Quick answer
What is dementia?
Dementia is a syndrome of progressive brain decline affecting memory, thinking, language, and daily function — not normal ageing. Alzheimer's disease is the most common cause. Early signs include forgetting recent events, repeating questions, and struggling with familiar tasks. See a GP for assessment — many treatable conditions mimic dementia. No cure yet but treatments slow some types; support services help patients and carers plan ahead.
Dementia — when memory loss becomes disease
Dementia is not a single illness — it is a syndrome of progressive cognitive decline severe enough to interfere with daily independence — memory, reasoning, language, visuospatial skills, and behaviour.
UK: ~900,000 people living with dementia — projected 1.6 million by 2040. Not normal ageing — though prevalence rises with age.
Early warning signs
Memory:
- forgetting recent events — appointments, conversations
- repeating questions
- reliance on notes for what used to be automatic
Function:
- difficulty managing money, paying bills
- getting lost in familiar areas
- struggling with cooking — safety risks
Language:
- word-finding pauses
- calling things wrong names
Behaviour:
- personality change — apathy, suspicion, disinhibition
- poor judgement — scams vulnerability
Onset: gradual months to years — sudden confusion → think delirium (infection, drugs) — urgent treatable cause.
Main types
Alzheimer’s disease (~60–70%)
- memory first
- slow progression over years
- amyloid plaques, tau tangles pathology
Vascular dementia (~17%)
- stepwise decline after strokes or small vessel disease
- executive function and speed affected
- risk factors: hypertension, diabetes, smoking
Dementia with Lewy bodies
- fluctuating cognition
- visual hallucinations
- Parkinsonism — tremor, stiffness
- sensitive to antipsychotics
Frontotemporal dementia (younger onset)
- personality and behaviour change before memory
- language variants
- 40s–60s peak
Reversible mimics — why GP tests matter
| Condition | Test |
|---|---|
| Depression (“pseudo-dementia”) | History, treatment trial |
| Hypothyroidism | TSH |
| B12 deficiency | B12, folate |
| Normal pressure hydrocephalus | MRI — gait, urinary triad |
| Medication anticholinergics | Drug review |
| Chronic subdural haematoma | CT after falls |
Never label dementia without basic bloods and collateral history.
Diagnosis pathway
- GP — concerns, informant history essential
- Bloods — FBC, U&E, LFTs, TSH, B12, folate, glucose, calcium
- Cognitive screen — MMSE/MoCA — gateway not diagnostic alone
- Memory clinic — detailed neuropsychology
- MRI brain — atrophy pattern, vascular change, exclude NPH, tumour
Disclosure — sensitive, planned, with support.
Treatment
Alzheimer’s — symptomatic drugs
- acetylcholinesterase inhibitors — donepezil, rivastigmine, galantamine — mild-moderate
- memantine — moderate-severe
- modest benefit — not cure — 6–12 month slowing in responders
All types
- treat cardiovascular risk — vascular
- avoid anticholinergics
- structured routine, orientation aids
- manage agitation — non-drug first; antipsychotics last resort — stroke risk
Legal and planning
Early after diagnosis while capacity present:
- Lasting Power of Attorney (health and finance)
- advance decision
- ** driving cessation** — notify DVLA
- work and financial planning
Carers
Unpaid carers — Carer’s Allowance, respite, Admiral Nurses, Alzheimer’s Society helpline.
Carer breakdown — common — request carer’s assessment.
Prevention — population level
- cardiovascular health — BP, exercise, not smoking
- hearing correction
- social engagement
- no guaranteed prevention — reduces risk
Dementia frightens people into silence — early assessment distinguishes treatable mimics from progressive disease and unlocks years of better-supported living.
Common questions
- What are the early signs of dementia?
- Forgetting recent events while recalling distant past, repeating questions, difficulty finding words, struggling with money or familiar routes, misplacing items in odd places, mood or personality change, reduced judgement. Gradual onset over months — not sudden single-day confusion (consider delirium).
- Is memory loss normal with age?
- Mild forgetfulness — misplacing keys occasionally — can be normal ageing. Dementia involves progressive decline interfering with independence — unable to manage finances, medication, or self-care — worsening over time. Memory clinic assessment distinguishes.
- Can dementia be cured?
- Most causes are not curable currently — treatments slow progression in Alzheimer's (donepezil, memantine) and manage symptoms. Some conditions mimicking dementia are reversible — thyroid, depression, normal pressure hydrocephalus, B12 deficiency — reason for full workup before assuming Alzheimer's.
- What is the difference between Alzheimer's and dementia?
- Dementia is umbrella term for symptoms — memory and cognitive decline severe enough to impair life. Alzheimer's is specific disease — abnormal protein deposits (amyloid, tau) in brain — most common cause. Vascular dementia from small strokes is second common in UK.
- How is dementia diagnosed?
- History from patient and informant, cognitive testing (MMSE, MoCA), blood tests excluding reversible causes, brain MRI or CT showing atrophy or vascular changes. Memory clinic multidisciplinary assessment — may take several appointments.
- How can carers get support?
- Carer's assessment through local council, Admiral Nurse helpline, Alzheimer's Society, respite care, dementia cafés, Lasting Power of Attorney for finances and health. GP can refer to memory clinic social prescriber.