Dementia
Definition:
There is often confusion about the relationship between dementia and Alzheimer’s disease but there is a clear distinction. Alzheimer’s disease is the single principal cause of dementia, but there are many other causes of which the most important is interference with the blood supply to the brain–a condition called vascular dementia, the risk factors of this are the same as the risk factors of heart disease.
It is also important to emphasise that dementia is not just accelerated ageing. The minor slips in memory eg forgetting the name of someone met the previous day, or the name of a film star from one’s youth are not signs of dementia.
The term cognitive reserve is important and is similar to physical reserve or resilience, namely the capacity to respond quickly and appropriately when challenged and that of course is similar to the definition of physical fitness.
Cause and scope for prevention:
There are three principal types of cause amenable to prevention:
1. Vascular disease
2. Direct damage to the brain caused by stress, over consumption alcohol and other drugs, poor sleep, head injury, and lack of stimulation.
3. Isolation, lack of social engagement, lack of purpose, and limited mobility contributes to lack of stimulation and therefore deterioration.
Diagnosis:
Diagnosis is primarily clinical based on evidence of significant problems in managing one’s house or income, or getting lost and being unable to find one’s way home, not on minor memory slips.
Standard medical therapy:
This is primarily supportive of carers but tackling the risk factors outlined above is part of the support programme so physical activity is of great importance.
Benefit of exercise therapy:
It is clear that physical activity has a direct impact on the brain. In addition, the beneficial impact on the causal factors will slow the process of development, notably activity in groups. Groups that are intergenerational and have a social purpose are especially beneficial.
Faculty of Sport and Exercise Medicine Guidelines on the balance of risks and benefits of activity for people with Cognitive Impairment:
The balance of evidence suggests that the benefits of physical activity in people with cognitive impairment far outweigh the associated risks. Strategies to maintain motivation, engagement and safety are important. These should be individualized, depending on level of function, stage of disease, communication, ability (including visual and hearing impairment), preferred environment and other medical conditions. People with cognitive impairment have an increased risk of falling so support from others is often beneficial.
Key references:
Midlife Physical Activity, Psychological Distress, and Dementia Risk: The HUNT Study.
Key organisations:
