of the brain is suddenly cut off
• lots of "mini strokes" that cause tiny but widespread damage to the brain

Not everyone who has a stroke will go on to develop vascular dementia.

Read more about vascular dementia.

Causes of dementia with Lewy bodies

Lewy bodies are tiny clumps of a protein called alpha-synuclein that can develop inside brain cells.

These clumps damage the way the cells work and communicate with each other, and the brain cells eventually die.

Dementia with Lewy bodies is closely related to Parkinson's disease and often has some of the same symptoms, including difficulty with movement and a higher risk of falls.

Causes of frontotemporal dementia

This is an important cause of dementia in younger people. It's most often diagnosed between the ages of 45 and 65.

It's caused by an abnormal clumping of proteins, including tau, in the frontal and temporal lobes at the front and sides of the brain.

The clumping of these proteins damages nerve cells in the frontal and temporal lobes, causing brain cells to die. This leads to shrinking of these areas of the brain.

Frontotemporal dementia is more likely to run in families than other, more common causes of dementia.

Read more about frontotemporal dementia.

Causes of mixed dementia

Mixed dementia is a combination of more than 1 type of dementia.

Vascular dementia and Alzheimer's disease is the most common type of mixed dementia but other combinations are possible.

It can be difficult to know how much each cause is contributing to a person's problems.

Rarer causes of dementia

There are many rarer diseases and conditions that can lead to dementia, or dementia-like symptoms.

They include:

• Huntington's disease
• corticobasal degeneration
• progressive supranuclear palsy
• normal pressure hydrocephalus

Mild cognitive impairment

Mild cognitive impairment (MCI) is not a cause of dementia.

It's a term used to describe minor memory and thinking problems, such as:

• memory loss (amnesia)
• difficulty concentrating
• problems with planning and reasoning

These symptoms are not severe enough to cause problems in everyday life.

MCI can be caused by an underlying illness, such as depression, anxiety or thyroid problems.

If the underlying illness is treated or managed, symptoms of MCI often disappear and cause no further problems.

But in some cases, people with MCI are at increased risk of going on to develop dementia, which is usually caused by Alzheimer's disease.

Can dementia be prevented? 

There's no certain way to prevent all types of dementia, as researchers are still investigating how the condition develops.

However, there's good evidence that a healthy lifestyle can help reduce your risk of developing dementia when you're older.

A healthy lifestyle can also help prevent cardiovascular diseases, such as stroke and heart attacks, which are themselves risk factors for Alzheimer's disease and vascular dementia (the 2 most common types of dementia).

Risk factors for dementia

A risk factor is something that increases your likelihood of developing a condition.

Some dementia risk factors are difficult or impossible to change. These include:

• age: the older you are, the more likely you are to develop dementia. However, dementia is not a natural part of ageing
• genes: in general, genes alone are not thought to cause dementia. However, certain genetic factors are involved with some of the less common types. Dementia usually develops because of a combination of genetic and "environmental" factors, such as smoking and a lack of regular exercise
• air pollution: research suggests that air pollution may affect the brain and could increase the risk of dementia

Research suggests other risk factors may also be important. These include:

• hearing loss
• untreated depression
• loneliness or social isolation
• sitting for most of the day

The research concluded that by modifying the risk factors we are able to change, around 4 in 10 cases of dementia could be prevented.

Experts agree that what's good for your heart is also good for your brain. This means you can help reduce your risk of dementia by:

• eating a balanced diet
• maintaining a healthy weight
• exercising regularly
• keeping alcohol within recommended limits
• stopping smoking
• keeping your blood pressure at a healthy level

Diet and dementia

The risk: a diet that's high in saturated fat, salt and sugar, and low in fibre, can increase your risk of high blood pressure, high cholesterol, becoming overweight or obese, and type 2 diabetes.

What you can do: eat a healthy, balanced diet following the Eatwell Guide.

Weight and dementia

The risk: being overweight or living with obesity can increase your blood pressure and the risk of type 2 diabetes, both of which are linked to a higher risk of Alzheimer's disease and vascular dementia.

What you can do: check if your weight is within the healthy range using the healthy weight calculator. If you are overweight or living with obesity, even losing 5% to 10% of the excess weight can help reduce your risk of dementia.

Exercise and dementia

The risk: a lack of regular physical activity can increase your risk of cardiovascular disease, becoming overweight or obese, and type 2 diabetes, which are all linked to a higher risk of dementia.

Older adults who do not exercise are also more likely to have problems with memory or thinking (known as cognitive ability).

