Head of dementia services Independent Nurse Prescriber Stevenrobertslptnhsuk Lincolnshire Partnership NHS Foundation Trust Aims of the Session What is dementia The different types The risk factors ID: 914174
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Slide1
Dementia
An Overview
Steven Roberts
Head of dementia services
Independent Nurse Prescriber
Steven.roberts@lpt.nhs.uk
Lincolnshire Partnership NHS Foundation Trust
Slide2Aims 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:
Slide3So, just what is
dementia..???
Slide4Dementia 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…
Slide5There 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
Slide6Impact on our brain…
Slide7So 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
Slide8So, 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.
Slide9Memory 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?
Slide10Enables 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??
Slide11So, can dementia be treated..???
Slide12Are 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
Slide13‘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)
Slide14So, is there anything else we can do..???
Slide15Yes…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…..
.
Slide16Body & 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
.
Slide17…
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
Slide18..
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
Slide19…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
Slide20Dementia
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!!
Slide21`THANK YOU
Any questions..???
…..if you are you still awake???