Dementia An Overview Steven Roberts - PowerPoint Presentation

Slide1

Dementia

An Overview

Steven Roberts

Head of dementia services

Independent Nurse Prescriber

Steven.roberts@lpt.nhs.uk

Lincolnshire Partnership NHS Foundation Trust

Aims of the Session

What is dementia?

The different types.The risk factors?What are the early signs?Benefits of diagnosis.TreatmentsWhat can we do?

Chance to ask questions.

To provide an overview of:

So, just what is

dementia..???

Dementia is…..

..an illness ‘syndrome’ – a collection of signs & symptoms

…usually caused by disease of the brain

….which is progressive

Dementia ‘

IS NOT

’ forgetfulness due to

normal

aging…

whatever that may be??

Decline in cognitive abilities (memory, language, perception, attention)

Changes in behaviour, mood or personality

Decline in our day to day functional ability

Accumulation of abnormal proteins that disrupt and kill brain cells and their connections

Changes in health of the blood vessels & supply of the brain

It is a chronic condition

Differing patterns of onset and progression

‘Average’ duration of 8 years

….not a single disease, but…

There are different types…

The main causes (or types) are:

Alzheimer’s disease > 62 %

Vascular dementia > 17 %

Lewy Body Dementia > 5 %

Frontal lobe dementia > 2%

Mixed dementia > 10%

All effect the brain and thus the person in different patterns and ways.

Important to diagnose – important for drug treatment and understanding the individuals behaviour and context

Gradual progression > Fluctuating cognition, visual hallucinations, parkinsonism, REM-sleep BD, falls, neuroleptic sensitivity, autonomic dysfunction, visuospatial deficits

Step-wise progression, multiple strokes, > seizures, unsteady gait, depression, behaviour change, incontinence, vascular problems

Gradual progression > rare, younger onset, memory initially intact, changed social conduct, speech reduction, early loss insight, emotional blunting, diet/eating changes, incontinence.

Gradual progression > 3 types, early onset(rare < 10%, late onset & familial (rare < 5%); ST memory, loss of judgement, communication – global impairment

A mixture of both Alzheimer type and vascular type dementia

Impact on our brain…

So how big is the problem?

National

: Mapping the dementia gap (2010)

Local

: Lincolnshire PCT (2011)

Currently - 10, 877 cases in Lincolnshire

But only

41- 45

% have been diagnosed

Number of cases set to rise by

43

% in the next 10 years

By

78

% in next 14 years

Higher than National average

Currently > 750,000 people with dementia in the UK

Over 16,000 under the age of 65 years

Estimated to be over 1 million by 2021

Lincolnshire has one of the fastest growing elderly populations in the UK

So, who is at risk?

….well, we all are…

Main Risk-Factors:

Age

Advancing age is the main risk. The incidence of dementia approximately doubles every 5yrs after the age of 65.

Family History/Genetics >

interact with ‘life style’ factors.

A number of genes discovered that increase the ‘risk’ for AD (i.e. PS1, PS2, APOE) and Frontal lobe dementia (FTDP-17) – these effect the processing of brain proteins

Family history heightens risk BUT ‘familial’ forms very rare (very early onset – 40’s).

Gender

Alzheimer’s disease – more females than males

Vascular dementia – more males than females

Diabetes & depression (stress)

Recent studies (2010) showed increased risk of dementia associated with these – due to links to the underlying biological processes

Head injury & anaesthesia

Some studies indicate that head trauma (with loss of consciousness) and anaesthesia may represent risk factors in vulnerable individuals

Predicted that up to

half

of the cases of Alzheimer’s could be attributed to lifestyle choices that could be modified. Including education, smoking, physical inactivity, depression, high blood pressure, diabetes and obesity.

(University of California, 2011)

SO

, risk can be modified as it is a combination of genetic and individual lifestyle and environmental factors.

These also give us clues as to how we can help people with dementia as well.

Memory loss – short-term memory, disorientation/getting lost

Difficulty with familiar tasks – cooking meals, organising tasks..Problems with language – word finding, naming..

Poor judgement – e.g. dressing inappropriately for weather.. Trouble keeping track of things – conversations, finances etcMisplacing things – putting things in unusual placesChanges in mood or behaviour – depression, mood swings, disinhibitedChange in personality – irritable, suspicious, anxious, asocial

etc

Loss of initiative

– passive, increased sleeping, loss of interest

etc

What are the early signs?

Enables people to understand their condition (

psychoeducation

)Early access to treatment to relieve symptoms (excess disability)To access support/carer supportAccess to information‘Opening a door’ – for future careLegal – Power of Attorney, Wills, Living WillsFinancial planningLife planning

Are there benefits of early diagnosis?

Early & accurate diagnosis is a National priority (NDS, 2009)…

….but why??

So, can dementia be treated..???

Are there drugs to treat dementia?

3 types of drug intervention..

1: Curative – where disease is eradicated

No treatments available

2: Disease Modifying

– where treatment alters course of illness

No treatments available

3: Symptomatic treatment

– aimed at minimising impact of illness

T

reatments available – current level of drug therapy

‘Anti-dementia’ drugs….

