Seven things you didn’t know about dementia

Published on: 20 May 2015

Spending time in a garden can be beneficial for care home residents with dementia.
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Dementia can happen to anyone and there's currently no cure. It can strip you of your memory, your relationships and your connection to the world you love, leaving you feeling isolated and alone.

To mark Dementia Awareness Week we asked some of the world-leading researchers working on dementia at the University of Exeter to give us some insights into the condition based on their areas of expertise.

1. Your lifestyle could increase your risk of developing dementia

There are many different types of dementia; the most common is Alzheimer’s disease. But what many people don't realise is that in about one third of cases lifestyle plays a part in whether or not someone develops Alzheimer's.

The risk of developing Alzheimer’s is increased for people who:

  • Are overweight or obese.
  • Have high blood pressure in middle age.
  • Smoke.
  • Drink alcohol to excess.
  • Experience depression.
  • Have diabetes (at any age).

 There are ways of reducing this risk. These include:

  • Being physically and mentally active.
  • Being involved in social activities.
  • Eating a healthy diet rich in fish and vegetables.

 Researchers are working on ways of helping prevent people developing dementia.

Professor Linda Clare, Professor of Clinical Psychology of Ageing and Dementia, The Centre for Research in Ageing and Cognitive Health, College of Life and Environmental Sciences

2. Human brain cells 'created' in a dish can help us understand dementia

Although brains from deceased humans have been available for scientific study for a long time, as exemplified by the pioneering investigations of Alois Alzheimer more than 100 years ago, scientists studying the processes that underpin brain diseases have been hindered by their inability to access and experiment on living brain tissues from disease suffers - we cannot extract a piece of living brain to study in the lab.

But recent advances in stem cell biology means we can now take easy to obtain human cells (such as white blood cells or skin cells) and turn them into various forms of brain cell 'in a dish'.

To achieve this we remove the original cellular identity of the donated cells, turning them into a cell type (stem cell) that is capable of being turned into any type of human cell. We then turn the stem cells we have created into brain cells.

University of Exeter scientists and their collaborators in other GW4 universities are using these methods to look at the neurobiology of cells obtained from dementia suffers, with the goal of better understanding disease processes. This knowledge will allow novel therapeutic directions to be considered for future treatment/cure of dementia.

Professor Andrew Randall, Professor in Applied Neurophysiology, University of Exeter Medical School

3. Gardens and outdoor spaces in care homes can reduce agitation for residents with dementia

Many people living in residential care homes have dementia or dementia-like symptoms and opportunities to help people to feel better without the use of medication are important.

Spending time in a garden can be relaxing and calming for residents of care homes, their families and staff.

A systematic review (a study that brings together all existing research on a particular question) lead by the PenCLAHRC Evidence Synthesis Team from the University of Exeter Medical School found 17 small studies from the US, UK, Australia, China, Canada, Sweden and Finland, most done in the last 10 years, that looked at the impact of horticultural therapy on the wellbeing of people with dementia with three of them looking at the impact of horticultural therapy on the wellbeing of people with dementia.

The key findings of the review were:

  • There was a promising impact on the level of agitation in care home residents with dementia who spend time in a garden.
  • Gardens need to offer a range of experiences to suit different needs.
  • Families valued somewhere pleasant to meet that stimulated interest and conversation.
  • Staff said residents found the gardens calming.
  • However, there were some barriers to use, such as the perception of the garden as a hazard and sometimes limited staff time for supervision.

 The research suggests that although there are promising relationships between garden use and agitation in care home residents with dementia. Further work in this area should focus on measuring key concerns in consistent ways, and on understanding and solving the causes of limited accessibility.

Dr Jo Thompson Coon, Senior Research Fellow, Evidence Synthesis Team, University of Exeter Medical School

4. Playing music at mealtimes can reduce agitation and aggression in care home residents with dementia

Around a third of people with dementia in the UK are cared for within long term care or nursing homes where staff are increasingly expected to provide appropriate care for people with a range of dementia symptoms from wandering, to fear and physical or verbal aggression.

