Dementia and Cognitive Impairment

What is Dementia?

Dementia is an umbrella terms which refer to a group of diseases and conditions which affect the brain. These conditions present with persistent and progressive decline in different cognitive functions, the most common of which are memory, orientation, language, ability to perform daily activities, problem solving, behavior, personality and judgment.

Dementia is mainly affecting people above the age of 65 and the risk increases with the age. While one in fourteen people aged 65 has dementia, the risk increases to one in six after the age of 80. Dementia rarely affects younger people; only 1 in 20 patients with dementia are under 65. In 2020, there were just under one million people in the UK affected by dementia and it is estimated that this number will increase to over two million by 2050.  In the UK, one third of patients with dementia do not have a diagnosis. Also, there can be significant delay since beginning of symptoms until getting a diagnosis.

Cognitive Symptoms

  • Problem with short-term memory: Forgetting daily matters; e.g. leaving door open, burning food, losing/misplacing items, medication error (not taking or taking too much), repeating same sentence or question in conversation. 
  • Problem with long-term memory: Forgetting important details; e.g. the year their children were born, their own job. 
  • Poor orientation to time: Forgetting day of week, date, month or year, forgetting important dates (anniversaries, birthdays), mixing up day and night (leading to reversal of sleep pattern). 
  • Poor orientation to place: Difficulty finding way in unfamiliar or even in familiar locations, losing one’s way in the house (advanced stages). 
  • Poor orientation to person: Not recognising or mis-recognising family and friends, talking to TV or own reflection in the mirror (advanced stages). 
  • Language problems: Word finding difficulties. Problem understanding language (verbal and written). • Problem with activities of daily living and problem-solving: difficulty attending to own personal care, inability to complete complex tasks (cooking, shopping, managing finance)

Non-cognitive Symptoms

  • Depressed and anxious mood
  • Apathy (lack of interest)
  • Agitation and aggression
  • Psychotic symptoms (paranoid ideas, hallucination)
  • Changes in the personality

Patient Focused Quality Care

Dr Behzad Basit can help patients suffering with dementia and memory problems. If your memory is causing a problem for you, we advice you to seek help.

Types of Dementia (& Mild Cognitive Impairment):

  • Alzheimer’s Disease is the most common type of dementia affecting two thirds of patients with dementia. In simple terms, Alzheimer’s disease can be considered as an accelerated ageing process mainly in the lateral parts of the brain (Temporal and Parietal areas). Alzheimer’s disease manifests gradual decline in cognitive function (cognitive symptoms) but patients can also present with non-cognitive symptoms like agitation, aggression and paranoid ideas. 
  • Vascular Dementia is the second common form of dementia affecting one fifth of patients. It is due to gradual narrowing of brain blood vessels. These changes either cause chronic starvation (shortage of nutrient and oxygen) of brains cells; or lead to strokes in different sizes and in different parts of the brain. Patients with vascular dementia show cognitive symptoms, in particular, language problems and word finding difficulties. Also, patients with vascular dementia are more likely to present with low and anxious mood even before showing cognitive decline.
  • Dementia with Lewy Bodies affects about one in seven patients with dementia. It is due to death of cells in some areas in the centre of the brain. Patients with this type of dementia experience visual hallucinations (vividly seeing people and animals without hearing them) along with cognitive symptoms. Dementia with Lewy Bodies also manifests abnormal involuntary movements and frequent falls.
  • Frontotemporal Dementia is a rarer form of dementia affecting less than five percent of patients. The changes are somehow similar to what is seen in Alzheimer’s disease but they start to happen mainly in the front part of the brain. Patients present with difficulties in executive function (e.g. difficulty managing finance, inability to problem-solve) or changes in personality; either showing apathy (lack of interest in personal care and other activities) or disinhibition (inappropriate comments and behaviours). They tend to get aggressive.
  • Mild Cognitive Impairment can be considered natural ageing of the brain manifesting mild problems with short-term memory without other symptoms of dementia. Mild Cognitive Impairment tends to be non-progressive. However, one in ten people presenting with Mild Cognitive Impairment are in fact in the very early stages of dementia. Therefore, it is advisable that people with Mild Cognitive Impairment have a cognitive test every 6-12 months.

Diagnosis of Dementia

Diagnosis of dementia is in the first instance a clinical diagnosis based on detailed history obtained from the patient and a source of collateral information (i.e. a family member). The confirmation of diagnosis is by completing a cognitive test like Addenbrooke’s Cognitive Examination (ACE) as well as brain imaging like PET-scan, MRI or CT-scan. It is of note that there are conditions (e.g. thyroid disease, shortage in Vitamin B12 and Folic Acid…) which can present similar to dementia. These conditions are usually treatable. It is important that patients, presenting with symptoms likely to be dementia, undergo a series of blood tests to rule out (or treat) the treatable causes of cognitive decline.

Management of Dementia

Dementia is a progressive and non-reversible condition, for which no cure currently exists. However, there are measures to improve patient’s quality of life and prevent complications. Providing and maintaining a safe living environment and healthy daily routine is the most important aspect of management in dementia. Medications known as Acetylcholine Esterase Inhibitors (e.g. Donepezil and Rivastigmine) and Memantine are to a degree helpful in slowing down progress of cognitive symptoms in some forms of dementia (mainly Alzheimer’s and Lewy Bodies) and maintaining the cognitive symptoms. Last but equally important, patients presenting with non-cognitive symptoms of dementia may need medications targeting low mood, psychosis or agitation.

Dr. Behzad Basit

I have experience in diagnosis, treatment and management of functional mental illnesses such as mood disorders, anxiety, OCD, bipolar affective disorder and psychosis; in particular the interaction between physical illnesses and mental health problems. I am also experienced in assessment, diagnosis and management of cognitive disorders and matters relevant to these conditions including capacity assessment. In addition, I have epicene in diagnosis and treatment of Adult ADHD.

Central London Dementia Clinic

Face to face appointments at our medical clinic can be booked by visiting our contact page here. Dr Basit also offers virtual appointments.

Yes, Dr Basit has admission privilege with Nightingale Hospital. During office hours, admissions are through his secretary or directly contacting Patient Services (Nightingale switchboard). If someone needs to be admitted under his care out of hours (in particular known patients), they can contact Nurse Coordinator via switchboard.

Yes, BUPA, AXA, Aviva, Vitality, Cigna, Healix.

Address

Nightingale Hospital 11-19 Lisson Grove, Marylebone, London NW1 6SH

VIRTUAL Appointments

Virtual Appointments are available with Dr Basit

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