What is dementia?
Dementia is a medical condition where damage to brain cells causes problems with memory, thinking, behaviour and learning new things.
It's uncommon in people aged under 60. By age 85 around 1 in 5 people will have dementia.
While we all get a bit more forgetful as we get older, dementia is different. It is not a 'normal' part of ageing.
Most causes of dementia are progressive, which means it gets worse over time.
But there are medications and a range of supports – financial, emotional and physical – to help a person with dementia, their family and friends.
What causes dementia?
Dementia is most commonly caused by:
- Alzheimer’s disease (tangles and plaques on the nerves connecting brain cells)
- vascular dementia (caused by strokes or blockages to blood vessels in the brain)
- Lewy body disease (proteins in the brain that damage cells)
- fronto-temporal dementia (in the frontal and temporal lobes of the brain).
A person's genes, environment and lifestyle play a part in developing these diseases.
In most cases, doctors and researchers can't predict who will develop dementia.
Age is the greatest risk factor. High blood pressure, high cholesterol, diabetes, smoking and family history are other risks.
Indigenous Australians are more likely to get dementia. They are also more likely to get it at a younger age.
You can reduce your risk of getting dementia by:
Symptoms of dementia
At first you might notice problems with:
- your memory
- finding the right words when speaking.
For example, you could be:
- making more mistakes at work or at home
- losing a wallet or car keys or putting them in strange places
- finding hobbies like sewing, knitting, or carpentry more difficult
- having trouble keeping track of characters in books or TV shows.
As dementia progresses you might:
- have trouble working out where you are, or what time of day it is
- withdraw from family, friends and social activities
- be unable to remember names, events, places, things and faces
- have mood swings, depression or anxiety
- experience hallucinations
- have changes in your personality
- have changes in your behaviour – you might feel angry or be less inhibited
- be unable to walk, wash or dress
- have problems eating or swallowing.
The early symptoms of dementia can be vague.
If you have concerns about yourself or someone else you should seek help.
Getting help for dementia
As a first step, see your GP (family doctor).
A GP can assess your symptoms and write you a referral to a specialist doctor if required.
In New Zealand, a GP can refer you to a local specialist health service.
Encouraging someone to get help for dementia
It’s common for a person with dementia to be unaware of their condition. They may become defensive if you suggest they might have a problem.
- Make a time for a conversation. You need to have their full attention, so do it when you are both free of distractions.
- Suggest they see their GP for a physical symptom (not sleeping well, for example).
- Make the appointment for them, and arrange transport.
- Write a letter to their GP.
Early and accurate diagnosis of dementia will rule out other treatable issues, and allow you to plan for the future.
Dementia symptoms can be confused with depression, infections and other conditions.
A specialist doctor is best placed to diagnose dementia.
This could be a:
- psychiatrist (mental health specialist)
- psychogeriatrician (psychiatrist specialised in illnesses of the older person)
- geriatrician (specialist in old-age medicine) or
- neurologist (specialist in the brain and nervous system).
Your doctor will only diagnose dementia after a full assessment.
This might include:
- a medical history
- tests of your memory, thinking, mood and behaviour
- blood tests
- a brain scan.
How is dementia treated?
Dementia gets worse over time and, unfortunately, there is no cure. Researchers are working to find new ways to prevent and treat dementia.
But there are ways to help some symptoms and make life easier and more enjoyable.
Psychological treatment, activities and home life
Cognitive behaviour therapy is a psychological treatment. It is helpful for anxiety and depression that can happen with mild dementia.
Cognitive stimulation therapy provides social engagement and activities.
Listening to old music, talking about the past and going through old photo albums may help a person to connect with others.
Later stage dementia
Pets, painting and massage can prevent restlessness and have a calming effect.
An uncluttered, well-lit living space will help someone with dementia.
There are medications available that can help with memory and thinking. They will work for a short time only, from 6 months to 2 years.
Other medications can be prescribed to help with depression, anxiety, agitation or sleeping problems.
Medication will only be suggested if other treatments have been tried and are not working well.
Sometimes medication can make dementia symptoms worse. Talk to your psychiatrist or treating doctor if you have questions.
New treatments are being developed all the time.
A clinical trial is a research study using volunteers to test new medications. It is a good way to access the newest drugs and other treatments.
What can a psychiatrist do for dementia?
A psychiatrist can:
- assess for dementia
- make a diagnosis of dementia
- help you and your family or carers manage the illness
- treat any depression, anxiety or psychotic symptoms (e.g. hallucinations)
- help with behavioural issues such as aggression
- provide referrals to other health professionals
- review your medications to find out if they are causing problems with memory and thinking
- link you into community services
- admit you to hospital if needed
- connect you to relevant clinical trials.
There are some psychiatrists who are experts in treating dementia. They work in hospitals, community settings, residential aged care and private practice.
‘Sometimes there is a bit of stigma there – a person might prefer to see a neurologist rather than a psychiatrist. But where we can really help is if there are psychiatric issues alongside the dementia, like depression or personality changes. As psychiatrists we are able to look at the whole mental and physical picture.’
Associate Professor Stephen Macfarlane, psychiatrist
Support for people with dementia
There are many options to help you to stay active and engaged with your family, friends and community.
There are community services and aged care packages available if you have dementia.
These might include:
- a community nurse who can visit your home
- cleaning services
- respite care
- help with washing and dressing
- medication pre-packaging
- meals on wheels
- attendance at a day centre.
Government aged care services have information on the practical help available in your area.
Australian Government Aged Care 1800 200 422
Health NZ services for older people
Full time care
In the later stages, a person with dementia will need full-time care at home or in residential care.
It's best to begin planning early for this.
Dementia information and support services
Call the national dementia helpline where you live to discuss your situation.
Alzheimer’s Australia 1800 500 100
Alzheimer’s New Zealand 0800 004 001
A dementia diagnosis is a life-changing event.
Some things you can do are:
Helping someone with dementia
Supporting a person with dementia can be challenging. Their care needs might be high. You might feel overwhelmed by the responsibility.
How you can help:
✔ Memory problems should not be ‘written off’ as a normal part of ageing.
✔ Planning and support will make living with dementia easier.
✔ There are medications that can help with the symptoms of dementia.