It is important that the public and professionals have the full facts about dementia. We all know someone who has been affected, and the numbers of people with dementia are rising as the population ages.
There are many common misconceptions about dementia. One of the commonest is that Alzheimers disease is not dementia. We have heard people say “ I don’t mind if its Alzheimers disease, as long as it is not dementia”.
People also believe that dementia is an inevitable part of growing old. But dementia is not a natural consequence of ageing. Most older people do not develop dementia. Approximately 5% of people over 65 have dementia. This number rises with increasing age to 20% of people over the age of 80.
It is not true that nothing can be done about dementia. A great deal can be done. Accurate and early diagnosis of the condition can prevent crises and improve the quality of life of the person with dementia and their family carers.
There is still a sense of stigma about the diagnosis of dementia. But stigma can be reduced. In the past there was huge stigma attached to a diagnosis of TB and of cancer. People did not want it known that the condition was in the family and often the person themselves was shielded from the diagnosis. These are now seen as treatable conditions and are talked about openly without a sense of shame and secrecy.
We hope that with better information and reduced stigma people will be encouraged to come forward earlier for diagnosis and treatment. Currently less than 50% of people ever receive a diagnosis. An accurate diagnosis is essential in order to address needs and to ensure access to services and supports. We believe that people have the right to know their diagnosis if that is their wish.
Often diagnosis occurs late on in the illness, or at a time of crisis, where opportunities for harm prevention and maximisation of quality of life have passed.
At present there are approximately 47,000 people in Ireland who have dementia. That figure will double by 2031 and more than treble by 2041, in the absence of any medical breakthrough, as the proportion of older people in the population increases.
Dementia has profound effects on family carers too, many of whom are themselves elderly with their own health and social care needs. They can have high levels of depression and physical illness and a diminished quality of life too as they care for their loved one. They above all are best qualified to advise on what services are needed throughout the care pathway and progression of the illness.
In all dementias there are structural and chemical changes in the brain leading to the death of brain tissue. The main
sub-types of dementia are Alzheimer’s disease, vascular dementia, mixtures of these two pathologies (‘mixed dementia”) and rarer types such as Lewy body dementia, dementia in Parkinson’s disease and Fronto-temporal dementia..
Early and accurate diagnosis is essential both to confirm the diagnosis and to identify the subtypes but also to identify and treat any reversible conditions which may present as a dementia. Depression in older people can cause symptoms similar to dementia, but these resolve when the depression is adequately treated. Likewise there are medical conditions which impair cognitive functioning. An under-active thyroid, Vitamin B12 and Folate deficiency and even some medications can cause an apparent dementia, which again can be treated successfully.
We now know that the risk factors for heart disease are also of huge importance in the development of dementia. Our risk of dementia may be reduced if we protect our general health by eating a healthy diet, stopping smoking, exercising regularly, drinking less alcohol and generally protecting the brain from injury. “What’s good for the heart is good for the head”. Likewise, when people have dementia, lifestyle can play a very important part in maintaining well being. Regular exercise, a Mediterranean diet, social stimulation and brain stimulation have all been shown to be effective and they are remedies that are readily available.