Overview

Dementia is an umbrella term to describe a collection of symptoms that can be experienced as a result of the ongoing decline of brain function. There are many different causes and types of dementia. Its symptoms result in a decline in cognitive abilities, such as memory, language and problem-solving. Alzheimer’s disease is the most common type of dementia. 

Dementia

Dementia is often mistaken as a specific disease when it is a general term for impaired cognitive function. Most commonly found in older individuals with those at least 65 years of age being the most common.¹  

There are many types of dementia:

• Alzheimer's disease -  The most common type of dementia, accounting for 60 to 80% of all cases. The identifying feature is trouble remembering recent things. 
• Vascular dementia 
• Lewy body dementia 
• Mixed dementia 
• Fronto-temporal dementia 

The symptoms of dementia can vary significantly but some examples of symptoms include:

• Memory loss 
• Impacted thinking speed 
• Impacted mental sharpness 
• Trouble with language 
• Impacted understanding and judgement 
• Fluctuations in mood and movement 

Pharmacological treatments for dementia

Dementia has no cure at the moment, however early diagnosis significantly reduces its progression, allowing the patient to retain cognitive function for a longer period.² Its treatment varies depending on the specific type and its progression, but a few prescription medications available can temporarily ease some of the symptoms. 

However, the medications are known to not work for every case and some even lose their effectiveness over time, as the medications are mostly recommended for early or middle stages of dementia. Research needs to be done to further develop new treatment options. This means that non-pharmaceutical options are essential for the treatment and management of dementia. 

Benefits of non-pharmacological approaches

Pharmaceutical treatment options for dementia are few and do not work for everyone so there is a strong emphasis on the vitality of non-pharmacological approaches to the treatment and management of dementia.²

Cognitive stimulation 

Cognitive stimulation therapy (CST) is a widely popular treatment option as it involves working with a small group on a regular basis. It involves a form of mental exercise by incorporating activities which aim to stimulate thinking and memory by discussing past and present events, topics of interest, word games, puzzles and music. 

The meaningful and stimulating activities have been proven to help maintain memory and mental functioning whilst also providing a fun and supportive environment where people can build new friendships. There are multiple benefits of CST with research showing it results in improved or slowed decline of cognitive abilities.³

Physical activity and exercise

Regular physical activity is a vital part of maintaining a healthy lifestyle for everyone no matter their age, it improves overall well-being as well as reduces the risk of developing a multitude of diseases. It also is incredibly beneficial in improving mental health by encouraging you to spend time focusing on yourself. Although there is no evidence to show a link between physical exercise and dementia prevention, it can improve some parts of memory.⁴

Leading a physically active lifestyle can have a significant positive impact on the well-being of those with dementia, as it encourages opportunities to meet new people whilst increasing confidence. 

Some examples of less intensive physical activity for those with dementia can include:

• Doing housework 
• Walking the dog 
• Pacing around the house 
• Seated exercise, such as gentle marching of the feet, cycling the legs, raising arms towards ceilings, raising opposite arms and legs, straightening legs in turn or moving from sitting to standing
• Gentle yoga or pilates - there are several dementia-friendly classes available all over the UK
• Tai chi or Qigong 
• Indoor bowls or skittles 

Moderate physical activity examples:

• Walking
• Gardening 
• Swimming
• Golf
• Table tennis or regular court tennis 

Vigorous physical activity examples:

• Dancing 
• Cycling 
• Team sports - football, netball or others
• Running or jogging 

A balance of stimulating and relaxing activities whilst making sure there is regular exposure to sunlight is a great way of boosting well-being. Ensure too strenuous activity is avoided if it does not seem suitable, always discuss with caregivers or healthcare professionals for each case to ensure no unnecessary risk. 

Nutrition and diet

Ensuring a healthy and balanced diet is essential in managing a healthy lifestyle however, people with dementia can sometimes experience difficulties with eating or drinking but there are ways of managing this. Someone with dementia may struggle to recognise food or drink given to them especially if it is presented differently. There is no special diet that should be followed by people with dementia. 