What you can do: follow the recommended guidelines of doing at least 150 minutes of moderate-intensity aerobic activity each week, such as brisk walking, cycling or dancing. You should also do strengthening exercises at least twice a week, such as gardening or yoga.

It's also important to sit less, so try to get up and move around regularly. For example, take the stairs, walk up escalators, and make phone calls while standing up.

Alcohol and dementia

The risk: drinking excessive amounts of alcohol increases your risk of stroke, heart disease and some cancers, as well as damaging your nervous system, including your brain.

What you can do: stick to the recommended limit of drinking no more than 14 units of alcohol a week for both men and women. If you regularly drink as much as 14 units in a week, you should spread your drinking over 3 or more days and have several alcohol-free days each week.

Smoking and dementia

The risk: smoking causes your arteries to become narrower, which can raise your blood pressure. It also increases your risk of cardiovascular disease, as well as several types of cancer.

Depression and dementia

The risk: the relationship between dementia and depression is complex. It appears that having untreated depression increases your risk of developing dementia. However, depression can happen as part of the overall symptoms of dementia itself.

Regardless, low mood, anxiety or depression can all affect your ability to be socially active and engage in mentally stimulating activities.

What you can do: if you're concerned that you, a relative, or a friend may be depressed, talk to a GP. They may refer you for cognitive behavioural therapy (CBT), or a talking therapy.

Try these tips for coping with depression.

What are the treatments for dementia? 

There is currently no cure for dementia. But there are medicines and other treatments that can help with dementia symptoms.

Medicines to treat dementia

Most of the medicines available are used to treat Alzheimer's disease as this is the most common form of dementia. They can help to temporarily reduce symptoms.

The main medicines are:

Acetylcholinesterase inhibitors

These medicines prevent an enzyme from breaking down a substance called acetylcholine in the brain, which helps nerve cells communicate with each other.

Donepezil (also known as Aricept), rivastigmine (Exelon) and galantamine (Reminyl) are used to treat the symptoms of mild to moderate Alzheimer's disease. Donepezil is also used to treat more severe Alzheimer's disease.

There's evidence that these medicines can also help treat dementia with Lewy bodies and Parkinson's disease dementia, as well as people who have a mixed dementia diagnosis of Alzheimer's disease with vascular dementia.

There's little difference in how effective these medicines are. However, rivastigmine may be preferred if hallucinations are one of the main symptoms.

Side effects can include nausea and loss of appetite. These usually get better after 2 weeks of taking the medicine.

Memantine

This medicine (also known as Ebixa, Marixino or Valios) is given to people with moderate or severe Alzheimer's disease, dementia with Lewy bodies and those with a combination of Alzheimer's disease and vascular dementia.

Memantine is suitable for those who cannot take or are unable to tolerate acetylcholinesterase inhibitors. It works by blocking the effects of an excessive amount of a chemical in the brain called glutamate.

Side effects can include headaches, dizziness and constipation, but these are usually only temporary.

Medicines to treat related conditions

There are some conditions, such as heart problems, that can affect symptoms of dementia, particularly vascular dementia. It's important that these are diagnosed and treated.

These conditions include:

• stroke
• heart problems
• diabetes
• high blood pressure (hypertension)
• high cholesterol
• chronic kidney disease
• depression

Medicines to treat challenging behaviour

In the later stages of dementia, a significant number of people will develop what are known as "behavioural and psychological symptoms of dementia (BPSD)". The symptoms of BPSD can include:

• increased agitation
• anxiety
• wandering
• aggression
• delusions
• hallucinations

These changes in behaviour can be very distressing, both for the person with dementia and for the person caring for them. However, there are coping strategies that can help.

If coping strategies do not work, antipsychotic medicines such as risperidone or haloperidol may be prescribed for those showing persistent aggression or extreme distress.

These are the only medicines licensed for people with moderate to severe Alzheimer's disease (risperidone and haloperidol) and vascular dementia (just haloperidol) where there's a risk of harm to themselves or others.

Risperidone should be used at the lowest dose and for the shortest time possible with regular reviews at least every 6 weeks. Like all medicines, risperidone can cause side effects, although not everyone gets them.

Haloperidol can be used only if other treatments have not helped.

The decision to prescribe a medicine should be taken by a consultant psychiatrist.

Antidepressants may sometimes be given if depression is suspected as an underlying cause of anxiety.

Alternative remedies

Some people with dementia and their carers use complementary remedies, such as gingko biloba, curcumin or coconut oil. However, there's not enough evidence to say whether such remedies are effective.

It's best to be wary of any products that claim to benefit people with dementia. If you're thinking of taking such a product or supplement, it's important to consult a doctor first.

