✔ Stage 5: The person needs some assistance but is still quite capable of washing, dressing, eating, going to the toilet and choosing appropriate clothes. Forgetfulness in relation to names and places is becoming more severe.
✔ Stage 6: The person is largely unaware of anything that’s happened to him in the recent past. He needs help with most of the basic activities of daily living and may need to be looked after in a care home. Incontinence is common.
✔ Stage 7: By this stage the person is experiencing severe dementia. He’s completely dependent on others for everything, often including mobility. Verbal communication skills are extremely restricted.
Recognising the causes of mild cognitive impairment and taking steps to avoid it
Some cases of mild cognitive impairment are caused by the development of similar protein deposits to those found in Alzheimer’s disease. This finding is perhaps not surprising, considering that those people who go on to develop dementia mostly have Alzheimer’s disease. Other brain changes noted include worsening blood supply and shrinkage of the part of the brain called the hippocampus, which is involved with memory.
No specific treatment for mild cognitive impairment exists and, in particular, no evidence suggests that the drugs used to treat Alzheimer’s disease are any use. You can gain some mileage, however, by addressing risk factors for poor circulation, by controlling your blood pressure, eating a low-fat and high-fibre diet, quitting smoking, drinking alcohol within the limits of recommended guidelines and taking regular physical exercise.
A multi-million-pound industry has developed producing specially designed ‘brain-training’ games and puzzles in response to people’s increasing fear of developing dementia.
In 2009, the Alzheimer’s Society in the UK teamed up with the BBC science programme Bang Goes the Theory to carry out a large-scale experiment looking at the effect of brain training on planning, problem solving and memory. The experiment, ‘Brain Test Britain’, gathered results from 13,000 people, which were then published in Nature, the eminent science journal.
The results clearly showed that while the brain-training exercises made people better at the particularly tasks they were performing, these skills weren’t transferred to other brain skills such as memory and planning. And while the research is continuing for the over 60s, the advice for those worried about cognitive impairment is to save money on these specialised products, because they offer no more benefit than do simple crosswords and puzzles.
A whole host of medical conditions can trigger symptoms in people that are very similar to dementia but don’t fit the full diagnostic criteria for it. These conditions often cause confusion and can stop people functioning normally in daily life, but they’re largely reversible with correct treatment and thus, thankfully, aren’t progressive in the same way as dementia is.
When people visit their doctor with symptoms that could mean dementia is setting in, they undergo a number of initial investigations involving blood and urine tests. Such tests are performed to rule out any reversible causes – most frequently, conditions that either affect the brain and nervous system or result from derangements of various bodily hormones. Acute infections can also trigger confusional states, and long-term alcohol abuse can lead to problems with memory (alongside its more commonly seen propensity to render people confused and disorientated).
Neurological causes
Some of the most well-known medical conditions affecting the brain and nerves have symptoms that can mimic some of the features of dementia alongside their own, more specific features. So doctors may want to rule some of these diseases out of their enquiries before coming to a final diagnosis:
✔ Parkinson’s disease: This condition does have a genuine overlap with dementia, because people with Parkinson’s disease have a higher-than-average risk of also developing dementia. In fact, Parkinson’s disease-related dementia accounts for 2 per cent of all cases.
The symptoms of Parkinson’s disease-related dementia are very similar to those of Lewy body disease, and researchers think that a link may exist between the two. Thus, alongside problems with cognitive function and movement, people also experience visual hallucinations, mood swings and irritability. Medication to help treat the movement difficulties found in Parkinson’s disease, such as tremor and stiffness of muscles, can unfortunately make the symptoms of dementia worse.
✔ Multiple sclerosis: In this disease, the outer coating of nerve cells, called myelin, is deficient in some parts of the nervous system, which means that messages carried by the nerves aren’t transmitted as well as they should be and may not get through at all. If the nerves affected are in the cortex of the brain, which is where most of the ‘clever’ functions people perform are carried out, patients can develop cognitive symptoms including forgetfulness and difficulty with problem solving.
✔ Normal pressure hydrocephalus: The brain and spinal cord are surrounded by cerebrospinal fluid, which supplies nutrients and acts as a shock absorber to protect the nervous system from damage during trauma. People with hydrocephalus have too much of this fluid, and it begins to damage nerve cells because of the increased pressure. Normal pressure hydrocephalus usually begins to develop in people aged 55 to 60.
The damage that normal pressure hydrocephalus causes in the brain produces symptoms similar to those of dementia, accompanied by difficulties with walking and urinary incontinence. Treatment involves fitting a shunt in the brain to allow the fluid to drain. If the treatment is carried out early in the disease process, the success rate for resolving symptoms is at least 80 per cent.
✔ Creutzfeldt–Jakob disease (CJD): This fatal brain disease is, thankfully, rare. It has four types, the most well-known being variant Creutzfeldt–Jakob disease. This version of the disease is believed to be linked to bovine spongiform encephalopathy, better known as BSE or, in tabloid headlines, mad cow disease.
CJD is contagious and is transmitted by an infectious protein called a prion. Once inside the body, prions rapidly destroy brain tissue, leading to death within a year. Symptoms of this awful disease include dementia, unsteadiness, slurring of speech, loss of bladder control and blindness.
✔ Huntington’s disease: Another of nature’s most unpleasant diseases, Huntington’s disease is hereditary and is caused by a defect on chromosome 4. If one parent has the disease, a couple’s children have a 50:50 chance of inheriting the condition. Symptoms don’t develop until middle age, but once they do the disease progresses relentlessly until death. Alongside dementia, sufferers develop jerking movements of their limbs and changes in mood and personality.
Hormonal and nutritional causes
The following conditions are generally not as devastating as the neurological conditions described in the preceding section. Many of the symptoms caused by these conditions are reversible with the correct treatment. Hormonal and nutritional causes of dementia include:
✔ Addison’s and Cushing’s disease: These conditions, named after the doctors who first discovered them, both affect the levels of a hormone called cortisol. In Addison’s not enough cortisol is produced; in Cushing’s too much. The knock-on effect of these altered cortisol levels is a corresponding upset in the levels of some of the minerals in the blood stream,