Carers can help by remembering what the individual likes and doesn't like ensuring a calm environment and not rushing them to eat or drink. 

Specific nutrition 

Food is vital for maintaining a healthy lifestyle and there is evidence to suggest a correlation between diet and brain processes such as thinking. 

Some specific nutrients have been associated with aiding an improved cognitive function in older people, such as:

• Omega-3 fatty acids - found in salmon, kiwi and walnuts
• Flavonoids - found in dark chocolate, and citrus fruits such as oranges and wine.
• Vitamin D - is found in egg yolk, milk and oily fish
• Vitamin B 
• Vitamin E - is found in seeds, nuts and olive oil
• Choline - is found in eggs, dairy, nuts and canned salmon

The mediterranean diet 

One specific dietary regime that has consistently demonstrated positive effects on health is the Mediterranean diet. This particular diet helps to avoid high levels of saturated fat and research has shown the Mediterranean diet to improve cognitive function and lower the risk of dementia.⁵

The diet emphasises plant-based foods and healthy fats by consuming things like:

• Lots of vegetables, legumes, fruits and nuts 
• Moderate amounts of alcohol (typically wine) and fish 
• Low amounts of dairy except yoghurts and cheeses
• Low amounts of red meat, choosing poultry instead or beans 
• Minimal sweets, sugary drinks or butter 
• A good amount of whole grains like brown rice 

The DASH diet 

The DASH diet or dietary approach to stop hypertension is designed to control blood pressure, which happens to be one of the risk factors for dementia. It is similar to the Mediterranean diet but with a larger emphasis on reducing salt intake. 

It focuses on consuming fruits, vegetables, beans, and nuts as well as whole grains, poultry, fish and low-fat dairy. 

Researchers at the University of Chicago combined the best of both these diets to create the MIND diet (Mediterranean-DASH intervention for neurodegenerative delay). Although data is still in its early days, the background is solid and does appear to reduce the risk of developing dementia. 

Social engagement and support

Staying socially and mentally active throughout life has been linked to improving the overall health of a person, and has specific benefits for people with dementia. 

Social engagement through activities such as clubs or voluntary work is a great way to maintain a connection to others. This is important as social activity supports brain health and reduces the risk of depression which is a side-effect of dementia. Community and social engagement helps to maintain a sense of purpose which can sometimes be lost in those with dementia, so support from neighbours and people around them can help them feel they have things to look forward to. 

What the activity is can vary drastically so it's beneficial to find what works for each individual as it helps maintain a feeling of fulfilment and motivation. Volunteering, for example, is a great way to meet other people whilst contributing to your community. Little acts of support and the feeling of community can go a long way in improving mental health and making them see they are not alone. This is not only for people with dementia but their caregivers too. 

Creativity and dementia 

Creativity is essential for cognitive health as it stimulates the brain by boosting cognitive function whilst also providing a therapeutic outlet. It can lead to improved memory, concentration and problem-solving skills. In people with dementia, it can also provide a new and different medium for communication with those around them. 

Art therapy 

Research has shown that art therapy can be hugely beneficial for people with dementia as it engages their attention whilst being therapeutic. Looking at the art that was created can also help caregivers understand how they might be feeling. There are many examples of activities that can be tried:

• Group poetry workshops 
• Painting and colouring 
• Collages
• Jigsaw puzzles

Art therapy can provide a sense of achievement in people with dementia, boosting their confidence and sometimes even boosting their moods.

Summary

Dementia is an umbrella term often used to describe abnormal brain changes resulting in issues with memory or thinking skills. 

Although there is no cure yet for dementia there are a few pharmacological treatment options, though these don't work for everyone. This means non-pharmaceutical management techniques such as art therapies, dietary changes, regular physical activity or therapies can work wonders in slowly improving some cognitive abilities. These additions to the lives of people with dementia can significantly improve their mental well-being, helping them to manage dementia with the help of their caregivers.