Frequently Asked Questions

There is no single cause of dementia. Dementia is a general term that describes the symptoms seen in a number of conditions affecting the brain, such as decline in memory and thinking skills. We outline the most common causes of dementia here

Early diagnosis can have a number of benefits:

  • Diagnosis provides access to dementia treatments. Although there is currently no cure for most types of dementia there are medications that assist with some of the symptoms, and these can only be prescribed when a formal diagnosis has been made. There is the opportunity to access trial therapies.
  • Early diagnosis gives the person with dementia an opportunity to plan for their future while they are still able to make decisions about how they wish to spend the years ahead, their care and support preferences, and time to address financial and legal matters.
  • Early diagnosis enables access to the services, resources and community supports available for people with dementia, such as education and support groups, as well as health and lifestyle initiatives to slow the progression of the condition.
  • Family members and friends can benefit from early diagnosis as it gives them the opportunity to learn about the condition and how to best support their loved one.
  • Although it is upsetting to find out that the cause of cognitive changes is dementia, receiving a diagnosis can provide answers, relieve some fear and uncertainty, and enable the person and their family to develop a pathway forward.

As an expert multidisciplinary service, SMS focuses on more than medical management of dementia and cognitive impairment. In addition to diagnosis and treatment, we can provide practical and safety advice, assist patients with accessing community services, provide carer support and education about dementia. SMS staff have extensive experience in a range of common and rare dementia syndromes and their management.

Minor thinking changes can occur as a person gets older, such as being a little slower to bring things to mind or finding it harder to multi-task.  These changes are subtle and do not interfere greatly with daily life.

Significant changes in memory or thinking are not a normal part of aging.  Loss of memory or change in behaviour and/or thinking skills that is severe enough to interfere with daily life should be investigated.

Changes often emerge gradually and it can be hard to know whether to be concerned.  If you are unsure about the changes you have noticed, consider seeing your GP to determine whether further investigation is indicated.

Dementia is a general term that describes the symptoms seen in a number of conditions affecting the brain, such as decline in memory and thinking skills. Alzheimer’s disease is a specific condition that causes dementia. Alzheimer’s disease is the most common cause of dementia. We describe Alzheimer’s disease in more detail here.

Unfortunately there is currently no cure for most types of dementia, however, there are medical treatments available for some conditions.

Medication can help with some of the symptoms of dementia:

  • Memory enhancing medications may improve symptoms or plateau decline for a period of time in people with Alzheimer’s disease
  • Medicines for significant symptoms of depression, anxiety, sleep disturbance, hallucinations, delusions or agitation may be appropriate for some people with dementia

There is some evidence in favour of the nutritional supplement drink ‘Souvenaid’.

Non-drug therapies such as allied health (including physiotherapy, dietetics, exercise physiology, music therapy, psychology, podiatry, occupational and speech therapy), implementing routines and structured activities, education/support groups etc. can assist in the management of dementia. Such approaches offer a means to address communication issues, safety concerns, general and physical health, mobility issues, carer coping/understanding, nutrition, continence and a range of other day-to-day and quality-of-life considerations.

As there is no cure for dementia and current medical treatments are limited, non-drug therapies and approaches that promote the independence, engagement and safety of the person with dementia are of considerable importance in assisting people with dementia to live well with their condition.

The terms early- and younger-onset dementia describe any form of dementia diagnosed in people before age 65.  Dementia that occurs from age 65 is called late onset dementia.

In the younger-onset group there may be a need to investigate for rarer causes of dementia, including genetic contributions and therefore significant consideration is given to any family history of dementia.

In both younger and late onset groups Alzheimer’s disease still represents the most common cause of dementia. Alzheimer’s in the younger age group may present with symptoms other than memory. These include planning and judgement issues, word-finding difficulties and visuospatial impairments.

In the younger onset group we see a greater proportion of frontotemporal dementia cases which represents the second most common cause.

In the late onset group it is more likely there is more than one cause for the dementia (‘mixed dementia’) such as the combination of Alzheimer’s disease and vascular dementia.

