What is dementia?

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Dementia is not a normal part of ageing. It is caused by damage to brain cells that affects their ability to communicate, which can affect thinking, behaviour and feelings.  

Common symptoms are:

• Memory loss
• Reduced concentration
• Confusion and disorientation
• Struggling with conversations, finding the right words Mood changes

Our specialist, Dr Singhai, who is a specialist in both cognitive and movement disorders, has extensive experience, knowledge and skills  in the diagnosis and management of the various causes of memory problems ranging from Mild Cognitive Impairment to the common causes of Dementia such as Alzheimers’s Dementia, Vascular Dementia and Lewy Body Dementia. Alzheimer’s is a specific disease and is the most common cause of dementia.

Mild Cognitive Impairment (MCI)

Mild cognitive impairment (MCI) is a condition in which someone has problems with cognition, whereby their mental abilities such as memory and thinking are worse than would normally be expected for a healthy person of their age. The symptoms are not severe enough to interfere significantly with daily life, and so are not defined as dementia, but a person with MCI can be more likely to go on to develop dementia.  People who are diagnosed with MCI can use this as an opportunity to make lifestyle changes and adopt preventive strategies to help reduce their chances of MCI progressing to dementia.

Alzheimer’s Dementia

Alzheimer’s is a degenerative brain disease in which there are damaged synaptic connections. This reduces the levels of important neurotransmitters within the brain and leads to symptoms that gradually worsen over time. The most common early symptom of Alzheimer’s is trouble remembering new information. This is because the disease typically impacts the part of the brain associated with learning first.

Vascular Dementia

Vascular dementia is caused by reduced blood supply to the brain due to diseased blood vessels.  The blood vessels either leak or become blocked so that oxygen and nutrients cannot reach the brain cells and they eventually die. This death of brain cells can cause problems with memory, thinking or reasoning. Vascular dementia can sometimes develop abruptly after an acute stroke or have a step wise deterioration due to smaller strokes.

Lewy Body Dementia

In Dementia with Lewy Bodies (DLB) clumps of a protein called alpha-synuclein aggregate in the brain’s nerve cells. DLB causes problems relating to both cognition and movement, particularly Parkinson’s symptoms such as tremor, stiffness and slowness of movements which can only really be identified by a Movement Disorders Specialist, especially when they are subtle. Lewy Body Dementia is the third most common cause of dementia affecting approximately 1 in 5 people with dementia. However, it is commonly not diagnosed, or misdiagnosed as Alzheimer’s Dementia.

Behavioural and Psychological Symptoms of Dementia (BPSD)

Dr Singhai also has extensive experience in the management of the Behavioural and Psychological Symptoms related to Dementia (BPSD). Behavioural and psychological symptoms of dementia (BPSD) include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviours. One or more of these symptoms will affect nearly all people with dementia over the course of their illness and usually are quite distressing for the affected individual and their families  often leading to loss of independence for the affected person and increased care needs. 

These “BPSD” symptoms require careful skilled and diligent assessment and are amenable to various forms of  treatment to improve quality of life for the patient and their families. Many patients with cognitive problems and dementia often decompensate because of underlying medical problems which can be can only be identified and treated by a specialist who has experience in both cognitive disorders and general medicine experience which other specialists such as psychiatrists and neurologists do not have.

The above article was written by Dr Soumit Singhai (Dementia Specialist based at 25 Harley Street in London)