Defining dementia

Dementia is a broad term for a collection of symptoms, characterised by a decline in memory and other cognitive abilities, which are caused by disorders affecting the brain. Dementia is therefore more of a syndrome rather than one specific disease. People are affected in different ways, depending on the type of dementia and the degree to which it impacts their everyday lives. The impact can be physical, emotional, and psychological.

The most common form of dementia is Alzheimer’s disease. Other types include vascular dementia, Lewy body dementia, frontotemporal dementia, and mixed dementia.

Dementia and ageing

The risk of developing dementia generally increases with age. Although ageing is accompanied by changes in the brain, including the formation of plaques, which are associated with Alzheimer’s disease, not everyone who experiences these changes develops dementia.

While dementia is more commonly associated with older age groups, it can affect people in their 40s, 50s, and early 60s. Younger-onset dementia (YOD), also known as early-onset dementia, is less common than dementia in older adults, but it can be more disruptive given the impact on individuals, their careers, and their ability to raise families and enjoy everyday activities.

As with dementia in older adults, the most common type of YOD is Alzheimer’s disease. However, other types of dementia, such as frontotemporal dementia, vascular dementia, and Lewy body dementia, can also occur.

Signs and symptoms of dementia

Early signs of dementia can be subtle and may not be immediately obvious. Symptoms include:

• memory loss: difficulty in remembering recent events, names, or faces
• cognitive decline: impaired thinking, problem-solving, and language skills
• changes in mood and behaviour: mood swings, irritability, depression, or anxiety
• impaired judgment: difficulty making decisions or solving problems
• difficulty performing familiar tasks: challenges in completing routine activities.

Treatment and management of dementia – today’s landscape

There is currently no cure for most types of dementia, but some strategies and treatments have been developed to help manage symptoms and improve quality of life for individuals with dementia.

Medical approaches

Cholinesterase inhibitors: Drugs such as donepezil, rivastigmine, and galantamine may be prescribed to manage symptoms by increasing levels of acetylcholine in the brain, a neurotransmitter that is often reduced in Alzheimer’s disease.

Memantine: This medication regulates glutamate, another neurotransmitter, and is often used in moderate to severe Alzheimer’s disease.

Behavioural interventions and psychological and social support

Cognitive stimulation therapy (CST): Activities and exercises designed to stimulate thinking, concentration, and memory may be beneficial.

Reality orientation therapy: Orienting individuals to their surroundings, time, and situation can improve their understanding of the world around them.

Psychosocial support: Counselling and support groups for both individuals with dementia and their caregivers can provide emotional support and practical advice.

Occupational therapy: Occupational therapists can help individuals with dementia maintain independence in daily activities by providing practical strategies and adaptive tools.

Music and art therapy: Creative activities, such as music or art therapy, may provide emotional expression and cognitive stimulation.

Lifestyle interventions

Physical exercise: Regular physical activity has been shown to have positive effects on cognitive function and can help manage behavioural symptoms.

Nutritional support: A well-balanced diet with adequate nutrients, including omega-3 fatty acids, antioxidants, and vitamins, may support brain health.

Environmental modifications

Creating a safe and structured environment can help individuals with dementia navigate their surroundings more easily and reduce anxiety.

New frontiers in development of treatments for dementia

Ongoing research into treatments continue to examine a wide variety of approaches including pharmacological interventions, lifestyle modifications, and innovative technologies.

New medical approaches

Anti-amyloid and anti-tau therapies: Clinical trials were investigating drugs targeting beta-amyloid plaques and tau tangles, which are characteristic hallmarks of Alzheimer’s disease. These trials aimed to slow down or stop the progression of the disease.

Neuroprotective and anti-inflammatory agents: Researchers were exploring compounds with neuroprotective and anti-inflammatory properties to reduce neuronal damage and inflammation associated with various types of dementia.

Precision medicine and biomarkers: Advances in precision medicine aimed to identify biomarkers and genetic factors associated with dementia, allowing for more personalised and targeted treatment approaches.

Blood-brain barrier penetration: Research focused on developing drugs that can effectively cross the blood-brain barrier, a protective barrier that can limit the delivery of therapeutic agents to the brain.

Immunotherapy and vaccines: Immunotherapeutic approaches and vaccine development aimed to stimulate the immune system to target and remove abnormal proteins implicated in dementia, such as beta-amyloid.

Gene therapies: Gene therapies, including gene editing techniques and gene modulation, are being explored to address genetic factors associated with familial forms of dementia.

New behavioural interventions and psychological and social support

Cognitive training and rehabilitation: Cognitive training programs and rehabilitation approaches are being developed to enhance cognitive function and improve the quality of life for individuals living with dementia.

New lifestyle interventions

Lifestyle modifications: Studies are underway investigating the impact of lifestyle modifications, such as diet, physical exercise, cognitive stimulation, and social engagement, on preventing or delaying the onset of dementia.

New technology-based interventions

Technologies such as virtual reality, artificial intelligence, and digital therapeutics are being investigated for their potential in cognitive training, monitoring, and support for individuals with dementia.

New combination approaches

Some research studies were exploring the efficacy of combining different treatments, such as combining pharmacological interventions with lifestyle modifications or cognitive training.