Rather than receiving a general diagnosis of dementia, wherever possible it is important to identify the specific cause of the dementia, because:

  1. Different types of dementia present specific symptoms over time. These symptoms are best managed with an individualised approach tailored to the patient and their condition.
  2. Different types of dementia have different rates of progression. It is more difficult for the person and family to plan ahead if they are unaware of the likely progression of the condition.
  3. Different dementias have differing genetic contributions. It can be important for the person and family to understand genetic risk factors in certain types of dementia.
  4. Some types of dementia have specific exacerbating factors. It is important that the person with dementia and their family are informed and aware of what to look out for, and clarifying the specific diagnosis enables individualised treatment planning and approaches to be offered.
  5. Treatment options differ between the different types of dementia.

At present there is no guaranteed way to prevent dementia, but there are several things you can do to reduce your risk:

  • Stay mentally and physically active
  • Look after your general health
    • keep a healthy weight
    • don’t smoke
    • only drink alcohol in moderation
    • eat a healthy diet such as a Mediterranean diet
    • ensure any vascular risk factors such as diabetes, high cholesterol and high blood pressure are well managed
  • Address any hearing problems and wear your hearing aids if these have been prescribed
  • Monitor your mood and address any low mood or depression
  • Maintain social contact and keep socially active
  • Ensure you get good quality sleep and have any issues such as sleep apnoea addressed

These recommendations are based on the current best evidence regarding modifiable risk factors for dementia.

Although there is no cure for most types of dementia, many patients with memory concerns find assessment beneficial for:

–       Clarifying the cause and extent of any changes and addressing any reversible factors

–       Enabling access to treatments and advice about preventing further decline

–       Providing useful information for advance planning and time to make decisions for their future, including the opportunity to attend to major ‘bucket list’ items.

–       Clarifying current cognitive strengths and weaknesses helps the person and family prioritise actions such putting compensatory strategies and supports in place and addressing any safety concerns

–       Involving family members in assessment and diagnostic discussions (with the patient’s consent) offers them opportunity to understand the changes in their loved one, how to best support them and to learn more about the condition

There are a number of different cognitive screening tests including the Mini-Mental State examination (MMSE), Montreal Cognitive Assessment (MoCA), Addenbrooke’s Cognitive Examination (ACE) and many more.

These take between 5-15 minutes depending on the test used and can be completed by trained medical and allied health staff. They assess a patient’s cognitive abilities across memory, concentration, spatial function, planning and language skills. They can provide valuable diagnostic information.

However, these tests should be seen as screening assessments. Limitations include:

–       Some are not culturally relevant or available in different languages.

–       Certain areas of brain functioning such as planning and judgement skills (frontal lobe function) are not tested comprehensively.

–       A  normal screening test result does not exclude dementia. Some patients at the early stages of the condition or with specific types of dementia can perform within the normal range. Patients who have a high intellectual activity can also do better on these screening tests.

This is a complex question because different types of dementia have different genetic involvement.

The vast majority of dementia is not strongly inherited and the biggest risk factor for dementia is age. Our ageing population and the higher rate of dementia in the elderly means that many people have a history of dementia in their family.

Some genes are what is called “autosomal dominant”. This means they are highly expressed. If a person has an autosomal dominant gene there is a 50 % chance of transmission of that gene to their children. We may suspect the presence of these genes in our patients if there is a strong family history of younger onset dementia (<65) in multiple family members.

Autosomal dominant genes occur very rarely in Alzheimer’s disease – less than 1 % of all cases. The frequency of these genes increases in very young onset Alzheimer’s disease cases (especially when age of onset is less than 50).

Autosomal dominant genes are more common in frontotemporal dementia (FTD), occurring in up to 30 % of cases. One of these genes, C9orf72, is linked to both FTD and motor neuron disease (MND). Family members can be affected by FTD or MND or even both in the same person.

In patients where assessments raise suggestion of these autosomal dominant genes, the option of gene testing may be discussed. Gene testing is available via specialised neurogenetic services, and involves in-depth genetics counselling. Genetic counselling is important so that the person is fully informed about the implications of genetic testing on themselves and their children, and is well supported in their decision.

Another group of genes are known as “susceptibility genes” that interact with certain environmental factors during a person’s life to increase risk of dementia.

In Alzheimer’s disease the most relevant gene is known as APOE-E4. This can impact the ageing brain’s ability to clear the abnormal protein involved in this condition called amyloid.

We do not routinely test for these susceptibility genes because there still remains a very strong chance that a person will not develop Alzheimer’s disease if they are a carrier, and testing may well cause unnecessary worry instead of much benefit.