If you suspect that a loved one has a form of dementia, it may take some time to persuade them to visit the GP. Getting a diagnosis can also prove challenging. The first stumbling block is that the person may not think anything is wrong, or they may blame their symptoms on stress or getting older (the NHS estimates that around 40 per cent of those over 65 will have some form of memory problem). When I suspected that my mum had dementia, I struggled to persuade her to see the doctor. She admitted that her memory was poor but put it down to being older. She refused to accept that anything else was wrong.
After a while, I gave up pushing her to see the doctor. I made an appointment to visit her GP on my own and spoke to her about my concerns. This meant my worries were on mum’s medical records. The GP understood that mum was refusing to see her about her memory, so she suggested that I bring mum to have her blood pressure checked as a routine check-up. Mum agreed to that, so when we took mum to the doctor, the GP was then able to talk to her about her memory while she was there.
When you first take a loved one to see their GP, they will first need to rule out other possible causes of memory loss. They may recommend blood tests to look at iron levels and levels of vitamin B1. They may also screen the person for depression, which can cause memory issues. Other conditions that may have similar symptoms to dementia include urinary tract infections and thyroid deficiencies. It’s also important to rule out confusion that may be caused by poor sight or hearing. If these tests come back negative, the GP will then make a referral to a specialist. This could be an old age psychiatrist, a general adult psychiatrist, a geriatrician or a neurologist. The person with dementia will most likely undergo A Mini Mental State Examination (MMSE), which tests memory, thinking and language. They may also be referred for a brain scan.
If the diagnosis is confirmed, the person will be under the care of the local community mental health team – namely psychiatrists, psychologists and community psychiatric nurses. They may also be given medication.
If the person is confirmed as having Alzheimer’s disease, they may be given medication to manage the symptoms. There are no dementia specific drugs available, although the person may be given other drugs to treat underlying conditions, such as heart disease, a stroke in the case of vascular dementia, or symptoms, such as hallucinations suffered by a person who has Dementia with Lewy bodies. A person with vascular dementia may be given drugs to treat high blood pressure, high cholesterol, diabetes or heart problems as these can be linked to the condition. Specialist drugs are only available for people with Alzheimer’s disease.
Medication for Alzheimer’s disease may slow down the progression of symptoms, but not the disease. They may help to reduce depression, aggression and anxiety, although the drugs will only work for some people. The current four types of medication used to treat Alzheimer’s disease include:
- Donepezil (Aricept)
- Rivastigmine (Exelon)
- Galantamine (Reminyl)
- Memantine (Ebixa or Axura)
Donepezil, Rivastigmine and Galantamine are known as cholinesterase inhibitors and these work by boosting levels of a chemical messenger called acetylcholine (ACh) inside the body, which improves communication between the nerve cells. Side effects include vomiting and diarrhoea. They may be beneficial for those with mild to moderate Alzheimer’s disease. They are not a cure, but can treat symptoms in some people. They may not work for everyone.
Memantine is usually prescribed for those with severe Alzheimer’s disease, or those with moderate Alzheimer’s if cholinesterase inhibitors aren’t suitable. It works by regulating activity of Glutamate, a chemical messenger involved in brain functions that is released excessively when brain cells are damaged. Side effects can include dizziness, aggression, depression, headaches and sleepiness.
If you have any concerns about any medication prescribed, for example, if you notice any changes in behaviour or side effects, always discuss these with the person’s GP or mental health team. It’s also important to ensure the person has regular check-ups every six months so that the GP can monitor their health and review dosage and medication if need be.