"Being diagnosed with Alzheimer’s disease is not the end of the world, whilst appreciating that things have changed, there’s still a whole world to enjoy." Pat

Dementias are a group of disorders which are characterised by progressive loss of function and memory. The loss of function may extend to activities of daily living for example inability to wash, dress, cook, feed, of handle money.

There are many different types of dementias but I would limit myself to the two most common kinds:

• Alzheimers Dementia
• Vascular Dementia

There is a discussion on HIV dementia in the HIV section

Alzheimer's Dementia

Alzheimer, is a physical disease affecting the brain. During the course of the disease 'plaques' and 'tangles' develop in the structure of the brain, leading to the death of brain cells.
Alzheimer's is a progressive disease, which means that gradually, over time, more parts of the brain are damaged. As this happens, the symptoms become more severe.

What are the Symptoms
People in the early stages of Alzheimer's disease may experience lapses of memory and have problems finding the right words. As the disease progresses they may:

• Become confused, and frequently forget the names of people, places, appointments and recent events.
• Experience mood swings. They may feel sad or angry. They may feel scared and frustrated by their increasing memory loss.
• Become more withdrawn due either to a loss of confidence or to communication problems.

What causes Alzheimer's disease?
Age is the greatest risk factor for dementia. Dementia affects one in 20 people over the age of 65 and one in five over the age of 80. However, Alzheimer's is not restricted to elderly people.
Alzheimer's can run in families and when it does, relatives tend to get it at younger ages.
People with Down's syndrome who live into their 50s and 60s may develop Alzheimer's disease.
People who have had severe head or whiplash injuries appear to be at increased risk of developing dementia. Boxers who receive continual blows to the head are also at risk.
People who smoke and those who have high blood pressure or high cholesterol levels increase their risk of developing Alzheimer's.

How is it diagnosed
There is no straightforward test for dementia. A diagnosis is usually made by excluding other causes.
The person being tested will usually be given a blood test and a full physical examination to rule out or identify any other medical problems. The person's memory will be assessed, initially with questions about recent events and past memories. Their memory and thinking skills may also be assessed in detail by a psychologist.
A brain scan may be carried out to give some clues about the changes taking place in the person's brain. There are a number of different types of scan, including CT (computerised tomography) and MRI (magnetic resonance imaging). A SPECT scan can be diagnostic.

Treatment
There is currently no cure for Alzheimer's disease. However, there are a number of drug treatments available that can ameliorate the symptoms or slow down the disease progression in some people.
People with Alzheimer's have been shown to have a shortage of the chemical acetylcholine in their brains. The drugs Donapezil, Rivastigmine and Galantamine work by maintaining existing supplies of acetylcholine. These drugs are only helpful for people with mild to moderate dementia. Side-effects may include diarrhoea, nausea, insomnia, fatigue and loss of appetite.
A drug called Memantine works in a different way to the other three - it prevents the excess entry of calcium ions into brain cells. Excess calcium in the brain cells damages them and prevents them from receiving messages from other brain cells. Memantine is the only drug that is suitable for use in people in the middle to later stages of dementia. Side-effects may include hallucinations, confusion, dizziness, headaches and tiredness.
These drugs are not a cure, but they may stabilise some of the symptoms of Alzheimer's disease for a limited period of time.

VASCULAR DEMENTIA

This is the second most common form of dementia after Alzheimers. The demetia is caused when blood cannot reach the brain and its cells die.

What causes it

There are a number of conditions that can cause or increase damage to the vascular system of the brain. These include high blood pressure, heart problems, high cholesterol and diabetes. Vascular dementia is common after stroke (haemorrhage). The risk is increased with smoking and alcoho.

What are the symptoms

Some symptoms may be similar to those of other types of dementia. However, people with vascular dementia may particularly experience:

• Problems concentrating and communicating
• Depression accompanying the dementia
• Symptoms of stroke, such as physical weakness
  or paralysis
• Memory problems (although this may not be the first symptom)
• A ‘stepped’ progression, with symptoms remaining at a constant level and then suddenly deteriorating
• Epileptic seizures
• Periods of acute confusion.
• Hallucinations (seeing things that do not exist)
• Delusions (believing things that are not true)
• ‘Wandering’ and getting lost
• Physical or verbal aggression
• Restlessness
• Incontinence.

How is it treated

Although the brain damage that causes vascular dementia cannot be reversed, it may be possible to slow the progression of the disease in a number of ways including:

• Taking medication to treat any underlying conditions, such as stroke, high blood pressure, high cholesterol, diabetes or heart problems
• Adopting a healthier lifestyle by stopping smoking, taking regular exercise, eating healthily and only drinking alcohol in moderation
• Receiving rehabilitative support, such as physiotherapy, occupational therapy and speech therapy, to help the person maximise their opportunities to regain their lost functions.

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