Dementia

Dementia is a term used to describe a variety of signs and symptoms which affect the cognitive and behavioural abilities of an individual (National Institute for Health and Care Excellence (NICE), 2018). The various diseases which cause dementia are all progressive and will inevitably lead to the individual’s death.

The signs and symptoms of dementia vary widely depending on:

• the type of dementia
• how advanced the dementia is
• any accompanying illnesses (eg a urinary tract infection and mental health issues)

The most common signs and symptoms of dementia include:

• short-term, and eventually longer-term, memory loss
• inability to make simple choices and decisions
• becoming repetitive and fixated on some routines
• being disorientated including in:
  • time (such as the time of day)
  • place
  • person (including forgetting who others are)
• inability to remember some words
• difficulties with holding a conversation
• seeing the world in two, rather than three, dimensions
• mood changes such that people become uncharacteristically:
  • apathetic
  • withdrawn
  • frustrated
  • sad
  • angry
• becoming delusional, hallucinating and paranoid
• forgetting how to interact with people and social norms
• becoming disinhibited
• feeling anxious and insecure and seeking comfort, for example asking about people who died long ago (Vik-Mo et al, 2018)

As the disease progresses, these signs and

Dementia has many causes, some of which are known and others which are speculative. Some dementias are caused by the deposition of proteins in the brain, for example Alzheimer’s disease, while others are associated with infections, such as human immunodeficiency virus.  Other dementias are associated with more systemic disease such as cardiovascular disease, for example vascular dementia; while some disease may relate to lifestyle choices such as excessive alcohol use or smoking (NICE, 2019).

Given the signs and symptoms of dementia, diagnosis is often made after other causes of ill health have been excluded. For example, an older person might visit their GP with ‘depression’ which is later linked to them having dementia, or headaches which require issues such as tumours and haemorrhages in the brain to be excluded.

There are many different types of dementia, the diagnosis of which is made through a combination of:

• consideration of the signs and symptoms (often gained from family members and/or carers)
• understanding the person’s life history (eg obtaining a comprehensive understanding of their lifestyle choices such as smoking and alcohol use)
• reviewing the person’s medical history (eg a history of Parkinson’s disease and previous brain injuries)
• considering the family history of disease (eg Alzheimer’s disease affecting a parent)
• blood tests (to exclude issues such as hypothyroidism and active infection)
• various tests of memory and cognitive function

The management of dementia depends to a great extent on the underlying causes.

Medical management of dementias relies on:

• acetylcholinesterase inhibitors - inhibit the breakdown the neurotransmitter acetylcholine providing some symptom relief relating to cognitive decline
• memantine hydrochloride - used to moderate the activity of some neurochemicals in people living with Alzheimer’s disease slowing the progression of symptoms
• antipsychotics - used specifically to manage extreme distress and agitation under the supervision of a specialist, for example haloperidol and risperidone (NICE, 2024)

Some diseases, primarily dementia with Lewy bodies, do not tend to respond well to drug therapies, so most of the management relies on non-medical therapies and the management of the person’s physical environment including:

• noise reduction
• simple signposting, eg pictorial signs on toilet doors
• removing items which may prove unsafe, eg matches and knives
• good lighting during waking hours and limited lighting at night (Social Care Institute for Excellence,

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages

Part 2: Procedures for the planning, provision and management of person-centred nursing care

3. Use evidence-based, best practice approaches for meeting needs for care and support with rest, sleep, comfort and the maintenance of dignity, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

11. Procedural competencies required for best practice, evidence-based medicines administration and optimisation

Gupta A. BMJ best practice: assessment of dementia. 2024. https://bestpractice.bmj.com/topics/en-gb/242 (accessed 6 February 2024)

National Institute for Health and Care Excellence (NICE). Dementia: assessment, management and support for people living with dementia and their carers. 2018. https://www.nice.org.uk/guidance/ng97 (accessed 6 February 2024)

National Institute for Health and Care Excellence (NICE). Dementia: quality standard. 2019. https://www.nice.org.uk/guidance/qs184 (accessed 6 February 2024)

National Institute for Health and Care Excellence (NICE). Dementia. 2024. https://cks.nice.org.uk/topics/dementia/ (accessed 6 February 2024)

Sandilyan MB, Dening T. Signs and symptoms of dementia. Nursing Standard. 2015;29(41):42. https://doi.org/10.7748/ns.29.41.42.e9440.

Social Care Institute for Excellence. Dementia-friendly environments. 2024. https://www.scie.org.uk/dementia/supporting-people-with-dementia/dementia-friendly-environments/(accessed 6 February 2024)

Soong A, Au S, Kyaw B, et al. Information needs and information seeking behaviour of people with dementia and their non-professional caregivers: a scoping review. BMC Geriatrics. 2020;20:61. https://doi.org/10.1186/s12877-020-1454-y

Vik-Mo AO, Giil LM, Ballard C, Aarsland D. Course of neuropsychiatric symptoms in dementia: 5-year longitudinal study. Int J Geriatr Psychiatry. 2018;33:1361–1369. https://doi.org/10.1002/gps.4933