What Is Dementia You Ask?

In this episode, we break down the basics in plain English; from the difference between dementia and Alzheimer’s, to why dementia affects far more than just memory. We explore what’s happening inside the brain, how different diseases cause dementia, and why symptoms can show up in thinking, behaviour, movement, and everyday life.

You’ll learn why dementia isn’t a normal part of ageing, what “probable” diagnoses really mean, and how understanding the condition helps us provide better care, support, and compassion.

Whether you’re supporting someone with dementia or simply want to learn more, this is the perfect place to start.

Transcript

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Hello and welcome to Age Compass, where we're navigating aging and dementia together. Today I want to talk about what dementia actually is. I know when I started on the journey with mum when she was diagnosed with dementia, I was hands down someone who knew the least about it. And ever since then I've been determined to learn as much as I can and share as much as I can to make it as easy on everyone else as possible. Because I I I definitely chose the hard road for everything until I started learning. So I've been to Union and studied dementia care and worked as a dementia consultant, worked in a geriatric ward for people who have a diagnosis of dementia. So I've definitely been able to educate myself and have the experience to really get in there and be able to help anyone who has a diagnosis, but also the families that are walking alongside the person who has a diagnosis of dementia. But I found it really confusing in the beginning what dementia actually was. So let's get into it. But firstly, and I will continue harping on this, dementia is not a normal part of aging. So it's a bit of a myth that you just get dementia when you get old, but dementia is definitely not a normal part of aging. It's actually an umbrella term for a syndrome that's characterized by cognitive decline. And that cognitive decline becomes severe enough to affect daily life. So under that umbrella that we call dementia, it's there sits many diseases, and they're the cause of the dementia. So Alzheimer's disease is actually the most common cause of dementia, and that's that equates to about 60 to 70% of all cases. And there are other types that are reasonably common, so vascular dementia, and that equates to about 15% of diagnoses, Lewy body dementia, frontotemporal dementia, they're both about 5 to 10%. Uh frontotemporal dementia, though, it's actually the second most common form of younger onset younger onset dementia. And that means someone's diagnosed under 65. And that's that's very young when you think about it to have a diagnosis of dementia, and again, gets rid of that myth that dementia happens when you're older. There's also alcohol-related dementia, that's about one to two percent of cases, and mixed dementia, and that's a combination of pathologies of different types of dementia, and that's about 25%. But frighteningly, it's determined now that someone is developing dementia globally about every three seconds, so that's pretty significant, which is why I'm determined to share as much info as possible because we need to be armed with the information to be able to help people and also prevent it. So I'm gonna be completely honest with you here and confess that seven years ago I didn't understand that Alzheimer's is a type of dementia. I'd I just thought Alzheimer's was one thing and then dementia was another thing. I genuinely thought they were two separate conditions. So remember, you don't know what you don't know, and I didn't know. So Alzheimer's is both a type of dementia because it it is one of those diseases that sits under that umbrella term of dementia, but it's the most common cause of dementia, and because it has the leading underlying pathology of all cases of dementia, and that's that 60 to 70 percent. So it's very significant. So the other thing that I learned as well was that a dementia diagnosis that's made during someone's life, it's based on probability. So no one can be really be certain of exactly what type of dementia until you've looked at the brain tissue itself under a microscope. And that can only happen after someone's passed away to get 100% certainty. So that diagnosis is made based on probability. So medical practitioners will make a probable or a likely diagnosis, and they do it with a whole lot of factors all combined together. So they look at a medical history of the person, so everything involved in all their, you know, actual medical history, and they take stuff from that person themselves, but also they'll interview the families. I know my daughter and I were both with my mum when she was having her diagnosis assessment with the geriatrician, and the geriatrician did rely heavily on both mine and Zoe's account of what mum's behavior, memory, functions, and all that was like. So it was very important we were there. So it's the medical history, specific cognitive testing, uh, brain imaging, so MRIs, CTs, and PET scans, blood tests, because it's really important to rule out any other potential causes that may be contributing to cognitive decline. And there's also a series of functional assessments. So it's a pretty holistic broad assessment to make sure that this probable or likely diagnosis can be given to a person and the family, so you know what plans and support to start getting getting going. So, for example, if my mum was diagnosed today, her condition would most likely be described as probable mixed dementia, including features of dementia with Louis bodies. What a mouthful, hey. But being able to include those uh the features of dementia with Lewy bodies was able to explain to us why she was experiencing such significant and frightening hallucinations. So that's where that probability comes in. But it's really helpful for us and the per and the people providing care for her. So, in a nutshell, the collection of all the symptoms that you would ever see in a diagnosis of dementia are pretty much the result of damage to the brain. So it's literally a set of symptoms that are resulting from damage that is occurring in the brain. And this damage for all the different types of dementia types, it can occur through a combination of a whole lot of things. So you can look at an accumulation of abnormal proteins. That's a significant one. So that's significant in Alzheimer's. And, you know, in that abnormal protein accumulation, we've got things such as amyloid plaques or things called tower tangles. And what that happens, that disrupts and damages and eventually kills brain cells. So it's very significant. And then there could be vascular changes. So those vascular changes in the brain, it reduces or interrupts blood flow to the brain tissue itself. And what that does, it deprives the brain cells of oxygen and nutrients. So it's this combination of things that equates to symptoms later. Then there's neuroinflammation, and that contributes to brain cell injury, and then in turn accelerates neurodegeneration, so more brain cell death. And there's other neurodegenerative