Research suggests that agitated and aggressive behaviours may be worse at meal times, which interferes with eating and impacts on other residents in the care home.

A systematic review lead by the PenCLAHRC Evidence Synthesis Team from the University of Exeter Medical School found 11 small studies from the US, UK, Australia, Canada, Sweden, Taiwan and Belgium where several alterations to mealtime environments were evaluated:

  • Playing relaxing music.
  • Changing to a family style meal service.
  • Improving the lighting conditions and general ambience.
  • Changing the colour of crockery used.
  • Introduction of a breakfast club.

 The research found that small simple and inexpensive alterations to mealtime environments in care homes, in particular playing music, can help reduce symptoms of agitation and aggression.

Music in particular seemed to have a long lasting effect, beyond that of the mealtime itself; and greater benefits appear to be seen in people with less severe symptoms of dementia. Further work in this area would benefit from focusing on the social aspects of mealtimes, such as engagement and independence, as well as overall resident wellbeing.

Dr Rebecca Abbot, Research Fellow, Evidence Synthesis Team, University of Exeter Medical School

5. Dementia is not just about loss of memory

Some types of dementia, particularly Alzheimer’s disease, result in memory problems. People find recent events harder to remember, but earlier childhood events are recalled more easily.

However, other problems are also common such as:

  • Problems handling money.
  • Difficulty learning to use new household objects.
  • Getting lost in familiar places.

 Often these changes are noticed by loved ones first.

Some types of dementia – particularly when the front part of the brain is affected, result in changes in behaviour such as being over-familiar with people, or withdrawn.

Mood is often affected, with people becoming more easily upset or irritable. Depression is common in dementia and can be treated separately.

Dr Maya Soni, Associate Research Fellow in Dementia, University of Exeter Medical School

Professor Rose McCabe, Professor of Clinical Communication, University of Exeter Medical School

6. Having vitamin D deficiency could increase your risk of dementia

Vitamin D deficiency is associated with a substantially increased risk of dementia and Alzheimer’s disease in older people according researcher led by Dr David Llewellyn at the University of Exeter Medical School.

In a six-year long study of elderly Americans it was discovered that adults who were moderately deficient in vitamin D were 53 per cent more likely to develop dementia, this increased to 125 per cent in those who were severely deficient.

Similar results were recorded for Alzheimer’s disease, with the moderately deficient group 69 per cent more likely to develop this type of dementia, jumping to a 122 per cent increased risk for those severely deficient.
Vitamin D comes from three main sources:

  • Exposure of skin to sunlight
  • Foods such as oily fish,
  • Supplements

Older people’s skin can be less efficient at converting sunlight into Vitamin D, making them more likely to be deficient and reliant on other sources. In many countries the amount of UVB radiation in winter is too low to allow vitamin D production.

Dr David Llewellyn, University of Exeter Medical School

7. Eating a Mediterranean diet may help to protect the ageing brain by reducing the risk of dementia

Over recent years many pieces of research have identified a link between eating a Mediterranean diet and a lower risk of age-related disease such as dementia. A Mediterranean diet typically consists of high consumption of plant foods such as fruits, vegetables, legumes and olive oil, moderate consumption of fish and dairy products, and reduced intake of red meat and processed foods. Moderate alcohol intake, usually wine, during meals is another common characteristic.

A systematic review led by Ilianna Lourida from the University of Exeter Medical School found 12 eligible pieces of research; 11 observational studies and one randomised control trial. In nine out of the 12 studies, a higher adherence to a Mediterranean diet was associated with better cognitive function, lower rates of cognitive decline and a reduced risk of Alzheimer’s disease. However, results for mild cognitive impairment were inconsistent.

Researcher Ilianna Lourida said: "The Mediterranean diet is highly nutritious, and our systematic review shows it may help to protect the ageing brain by reducing the risk of dementia. While the link between adherence to a Mediterranean diet and dementia risk is not new, ours is the first study to systematically analyse all existing evidence. Robust clinical trials are now needed to confirm these observations."

Ilianna Lourida, PhD student, University of Exeter Medical School

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