Six questions that could show if you’re at risk of dementia

How to cut your risk. How to cope if it strikes. And a simple test to help spot it early. Starting today, a vital Good Health Series

WHAT concerns you most about your future health? Chances are it is not the condition of your heart or even the risk of cancer. Today, the greatest fear for people is that they may end their days slipping into dementia.

The idea of losing control of one’s thoughts or being unable to remember loved ones causes understandable anxiety, and it happens to an increasing number of people.

According to the Alzheimer’s Society there are already more than 800,000 people with dementia in the UK and that number is set to double over the next 35 years.

Fears about becoming one of them has led to a surge of people turning up at dementia clinics. Figures published by the Royal College of Physicians earlier this month show there’s been a four-fold rise in the number of patients seeking help at these specialist centres.

They’re anxious about their forgetfulness and unsure of what it means.

So how can you tell if you — or someone close to you — is just a bit forgetful or in the early stages of dementia? And what can you do to cut your risk of developing the disease in the first place?

Over the coming weeks, these questions and many more will be answered in this major Good Health series, helping you understand everything you need to know about this disease, its diagnosis and how best to treat it.

We’ll also look at other conditions, from depression to thyroid problems, that are often wrongly diagnosed as dementia.

And if you’re one of the legion of silent heroes caring for someone with dementia, we’ll also focus on how to cope with the challenges you face.

As dementia becomes increasingly common, we all need to know how to live well with this disease . . .we hope to help you find the way.

THERE ARE 200 TYPES OF DEMENTIA

DEMENTIA is not a single disease, but is an umbrella term for a group of conditions that damage the brain. in fact, there are more than 200 types of dementia. Alzheimer’s disease, which accounts for 60 to 70 per cent of cases, is the most common form.

One of the main features of Alzheimer’s — and all forms of dementia — is that the brain shrinks. initially this affects the hippocampus, the area of the brain associated with memory.

There is also an overproduction of tau, the protein made by nerve cells in the brain to maintain their shape.

The excess tau forms ‘ tangles’,

which affect the normal connections between neighbouring cells.

In addition, there is a drop in acetylcholine, a chemical messenger vital for memory. Structures called amyloid plaques, clumps of a protein produced by nerve cells, are also found in the brains of those with Alzheimer’s.

After Alzheimer’s, the next most common form of the condition is vascular dementia, which accounts for 20 per cent of cases and is linked to lifestyle — it’s a bit like heart disease of the brain. It occurs following a stroke or when the blood vessels supplying the brain become furred up or blocked. If blood supply is cut off to a part of the brain, the brain cells die off within just six minutes.

With this, as with some other forms, there may be no memory loss at all — patients may, for example, have prob- lems finding the right words to express themselves or have balance problems, making them prone to falls.

Some people suffer from ‘mixed pattern’ dementia, a combination of Alzheimer’s and vascular dementia.

Whereas all forms of dementia involve some form of damage to the brain, what differentiates them is where that damage occurs.

DO WE ALL GET IT EVENTUALLY?

DEMENTIA is not a normal part of ageing. It’s true that as we age, even healthy brains shrink from the age of 50.

Between the ages of 50 to 65 the average brain may lose 4oz or 5oz in weight. the levels of chemical messengers, called neurotransmitters, also drop and the brain’s ability to absorb glucose, which it needs to function, is reduced.

this is why some notice a slowing down of their mental functions or they can’t do things as quickly as they used to.

this can lead to the ‘tip of the tongue’ problem when you can’t remember a word or name. this is incredibly common and in most cases does not mean that person is developing dementia.

In dementia, the brain cells die off faster than they normally would and there will be greater shrinkage of the brain. this leads to a far more extreme deterioration than simple ageing.

Why some people go on to develop dementia while many others don’t is not known for sure. Lifestyle factors such as having high blood pressure or raised cholesterol increase the risk, as does being a woman — two-thirds of people with dementia are female. Genetics can play a part — but only in a small percentage of cases. We will cover the various causes in more detail in the weeks to come.

HOW CAN I TELL I’VE DEFINITELY GOT IT?

THIS is the key question. there is no definitive test for dementia. the only way to know for sure if someone has had it is after death, in an autopsy.

But doctors do use memory tests as a basic screening device to identify those who may be at risk.

the test your GP is most likely to use is the Six Item Cognitive Impairment test, developed in the U.S. in 1983 and updated as the 6CIt-Kingshill Version by Dr Patrick Brooke, a British GP.

here we reproduce the test, with the caveat that you should always see your GP with any concerns.

Ask someone to put these questions to you and then score each answer to give a possible total out of 28.

1. WHAT YEAR IS IT?

(score 0 if you answer correctly, 4 if incorrect )

2. WHAT MONTH IS IT?

(correct: 0; incorrect: 3) At this point in the test, a name and address is given and the person is asked to remember it. It should have several components, for example: Peter Smith, 56 high Street, Luton.

