WHAT IS DEMENTIA
Many people, including many members of the medical profession are confused about dementia and its relationship to Alzheimer’s disease
If you consult the World Health Organisation (WHO) International Classification of Diseases it says that Dementia is classified as an “organic mental disorder” namely one caused by damage to the brain, as distinct from schizophrenia which is a disorder of the mind. For diagnosis of dementia the WHO require evidence of
Dementia is a condition that some people develop in old age. This is characterised by confusion and memory problems and its effect on the individual affected is determined by the degree of severity of the dementia, their personality before the dementia developed and by their social circumstances and support.
Alzheimer’s Disease is a disease of the brain of unknown cause and is one of the principal causes of dementia but it seems that there are some people who do develop Alzheimer’s Disease but who develop no symptoms of dementia.
Vascular dementia is the other principal cause of dementia and results from impairments of the supply of oxygen rich blood to the brain, due to disease affecting the arteries of the brain. These two conditions often occur together
The other causes of dementia are a set of less common diseases such as Pick's Disease or some types of Parkinson’s Disease
There is one more term which we need to explain that you may see in the newspapers or on the web – Mild Cognitive Impairment
Mild Cognitive Impairment (MCI)
This is a more problematic term. The American Alzheimer’s Association and the Alzheimer’s Societies of Canada and the UK define it as a disorder that
Why is dementia important?
The brain like all other organs is affected by the normal biological ageing process which has two effects in any tissue or organ. One is a loss of the maximum level of ability you can achieve. For example even if Bradley Wiggins had continued to train he would not have been able to improve his world records because the maximum rate at which his heart could beat decreases from about forty on. The second effect is loss of resilience, the ability to bounce back after an injury or the onset of a disease or when there is a change in environmental temperature. Resilience is reduced by the normal ageing process.
The activities of the brain and the mind are usually classified as being either to do with emotion (feeling) or cognition (logical thinking) and it is the latter that is of greater concern because as what is called normal ageing occurs the brain loses some of the ability to carry out activities such as quick decision making and remembering. Of these remembering is most widely recognised and talked about and many people worry that memory slips are the early signs of dementia. Memory slips are not a sign that dementia will inevitably develop and listed in the box below are common memory slips that occur frequently and normally: -
The other type of change that is common and obvious is the loss of ability to make decisions quickly, for example if competing in a television or pub quiz, and much is made of the superior ability of young people’s decision making speed. However, speed is only one criterion by which the quality of a decision should be judged. You certainly need quick decision making if you are flying a fighter jet. However not many people need these skills, and of course, computers with artificial intelligence – the robots - are taking over many of the tasks that require rapid decision making and hand/eye coordination. Furthermore, many decisions do not have such time pressure, decisions about work and social life for example, and it is possible to make such decisions too quickly. Oscar Wilde wrote that “experience is the name we give to our mistakes” and the importance of experience is now recognised. Older people have more experience and are certainly no worse at making decisions that matter than young people and may even be better because they don’t make decisions so quickly, having made so many wrong decisions before. And the American College of Physicians , a highly respected and scientific organisation emphasised in their report on ageing that although “some cognitive functions, such as memory and reaction time, decrease others such as wisdom and knowledge, increase with age”
So, dementia is a condition that is different from normal ageing. It may be caused by a number of disorders, one of which, Alzheimer’s diseases, has no known cause and therefore no means of prevention. The importance of dementia is that it makes it difficult to live on your own and it is therefore the single commonest cause of disability
Many people, including many members of the medical profession are confused about dementia and its relationship to Alzheimer’s disease
If you consult the World Health Organisation (WHO) International Classification of Diseases it says that Dementia is classified as an “organic mental disorder” namely one caused by damage to the brain, as distinct from schizophrenia which is a disorder of the mind. For diagnosis of dementia the WHO require evidence of
- “A decline in memory, which can be “mild”, “moderate” or “severe” and
- A decline in other cognitive abilities characterized by deterioration in judgement and thinking, such as planning and organising “and again this deterioration can be graded “mild”, “moderate” or “severe.”
Dementia is a condition that some people develop in old age. This is characterised by confusion and memory problems and its effect on the individual affected is determined by the degree of severity of the dementia, their personality before the dementia developed and by their social circumstances and support.
Alzheimer’s Disease is a disease of the brain of unknown cause and is one of the principal causes of dementia but it seems that there are some people who do develop Alzheimer’s Disease but who develop no symptoms of dementia.
Vascular dementia is the other principal cause of dementia and results from impairments of the supply of oxygen rich blood to the brain, due to disease affecting the arteries of the brain. These two conditions often occur together
The other causes of dementia are a set of less common diseases such as Pick's Disease or some types of Parkinson’s Disease
There is one more term which we need to explain that you may see in the newspapers or on the web – Mild Cognitive Impairment
Mild Cognitive Impairment (MCI)
This is a more problematic term. The American Alzheimer’s Association and the Alzheimer’s Societies of Canada and the UK define it as a disorder that
- causes more serious cognitive changes than are observed in normal ageing but are
- changes not severe enough to interfere with daily life or independent function.
Why is dementia important?
The brain like all other organs is affected by the normal biological ageing process which has two effects in any tissue or organ. One is a loss of the maximum level of ability you can achieve. For example even if Bradley Wiggins had continued to train he would not have been able to improve his world records because the maximum rate at which his heart could beat decreases from about forty on. The second effect is loss of resilience, the ability to bounce back after an injury or the onset of a disease or when there is a change in environmental temperature. Resilience is reduced by the normal ageing process.
The activities of the brain and the mind are usually classified as being either to do with emotion (feeling) or cognition (logical thinking) and it is the latter that is of greater concern because as what is called normal ageing occurs the brain loses some of the ability to carry out activities such as quick decision making and remembering. Of these remembering is most widely recognised and talked about and many people worry that memory slips are the early signs of dementia. Memory slips are not a sign that dementia will inevitably develop and listed in the box below are common memory slips that occur frequently and normally: -
- Inability to record the name of someone met yesterday.
- Forgetting where the car keys are.
- Ringing the mobile phone to find out where in the house it is, and hoping that it is not on silent.
- Inability to recall the author of a book which made a great impression when read twenty years ago.
- Failure to remember if one has double locked the front door or not.
The other type of change that is common and obvious is the loss of ability to make decisions quickly, for example if competing in a television or pub quiz, and much is made of the superior ability of young people’s decision making speed. However, speed is only one criterion by which the quality of a decision should be judged. You certainly need quick decision making if you are flying a fighter jet. However not many people need these skills, and of course, computers with artificial intelligence – the robots - are taking over many of the tasks that require rapid decision making and hand/eye coordination. Furthermore, many decisions do not have such time pressure, decisions about work and social life for example, and it is possible to make such decisions too quickly. Oscar Wilde wrote that “experience is the name we give to our mistakes” and the importance of experience is now recognised. Older people have more experience and are certainly no worse at making decisions that matter than young people and may even be better because they don’t make decisions so quickly, having made so many wrong decisions before. And the American College of Physicians , a highly respected and scientific organisation emphasised in their report on ageing that although “some cognitive functions, such as memory and reaction time, decrease others such as wisdom and knowledge, increase with age”
So, dementia is a condition that is different from normal ageing. It may be caused by a number of disorders, one of which, Alzheimer’s diseases, has no known cause and therefore no means of prevention. The importance of dementia is that it makes it difficult to live on your own and it is therefore the single commonest cause of disability