conditions like Parkinson's disease, and in some cases, that can progress to Parkinson's disease dementia. And there's also repeated head trauma, and that repeated head trauma or traumatic brain injury, that's what can lead to long-term cognitive decline. So I hope this is all making sense so far. So to wrap that up, right, as a result of these different things that can happen within the brain, the result is brain cells, which are neurons, so they become damaged or die. And then the connections, which are called synapses, so the synapses between the remaining brain cells, they're disrupted. So the loss of these neurons and then the connections between them, that's what leads to this progressive cognitive and functional decline. And to put that in everyday terms, that's the changes in thinking and memory and behavior and movement. So it is this combination. I used to think it was just memory, but it's cognitive and functional decline as a result of where the damage is in the brain. And the type of symptoms that someone might experience with the type of dementia that they're likely to have, they vary on which brain regions are most affected. I know this is a lot. Stay with me, but I'll I'll do another episode and go into more specifics about the brain regions and the brain regions that are affected with each type of dementia because that can be really helpful. And in understanding, it's not the person being difficult, it's the damage in the brain that's resulting in these changes and symptoms. It's definitely what helped me understand so much more about what to expect in mum's diagnosis and how to care for her better, and in turn, care for the people that I look after better and help their families as well. So dementia often starts with quite subtle changes, and that they are easy to dismiss as normal aging, you know. As we age, we do take longer to find our words, but over time, there are little changes that add up, and that's what points to something more. And that's what I said. Dementia affects so much more than just memory. So think of five domains that dementia can be can really affect, and and it's what makes it easy to understand how much more it actually it is. So the domains that are affected in the brain, it's the biological damage in the brain. And it is a lot easier to view someone living with a diagnosis when when there's this understanding that it is damage in the brain, because it is that invisible reason behind the symptoms that you might be seeing in someone or that you might be experiencing yourself. Okay, I'll go through the framework of the domains that are affected. But firstly, I want you to picture this because I am a visual analogy person, and again, that's how my brain works. So imagine everything you've ever learned and all your normal automatic functions, they're all sets of information. So they're all sets of files, and you've got these files and you put them all in filing cabinets, and they're all the instructions of everything you've learned over your lifetime. So some we're really conscious of and some we're not. Like, so driving a car, that's a really conscious, learned task that we've we've done, we've adapted, we've filed all these files away in our filing cabinets. How to start the car, drive the car, where to go. All of these are instructions that we've filed and put away. Even making a cup of tea is a set of instructions that we've filed and put away. But things like breathing and digestion, they're sort of already pre-programmed files that are stored but put away. So basically, our whole operating system is a whole lot of files. I like to simplify things. So I hope this helps with you. Okay, now imagine all these instructions in your filing cabinets. And then when we go through these domains, what I want you to picture is someone just coming along and randomly ripping out these files, burning them, throwing them, whatever they do, just destroying them completely from your filing cabinet, and then they're just missing. That's what it's like when these five domains are affected. So the five domains that are affected in a dementia diagnosis is cognitive, functional, psychiatric, behavioral, and physical. That's a that's a lot to be affected, and that's why that damage is so important to understand that as the brain cells are dying and the connections are dying, things are being affected in the brain, and this is the result of those neuronal deaths, like the damage that's occurring. So the cognitive domain, that's the memory loss and poor judgment with difficulty concentrating, and the functional is where you have trouble with everyday tasks like dressing or cooking or managing money, and that's where even making the cup of tea becomes difficult because someone stole the files of all the steps involved in making a cup of tea. Then there's psychiatric changes, so mood changes, depression, anxiety, paranoia, and in my mum's case, hallucinations. Then the behavioral, so that's where someone who was always calm, cool, and collected might show aggression or agitation, it's where disinhibition can occur, or just apathy when no one wants to do anything. Then there's the physical changes, and that's changes in sleep cycles, continence, the person's movement, and consequently they become a higher category for fall, like for falls. So it's much higher risk for someone to fall, and unfortunately, falls can equate to hospital admission, and it goes on from there. So it's so much more than memory when you look at that as a list. It's just it's so important to understand that, but it also helps understand that because once I understood that mum's brain was undergoing these changes as a result from the neuronal damage, so much of her behavior started to make sense to me, and it's what helped me take things way less personally because I was just able to respond so much better with more patience and definitely a lot more empathy because she literally couldn't help it. So when people talk about these changes, it's often referred as progressing through three stages so mild, moderate, and severe, and each stage requires different levels of care and support. But if planning can be done early on, it's so much easier on that person who has the diagnosis, as well as the family or the person that is providing care, because all the plans and support are thought about and put in place in place. Okay, we have covered some very information, but I want you to know there is definitely good news because there are so many preventative measures that we can undertake to protect our brain and even preserve brain function even after a diagnosis. You know, exercise, cognitive stimulation, social connection, they're all associated with better cognitive health and resilience. And that relates to the neuroplasticity. So our brain's ability to adapt and recruit alternative networks, so build our back streets to find and gather our information. I really do hope this has helped a bit. Uh, I'll do another episode to explain more about each type because I promise all the information together helps when we're trying to navigate this path together. Thank you so much for listening, team. Take care.