Dementia – But there’s nothing wrong with me!

My last Health-e-Byte prompted many people to ask the following questions:

What if my relative refuses to go to the doctor because they think they’re fine?
Are there any symptoms that set off alarm bells for oncoming dementia?
What causes dementia?

To say that someone has dementia is like saying that someone has cancer without specifying the type. The symptoms vary widely depending on the part of the brain that is affected. Even with the one person, symptoms can fluctuate from day to day and even from hour to hour.

Signs to look out for include – but are not restricted to:

  • the person starts forgetting how to do things they used to be able to do
  • they forget how to get somewhere they’ve been many times before
  • loss of motivation to do things
  • becoming withdrawn and not wanting to socialise
  • getting confused and disoriented
  • personality changes
  • short term memory loss
  • difficulty focusing
  • problems communicating
  • not being able to understand simple instructions

As for what causes dementia, the short answer is we don’t know. Inflammation, abnormal protein accumulation, death of brain cells – these are physical changes that scientists have observed in the brains of people with dementia but we don’t know why they happen.There are several theories and medical research has been testing them for decades but there are no clear answers to date. A minority of dementias are hereditary but the vast majority are not. Certain genes may increase or decrease your risk of dementia but only to a small degree.

The following lifestyle factors appear to increase your risk of developing dementia more than the genes you carry. However I emphasise that these things are risk factors, not causes.

  • Having had a serious head injury – war veterans, boxers and football players are all at increased risk if they’ve had a lot of head trauma.
  • Cyclists please wear helmets!
  • Type 2 diabetes
  • Stroke, heart disease and high blood pressure. What’s good for the heart is good for the brain.
  • Smoking can increase risk of dementia by 70%.
  • Excessive alcohol consumption especially regular binge drinking.
  • Chronic major depression, severe stress or poor sleep throughout life – this means more than a one off bout of depression, stress or insomnia.

People are often resistant to going to the doctor for several reasons. They may have no insight that anything is wrong because the disease robs them of insight. Sometimes dementia causes paranoia so the person is suspicious of your motives for wanting to take them to the doctor. Other times the person is aware that something is amiss but they’re afraid of having their fears confirmed.

My father has passed through all of the above stages and has never wanted to see a doctor. (Yes, I’m a doctor but it’s not a good idea to treat your own relatives.) So I tell him that it’s time we both had a check up. ‘Everyone needs to see the doctor on a regular basis to get their body serviced in the same way you need to get your car serviced.’ I remain upbeat and cheerful so that he sees it as just another thing to tick off our to-do list. If I were to say ‘I’m worried about you,’ he would NEVER agree to come to the doctor. If your relative is on medication for any other condition, you might suggest that the doctor needs to review the dose. Maybe a new/better medication has become available? It’s tricky and challenging because I don’t want to be deceptive but it’s important to get a diagnosis as early as possible. Many conditions like thyroid disease can be treated with medication and the person’s symptoms will disappear. A brain tumour can be removed if it’s small enough. And if it turns out to be dementia, medication may slow down the progression of the disease if it is caught in the early stages.

This article is part of a series on dementia.
Discover the rest of the series below:

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