W

hat are they? Cholinesterase Inhibitors

Donepezil (Aricept),

Rivastigmine

(Exelon)

Galantamine

(Reminyl

)

W

hat are they for?

Mild to moderate Alzheimer’s disease

(can worsen FTD)

To improve ‘daily functioning’. Concentration

? Behaviours that challenge

W

hat is the evidence?

Controversy – cost effectiveness

High potential for side-effects – heart, breathing, falls, upset stomach

Modest benefit – approx 40% (NNT = 14: 1 in every 14 benefit)

Also:

Memantine

: works by different mechanism

For severe Alzheimer’s disease (MMSE of 10 points or less)

To improve functioning/behaviours that challenge

Modest benefit – again

approx

40% NNT = 14: 1 in every 14 benefit)

So, is there anything else we can do..???

Yes…The ‘Big Five’ for Optimal Brain Function

Growing evidence that some lifestyle practices can slow or prevent issues that compromise mental function -

The BIG FIVE:Physical activity

Nutrition

Mental stimulation

Socialization

Creativity and attitude – stress reduction

The very

GOOD NEWS

– for the most part these are issues you can do something about –

RIGHT AWAY, RIGHT NOW…..

.

Body & Mind…

For starters

….’What is good for your heart is ALSO good for your

brain

’

Arterial disease

Strokes

Heart Attacks

Share common risk factors...cholesterol, high blood pressure, obesity, arterial damage, plaque build up…

SO

…

…..when you watch your cholesterol, maintain a healthy weight, and exercise for your heart,

your brain benefits too

.

…

stay healthy

…

Researchers looking at memory loss in older adults are becoming increasingly interested in the role played by diet and exercise….

1: Physical Activity:

2:Nutrition:

Daily, at least two and a half hours per week:

Daily tasks

(use the stairs, gardening, vigorous cleaning)

Swimming

(works joints/muscles without drag of gravity)

Dancing

or aerobics

(exercises brain as well, fun)

Biking/stationary bike

(but protect your brain with a helmet!!)

Tai-chi, yoga, Qui

gon

(strength, balance, concentration, de-stress)

Walking, walking, walking

…………………..

Clutch of new studies indicate that walking 5 miles per week associated with lower risks of dementia

(observed increased size of brain in areas associated with memory)

Uni. Pittsburgh > walking 5-6 miles a day slows the progress of dementia in those showing MCI or AD.

Basics: your brain needs good fuel!

Avoid

:

saturated fats, processed meats, simple carbohydrates, salt;

Pile on:

fruits, veggies, complex carbohydrates, grains & nuts, Oily fish & Omega-3 fatty acids

Anti-oxidants:

links with dementia :

Vitamins E & C – diet rich in fruit & veg, green tea,

blueberris

, red-wine,

ginko

biloba

etc…

Mediterranean diet

– fruit, veg, olive oil, legumes, grains and fish – associated with reducing risk of dementia.

N

utrition can help manage vascular risk-factors & diabetes associated with dementia

..

use your mind & connect

..

‘Exercise’ your brain

….

Education is neuroprotective.

Brain trainers.

Puzzles

,

games, sensory

stimulation, crosswords, reading, CST etc.

BUT

-

Appropriate

level -

adapt to changing abilities

!

`Use it or lose it!’

3: Mental stimulation

..remain socially connected.

Humans are social creatures

Appropriate

socialization

Work with known difficulties not against

Trust in and inform

others to help.

4

: Socialisation

Things socialisation does for your brain:

Lowers your blood pressure > risk of stroke

Improves immune function

Lowers memory loss by keeping mind active

…and manage stress and spirit..

5:

Creativity, attitude & spirit:

Manage

and be aware of

stress:

Antidepressants

(depression as risk factor)

A

romatherapy

,

diet

and exercise

(

e.g.

tai chi, yoga etc.)

Meditation

(mindfulness – the here and now)

As dementia emerges your emotional life grows..

Just as your brain dictates your feelings, your feelings affect your brain >

stress hormones!!.

Be creative – be human!

Music

(singing for the brain)

Art

(art therapy)

Dancing

Adapt and support in the ‘now’…

Mood & behaviour as coping

defences?

Communication (e.g. SPECAL)

adapt activities to present abilities

Music can:

Reduce anxiety, aid sleep, lower blood pressure, reduce stress hormones

.

The creative brain:

memory for music and emotion are in a different part of the brain from memory about ‘things’ and is often intact much longer in even sever dementia

This means these intact abilities can be tapped into in dementia

Dementia

is a collection of signs and symptoms –presents in many different ways

and people experience it differently.Due to changes in the brain – different types Multiple risks – not one thing alone – genes & lifestyle/environment.Important to identify early – to plan, understand, manage and support.Drug treatments – currently limited to symptom relief – do not cure!

Lifestyle changes

can reduce risks & maximise wellbeing – there are things we can all

do NOW!

Summary…

at last!!



`THANK YOU

Any questions..???

…..if you are you still awake???

