Memory Disturbance and Dementia
Experiencing a difficulty with memory can be the first sign of dementia. However, it is important to know that there are a number of other treatable neurological and medical conditions such as chronic migraine, obstructive sleep apnoea, or anxiety and depression that can also result in problems with memory. This means that having symptoms of a disturbance in your memory does not always necessarily mean a diagnosis of dementia.
Dementia also does not necessarily mean that you need to have a problem with your memory. Alzheimer's disease is the most common form of dementia and it usually presents with memory problems. However, there are other types of dementia that can present with very different symptoms. Certain types of dementia can present with progressive changes in behaviour or personality, or a disturbance in speech and language abilities, or even a disturbance in the way in which you process visual information. Furthermore, people who develop dementia under the age of 65 tend to have a wider range of presentations including symptoms of anxiety and depression which can often lead to a misdiagnosis.
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Some Forms of Dementia
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Alzheimer's Disease and its variants
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Lewy Body Dementia
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Parkinson's Disease Dementia
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Frontotemporal Dementia
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Primary Progressive Aphasia
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Progressive Supranuclear Palsy
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Corticobasal Degeneration
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Vascular Dementia
Amyloid PET scan for diagnosing
Alzheimer's Disease
Dementia Assessment
Careful assessment of symptoms with a neurologist combined with detailed neuro-psychological testing of your various cognitive functions is necessary for the accurate diagnosis of your condition. In most cases, specialised investigations involving MRI scanning of your brain to look for any alteration to your brain structure, or Positron Emission Tomography (PET) scanning of your brain to assess for any loss of cerebral function might also be required to confirm the diagnosis.
If a diagnosis of Dementia has been established, a range of research-proven medications can then be commenced to try to improve the cognitive function of people who have certain types of dementia. There are now also treatments (Lecanemab and Donanemab) available to slow the rate of progression of Alzheimer's disease (see section below).
However, the treatment of Dementia involves more than just the use of medications and ultimately requires a holistic approach to care.
Being given a diagnosis of Dementia will have a significant impact on a person and on their family. Understanding the nature of the condition, both from the perspective of the person suffering with the condition, and from the perspective of family members, is crucial in helping to provide the necessary long-term support so as to enable the person with Dementia to have the best quality of life possible. Enlisting the help of local services and supportive organisations like the Alzheimer's Society in this process can be invaluable.
Amyloid Targeting Therapies for Alzheimer's Disease.
What are Amyloid Targeting Therapies (ATT)?
Amyloid Targeting Therapies are a class of disease-modifying drugs for the treatment of Alzheimer’s disease. They are a form of monoclonal antibody treatment (proteins that helps your immune system target specific proteins for removal) designed to remove a protein called amyloid beta from the brain. Amyloid beta is an important protein involved in the progression of Alzheimer’s disease.
Amyloid Targeting Therapies do not cure Alzheimer’s disease, but they are shown to modestly slow the rate of progression in patients with mild cognitive impairment (MCI-AD) or early-stage dementia caused by Alzheimer’s disease (mild AD). Currently available Amyloid Targeting Therapies can delay the progression of your symptoms by up to six months after 18 months of treatment.
It is important to understand that although they have been demonstrated to delay the progression of the condition, this does not mean that you are going to experience in yourself an improvement in your current symptoms whilst on these treatments. Your condition will continue to progress, although at a slower rate than if you are not taking the treatment.
Treatment with Amyloid Targeting Therapies
There are currently two Amyloid Targeting Therapies approved in the UK for the treatment of MCI-AD or mild AD. These are currently only available privately as they have not been approved for use in the NHS due to the costs of these treatments.
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These treatments are also not currently reimbursed by private medical insurance and are available only as self-pay treatments.
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Find out more about accessing these treatments under Dr Chan at HCA Healthcare at London Bridge Hospital.
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Lecanemab (Leqembi®)
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Donanemab (Kisunla™)
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What does treatment with Lecanemab or Donanemab involve?
How is the treatment given?
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Both Lecanemab and Donanemab are given as intravenous infusions and this is done as a day-case visit in an infusion suite at the hospital.
Each infusion takes up to an hour. How regularly you have the infusion depends on which treatment you choose:
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If you are on Lecanemab, you’ll have an infusion every two weeks.
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If you are on Donanemab, you’ll have an infusion every four weeks.
How long do I have to be on treatment?
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If you are on Lecanemab, you will continue with this treatment for 18 months. After 18 months, you will switch to maintenance treatment which is given every 4 weeks and you will remain on treatment unless you progress to a moderate stage of Alzheimer's disease.
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If you are on Donanemab, you will only have a maximum of 18 months of treatment. If you have a repeat Amyloid PET scan at 6 or 12 months that shows sufficient clearance of amyloid protein in your brain, you can also stop the treatment then.
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What are the risks of treatment?
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Amyloid-targeting therapies can cause a side effect known as amyloid related imaging abnormalities, or ARIA for short. ARIA involve leakiness of the blood vessels in your brain which leads to brain bleeding or swelling, or a combination of both.
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Your risk of ARIA depends on a gene known as the APOE gene. People with two copies of the E4 version of this gene are at a much higher risk of ARIA than people who have only one or no copies of the gene. In the UK, the MHRA has disallowed the use of amyloid-targeting therapies in people with two copies of the APOE4 gene version to significantly reduce the risks of treatment. Before starting on treatment, we’ll carry out a genetic test to make sure you have either one or no copies of the e4 gene to check that you are able to have the treatment.
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If you do not have two copies of the e4 gene version, although up to 1 in 3 people can develop ARIA, only up to 3 in 50 people will develop symptoms from it and less than 1 in 50 people will have serious complications from it.
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In the majority of cases, ARIA is very mild and does not cause any symptoms. You will also be having regular MRI scans during the first 6 months of treatment to screen for ARIA as this is when it is most likely to occur.
Collaboration with the Alzheimer's Society
My previous partnership with the Alzheimer's Society has been showcased in June/July 2017 publication of "Living Well With Dementia", the national magazine of the Alzheimer's Society.
https://www.alzheimers.org.uk/info/20228/junejuly_2017/1109/on_the_spot
Young Onset Dementia
Young onset dementia is dementia that affects people who are under 65 years of age. The different ways in which dementia presents in this age group can make the diagnosis more challenging. As a fair number of people with young onset dementia are still of working age, the impact on their lives is also significantly different and they often require different avenues of support.
You can find out more about Young Onset Dementia with the following links:
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