Some remedies interact with prescribed medicines and they should never be taken as a substitute.

Treatments that do not involve medicines

Medicines for dementia symptoms are important, but are only one part of the care for a person with dementia. Other treatments, activities and support – for the carer, too – are just as important in helping people to live well with dementia.

Cognitive stimulation therapy

Cognitive stimulation therapy (CST) involves taking part in group activities and exercises designed to improve:

• memory
• problem-solving skills
• language ability

Evidence suggests that CST benefits people with mild to moderate dementia.

Cognitive rehabilitation

This technique involves working with a trained professional, such as an occupational therapist, and a relative or friend to achieve a personal goal, such as learning to use a mobile phone or other everyday tasks.

Cognitive rehabilitation works by getting you to use the parts of your brain that are working to help the parts that are not. In the early stages of dementia, it can help you cope better with the condition.

Reminiscence and life story work

Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music.

Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.

These approaches are sometimes combined. Evidence shows that they can improve mood and wellbeing. They also help you and those around you to focus on your skills and achievements rather than on your dementia.

Is there a cure for dementia? 

There is currently no cure for dementia. In fact, because dementia is caused by different diseases it is unlikely that there will be a single cure for dementia.

Research is aimed at finding cures for dementia-causing diseases, such as Alzheimer's disease, frontotemporal dementia and dementia with Lewy bodies.

Read more about the causes of dementia

Huge strides have been made in understanding how different diseases cause damage in the brain and so produce dementia. And with increased funding over the past few years, there are now many more research studies and clinical trials taking place.

Although a cure may be some years away, there are some very promising advances.

Here are some of the areas researchers are working on and their findings so far.

Stem cells and dementia

Stem cells are building block cells. They can develop into many different cell types, including brain or nerve cells.

Scientists have taken skin cells from people with certain types of dementia, such as Alzheimer's disease, and reprogrammed them into stem cells in the lab. They've then triggered these stem cells to become brain cells.

By studying these cells, scientists have gained important insights into how the damage to the brain begins and how it might be halted.

These brain cells can also be used to test potential treatments at a very early stage.

Immunotherapy

Immunotherapy involves boosting the body's immune system to fight disease. It's been effective at treating some other long-term diseases such as cancer.

Different types of immunotherapy treatment for dementia have been trialled in recent years, or are currently being studied. For example, some studies have tried using a vaccination against abnormal proteins that build up in the brain in Alzheimer's disease. Other studies have used monoclonal antibodies (artificial versions of immune system antibodies) to target the abnormal proteins to try to slow the disease progressing.

These studies have had mixed results so far, with some being unsuccessful. But some monoclonal antibody medicines have shown promising results, and are now being considered as treatments for Alzheimer's.

Another area being explored by researchers involves specialised immune cells in the brain called microglia. These cells are involved in clearing out debris from the brain.

In Alzheimer's disease, these immune cells appear to become overactive, which may be causing further damage to the brain. Current studies are trying to identify how to prevent this.

Gene-based therapies

There is great interest in using gene-based therapies to target genes that can cause dementia, such as Alzheimer's disease or frontotemporal dementia.

These gene-based therapies are also being used to reduce the production of proteins involved in a dementia-causing disease, such as tau in Alzheimer's disease.

Repurposing medicines

Developing new medicines to treat dementia takes many years and millions of pounds.

Repurposing existing drugs used for other conditions is another, often quicker, way of finding medicines to treat dementia.

Current medicines being explored as possible treatments for Alzheimer's and vascular dementia include those used for:

• type 2 diabetes
• high blood pressure
• erectile dysfunction

Identifying who's at risk of dementia

Experts know that damage to the brain caused by Alzheimer's disease can start many years before symptoms appear. If people at risk of Alzheimer's could be identified at an early stage, it is hoped that treatments could be offered that would slow down or even stop the disease.

Specialised brain scans, known as PET scans, have been developed to study two proteins (amyloid and tau) in the brains of those with Alzheimer's disease. The aim is to increase the understanding of the disease process, and also to identify those people who will benefit most from new drug treatments.

Although PET scans are sometimes used to help with a dementia diagnosis, these highly specialised scans are usually only available as part of clinical trials.

A number of different trials are now under way in people who are currently well but are at increased risk of Alzheimer's disease.

Prevention is important

Even if we find an effective cure for dementia, it would be better to try to prevent it happening in the first place.

Research has shown that the risk factors for heart disease and stroke – such as raised blood pressure, diabetes, obesity and smoking – are also risk factors for dementia. By modifying or changing these risk factors in mid-life, the risk of dementia could be reduced by up to 30%.