It starts off small — a lost word, a misplaced item, a stumble in familiar territory. Almost indistinguishable signs. For who hasn't had a word 'on the tip of their tongue', forgotten where they left the car keys and been puzzled by complex book or movie?

But when 'whatyoumacallit' and 'thingymajig' become regular word placeholders, the keys find their way into the freezer and 'Bee Movie' sparks confusion, it is time to become concerned. These may be the early symptoms of dementia.

Yes, dementia is terrifying. We hate to see our infallible parents or grandparents losing a grip on reality. We are filled with pity as they struggle to do what once came easily. We are saddened by the premature and unfair loss. And we are terrified that, one day, we may face the same demons.

But ignoring the signs won't make it any less real.

In fact, there are numerous benefits to paying attention to the signs and seeking help early. While most forms of dementia are irreversible, some are not. Furthermore, early intervention can sometimes slow the progress of the condition.

A frightening reality

Although a diagnosis can be frightening, it also gives the patient an opportunity to decide while they still can how they would like their affairs to be managed once they no longer have full control. It opens the door to compassion and, hopefully, assures the patient that they will not have to face the scary changes alone.

Dementia is not a disease, but rather an umbrella term for a variety of symptoms that are characterised by a decline in memory, reasoning and other cognitive functions.

The decline usually impairs the individual's ability to carry out everyday activities, leading eventually to total dependence on others. Although dementia is most common in elderly people (it affects 30 to 50 percent of people over the age of 85), it is not an inevitable consequence of ageing.

Causes of dementia

The most common cause of dementia, accounting for about half of all cases, is Alzheimer's disease. The causes of Alzheimer's disease are not yet fully known.

The disease is characterised by loss of neurons and synapses in the cerebral cortex and certain sub cortical regions which control memory, language, perceptual skills, attention, orientation and problem solving.

Alzheimer's is believed to be at least partially hereditary and although it is not reversible and has no cure, the progress of the disease can be slowed with medication.

The second most common, but less well-known, cause of dementia is vascular (or multi-infarct) dementia (accounting for up to almost 40 percent of cases).

This is caused by the hardening of arteries (atherosclerosis). Deposits of fats and dead cells form inside the arteries, blocking blood flow and causing multiple mini-strokes or interruptions of blood flow to the brain.

Vascular dementia is related to high blood pressure, high cholesterol, heart disease and diabetes. Treating these conditions therefore, can slow the progress of the dementia. However, once functions have been lost, the loss is permanent.

There are other, less common, irreversible causes of dementia including Parkinson's disease, Lewy body dementia, Huntington disease, Creautzfeldt-Jakob disease and Pick disease (frontotemporal dementia).

However, dementia can also be caused by treatable conditions, in which case the dementia may be reversible or partially reversible.

These conditions include meningitis, HIV/Aids, syphilis, hydrocephalus, brain tumours, metabolic disorders (diseases of the liver, kidneys or pancreas), hormonal disorders (thyroid, pituitary and adrenal glands) and hypoxia (poor oxygenation).

Dementia can also be caused by exposure to toxic substances, drug reactions (or abuse), chronic alcoholism and nutritional deficiencies (particularly vitamin B deficiencies).

Early symptoms of dementia

  • Memory loss, particularly short-term memory loss (a difficulty to retain new information).

  • Word-finding difficulty — at first the individual may be able to compensate by using synonyms or defining the word, but this will become increasingly difficult.

  • Forgetfulness — names, appointments, items, relationships, whether or not something has been done.

  • Misplacing things — more frequently than in the past and often in unusual places.

  • Difficulty performing familiar tasks — driving, cooking, household chores, personal finances.

  • Problems keeping track of things — a conversation, a movie or a bank account.

  • Personality changes, uncharacteristic behaviour, sudden mood swings, poor judgment and mild paranoia or increased suspiciousness.

  • Confusion or disorientation in unfamiliar (and later familiar) surroundings.

  • Loss of initiative

  • Physical symptoms, which often precede cognitive ones, may include a slowing gait, poor balance and a weak handgrip.

    • What can you do?

    Individuals with dementia should try to stay physically, mentally and socially active.

    By taking mild daily exercise and following a healthy diet (of low-fat proteins, fruit and vegetables), you will be able to keep conditions which might exacerbate the dementia (such as high blood pressure and high cholesterol) at bay.

    While mental activity will obviously be a little more challenging than it was in the past, it is believed to slow the progress of some types of dementia. Activities such as reading, puzzles, games and crafts are all useful.

    Finally, remember that if you find the topic of dementia terrifying, it is probably infinitely more so for the individual suffering from the condition. Assure them of your support; be patient; and try to remember that behind the befuddlement, there is an individual whose opinion you once valued.


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