SeniorCare.ie Interview – Dementia and Alzheimer’s Questions Answered

This interview was generously given by Joanne Flood. We are very grateful for her taking the time out to give such comprehensive answers.

1. Thank you so much for giving your time to answer these questions. Can you tell us a little about your background?

I am a registered psychiatric nurse with 12 years experience in older persons nursing and mental health of the elderly. More then ten years of my professional experience is in dementia care across many different settings to include:

– Long term care settings
– Acute care settings
– Gerontological nursing
– Liaison psychiatry
– Clinical nurse specialist in the community for crisis in dementia care

During his time I have lectured extensively throughout many healthcare settings on a national basis on dementia care and its management. I currently work in a private dementia care facility as an education and training officer. I completed a PG Dip in Gerontological Nursing, a MSc in mental health of older people, and I’m currently undertaking a PhD in community dementia care.

2. What are the most common causes of Dementia?

Id prefer to answer this question by talking about what exactly Dementia is and then describe its causes if this is ok?

The word Dementia is an umbrella term used to describe a group of diseases which affect the brain and cause a progressive decline in the persons abilities to remember, think and learn. The main abilities affected are:

– Memory – particularly short term memory. What I mean by this is that the person may recall what they did years or decades ago but are unable to talk about something they may have done earlier that day or the previous week.

– Orientation – this is when a person with dementia can become disoriented outside their usual environment and get easily lost going to the shops or post office.

– Comprehension – the person with dementia may be unable to understand what is asked or said to them and in turn can become frustrated.

– Judgement – they may start to lose their ability to make decisions around safety, for example going out in the cold without the appropriate clothing on, leaving doors open at night, leaving cookers or ovens on, or even big decisions around finances.

– Language – they will lose their ability to communicate with others as the disability progresses and in turn it can become very difficult for another to communicate with them also.

There are many different causes of Dementia. The main causes are:

– Alzheimer’s disease which accounts for approx 50% of all dementia and this is recognisable in its insidious progressive onset. The person continues to get a little worse over time.

– Vascular dementia – this is due to mini strokes in the brain and accounts for about 25-30% of all cases. This has a more step wise progression in that they move on in their dementia when they experience a vascular event or mini stroke. Some people can have Alzheimer’s Disease and Vascular Dementia together.

– Lewy Body dementia (15% of cases) – there are unusual features of intermittent memory loss and can suffer some tremor like movement which can influence falls and may have some visual disturbances also in the guise of hallucinations.

– Frontal lobe dementia (10% of cases) – this can affect those under the age of 65.

There are numerous other types of dementia such as Huntingtons chorea and parkinsons dementia to name a few. The main predisposing factor for developing a dementia is age: 5% chance if over 65yrs, 20% chance if over 80yrs.

3. Does a decline in memory indicate dementia?

In today’s increasingly paced lifestyle there can be many reasons for dips or decline in memory. Stress can cause some memory lapses. Significant life events are known to have an effect on memory also. We can run upstairs to get or do something and when we get there we forget what it was!

It is important though if a memory decline or loss occurs, particularly if it’s sudden or seems to continue, to have it checked out as soon as possible.

4. Are there any dietary supplements which protect against dementia?

This is a tricky one to answer as research around folates in particular is ongoing worldwide and has varying results. Ultimately it is known that a healthy lifestyle and diet can go towards preventative measures of vascular dementia in particular. However one longitudinal study in the US showed that increased use of folates had a reduced risk in developing Alzheimer’s dementia.

5. What are the early signs of dementia?

Some of the early signs of dementia from a practical aspect can be memory. However the early signs can be subtle and may not be immediately obvious. A person’s ability to remember recent events can be an indicator. They might forget that someone has just visited. They may forget to pay bills. There may be difficulty performing some everyday simple tasks such as preparing meals or going shopping.

Misplacing things, repetitive questions or mixing up appointments are often reported by family members. Again if you are doing this it does not mean that you have a dementia but if it is ongoing in yourself or a loved one it is important to get checked out by your GP as there could be another reason why it may be happening such as stress or an infection.

6. What can the GP do?

The GP can do a number of things and will first assess your memory using a mini mental test. The GP will also take some blood to have tested to perhaps make sure there isn’t an infection going on that could be causing these symptoms. They may talk to you about recent events and your lifestyle and maybe even a family member also. This is typical so don’t feel intimidated. The GP may refer you to a memory clinic for further testing.

7. Are there any treatments available to slow down the progress of dementia?

Treatment of dementia with cholinesterase inhibitors and memantine can result in improvement in measures of memory in dementia. However they work differently for all individuals.

8. Are there any defined stages of progression with dementia?

It is difficult to talk of defined stages of dementia unless you look at the different types of dementia mentioned above. Generally Alzheimer’s disease can have 3-4 stages: mild, moderate, severe, terminal.

Vascular dementia moves in a non conforming manner – depending on the individual.

I have learned in my time working with people with dementia that everyone is an individual and when you think they will follow a certain progression in their dementia, the reality can be very different. It is important to keep linked in with your GP or PHN and if any changes occur to inform them.

9. Is Alzheimer’s Disease inherited?

Alzheimer’s disease depends on many genetic and NON genetic factors. However the most susceptible gene for Alzheimer’s Disease which has been studied is APOE on which there are variations and one of these variations confers with an increased risk of Alzheimer’s Disease.

10. It has been recently reported that smoking can increase the risk of Alzheimer’s. Is that true?

I have read research that smoking particularly in middle age increases the risk of both Alzheimer’s Disease and Vascular dementia. Again what we need to remember is the healthy lifestyle that has been pushed by experts for decades in order to live into a healthy old age.

11. Who can a relative contact for information or support, following a diagnosis of dementia?

The top support group I recommend is the Alzheimer’s Society: www.alzheimer.ie or 1800341341

Family Carers Ireland: https://familycarers.ie/ or 1800240724

However for those who are concerned about their memory and DO NOT have a diagnosis of Dementia there is a memory screening clinic above the VHI Swiftcare clinic in DCU that accepts self referral. The number to enquire about this service is: 01 7007171

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