3. WITHOUT LOOKING AT A CLOCK, WHAT TIME IS IT, TO THE NEAREST HOUR?

(correct 0; incorrect 3)

4. COUNT BACK FROM 20 TO 1

(correct 0; error 2; more than one error, 4)

5. SAY THE MONTHS OF THE YEAR IN REVERSE ORDER

(correct 0; one error 2; two or more errors 4)

6. TELL ME THE NAME AND ADDRESS I GAVE YOU EARLIER

(correct: 0; one error: 2; two errors: 4; three errors: 6; four errors: 8; all wrong: 10)

SCORE

0-7 no sign of memory problems. 8- 9 Some evidence of memory problems — see your GP.

10-28 high evidence of memory impairment that needs further investigation.

WHY A DIAGNOSIS IS SO IMPORTANT

AS MOST people know, there is no cure for dementia. But you shouldn’t think that this means getting diagnosed doesn’t matter.

the expert view is that it’s vital to get a diagnosis in order to start getting support in place, especially as roughly a third of people with dementia live on their own.

Also, there are drugs such as Aricept that can help to slow down the progression of Alzheimer’s disease.

Getting the right diagnosis also matters if other conditions such as depression are compounding the underlying dementia — treatment for the depression, for instance, can make a big difference.

Diagnosis also allows help — practical or financial — to be put in place.

to get a diagnosis, the first port of call is your GP, who may carry out the Six Item Cognitive Impairment test.

After this, the GP may order blood tests to rule out other conditions such as a vitamin B12 deficiency, as the body needs this vitamin to make crucial brain chemicals.

You may then be referred to a dementia or memory clinic; a coordinating centre with a full range of assessment, diagnostic, therapeutic and rehabilitation services able to accommodate the different types and the different severities.

here, further assessments will be done, and possibly also a brain scan that can rule out other causes of the symptoms and spot signs of shrinkage. this, however, may not be conclusive as in the early

stages this shrinkage may not be obvi‑ ous. So diagnosis may be delayed by months as doctors wait to see if the memory gets worse.

ISN’T THERE A BLOOD TEST YOU CAN HAVE?

SCIENTISTS are now working on new ways to try to improve the way dementia is diagnosed.

Already in some European countries doctors are using lumbar punctures, where cerobrospinal fluid is removed from around the spinal column and tested. In this case, it is for the presence of two proteins — amyloid and tau — which are associated with Alzheimer’s, says Professor Simon lovestone, professor of translational neuroscience at the University of Oxford, who is leading the trial.

He adds that the tests are used in the UK but not widely.

Professor lovestone is heading an international collaboration funded by Alzheimer’s UK working on a simple blood test to confirm if memory lapses are early signs of dementia.

Researchers have already identified proteins that if present in a blood test could predict those with memory problems most likely to develop dementia.

‘We now know that there is a set of ten proteins that can predict whether someone with early symptoms of memory loss, or mild cognitive impairment, will develop dementia within a year, with a high level of accuracy of around 85 per cent,’ says Professor lovestone.

‘ Our next step will be to test our findings in even larger sample sets, to fur‑ ther improve accuracy and reduce the risk of misdiagnosis, before we can develop a reliable test suitable to be used by doctors.’ It is not known when it will be available. Finding a new reliable test that can pinpoint the disease early could change the way the disease progresses.

‘Alzheimer’s begins to affect the brain many years before patients are diagnosed with the disease. Many of our drug trials fail because by the time patients are given the drugs, the brain has already been too severely affected,’ says Professor lovestone.

He predicts that simple phone apps could be used in the future. ‘Apple has recently launched the M Power, which can help diagnose Parkinson’s disease by the way patients pronounce ‘Aah’ [changes in speech patterns can be a symptom of Parkinson’s disease].

‘It’s possible a similar sort of screening tool could be developed for dementia, including Alzheimer’s.’

A sniff test could also be on the horizon. It has been shown that the part of the brain involved in smell is one of the earliest areas to be affected in those with Alzheimer’s.

Researchers have run a trial comparing how well people with mild to moderate Alzheimer’s disease and people without the disease identify 12 aromas including banana, apple and motor oil.

The researchers, from the University of leicester, found that those with Alzheimer’s were less able to identify the smells — and that the test could distinguish between those who had Alzheimer’s and those who did not with an accuracy of 86.7 per cent, according to data published in the Journal of Alzheimer’s Disease.

The researchers say it may, in combination with other diagnostic tests, help to improve early detection of Alzheimer’s in the future.

Dr Souter is a retired GP and fellow of the royal College of General Practitioners. Adapted by LUCY ELKINS from Your Guide To Understanding And Dealing With Dementia by Dr Keith Souter, published by Summersdale, £8.99. Order at mailbookshop.co.uk, or call 0808 272 0808. P&P is free for a limited time only.

Additional reporting: JO WATERS and ROGER DOBSON