Dementia – everything you need to know but were afraid to ask Dr. Shehram Moghul Consultant in OPMH Liaison Psychiatry Southampton General Hospital Nuffield Wessex Hospital, Chandler’s Ford

Biography Consultant in Hampshire since 2003 GMC examiner Medical member for Ministry of Justice Board of Royal College of Examiners Private Consultant for memory problems at Wessex Nuffield Hospital and Priory Hospital www.moghulmedical.co.uk (private sec. 02380 877524)

Learning outcomes Dementia vs old age (‘normal ageing’) Different types How it ideally should be diagnosed How it can be helped Some tips Time for questions

Learning outcomes Dementia vs old age (‘normal ageing’) Different types How it should* be diagnosed How it can be helped Some tips Time for questions *Increasingly difficult due to NHS pressures

What is normal ageing vs dementia?

Dementia vs normal ageing

What’s normal for you?

Learning outcomes Dementia vs old age (‘normal ageing’) Different types (dementia vs Alzheimer’s) How it ideally should be diagnosed How it can be helped Some tips Time for questions

What’s the difference between dementia and Alzheimer’s

Umbrella term DEMENTIA Alzheimer’s disease Vascular dementia Lewy Body dementia Frontotemporal dementia Others e.g. Huntingdon’s disease, Creutzfeld Jakob disease Alcohol

Vascular dementia – clinical features Patchy cognitive deficits, cardiovascular disease Abrupt onset, stepwise decline Vascular dementia Focal neurological symptoms and signs

Lewy Body Dementia LEWY BODY DEMENTIA Neuroleptic sensitivity Spontaneous motor Parkinsonism, Falls Complex visual hallucinations LEWY BODY DEMENTIA

Umbrella term DEMENTIA Alzheimer’s disease Vascular dementia Lewy Body dementia Frontotemporal dementia Others e.g. Huntingdon’s disease, Creutzfeld Jakob disease Alcohol

Frontotemporal Dementia Speech abnormalities Impaired judgement Disinhibition, Coarsened social behaviour e.g. sexual FRONTOTEMPORAL DEMENTIA

Umbrella term DEMENTIA Alzheimer’s disease Vascular dementia Lewy Body dementia Frontotemporal dementia Others e.g. Huntingdon’s disease, Creutzfeld Jakob disease Alcohol

Learning outcomes Dementia vs old age (‘normal ageing’) Different types How it ideally should* be diagnosed How it can be helped Some tips Time for questions *Recognise can be difficult due to NHS pressures

How do I diagnose dementia? History (duration, pattern of symptoms) Examination (physical, neuro, cognitive) MMSE – 25/30 Blood screen (thyroid, alcohol, kidney, B12) Maybe a brain scan

Dementia gets worse over time 5 10 15 20 25 30 1 2 3 4 6 7 8 9 MMSE Years Cognitive symptoms Early Loss of functional independence Mild-moderate Behavioural problems Nursing home placement Verbally explain differences seen in the natural history of VaD compared with AD. Severe Death Feldman H and Gracon S in: Clinical Diagnosis and Management of Alzheimer’s Disease. 1st ed. Martin Dunitz Publ London, England: Taylor & Francis Group; 1998

The spectrum of BPSD Psychotic symptoms Affective symptoms Hallucinations Delusions Misidentifications Affective symptoms Depression Apathy Elation Anxiety Disinhibition Behavioural Symptoms Aberrant motor behaviour Irritability/Aggression Agitation Sleep disturbance Stereotypies Hyperorality Eating disturbance Hypersexuality Mega et al. Neurology 1996

Learning outcomes Dementia vs old age (‘normal ageing’) Different types How it should be diagnosed How it can be helped Some tips Time for questions

Current treatment There is a cure for dementia? True or false?

false!

Approaches to management Management of dementia Licensed medication Unlicensed medication Non-pharmacological approaches Acetylcholinesterase inhibitors, Memantine Antipsychotics, antidepressants, Benzodiazepines e.g. activity, one to one care, aromatherapy

Memantine mechanism of action

What Does AD Treatment Mean for the Patient? Untreated, patients will decline rapidly, become severely dependent on caregivers leading to early admissions to nursing homes Mild Successful treatment Global Symptom Severity Untreated Severe Time

How do you prevent dementia?

Die young!

How to prevent dementia?

Learning outcomes Dementia vs old age (‘normal ageing’) Different types How it should be diagnosed How it can be helped Some tips Time for questions

Senses - sight Peripheral vision 180 degrees reduced to 35…equivalent to glaucoma Be within field of vision Don’t speak until you are within field! Colour perception drops (rods and cones)– ignore good taste and glam up! Bright plates, presentation darling Food dye (Westacre RH)

hearing Reduction of high frequency receptors

Worsened in dementia Natural loss worsened in dementia

LOWER THE TONE OF YOUR VOICE! Low, familiar tones, spoken slowly…

Taste and smell Bitter and sweet are the last receptors to deteriorate Therefore reconsider foods if appetite seems poor Sherbert lemons, humbugs, don’t worry about diet

The case of the tidy room

Learning outcomes Dementia vs old age (‘normal ageing’) Different types How it should* be diagnosed How it can be helped Some tips Time for questions *Increasingly difficult due to NHS pressures

Don’t worry! It’s not genetic!* *Ahem, actually it is sometimes…

Biography Consultant in Hampshire since 2003 GMC examiner Medical member for Ministry of Justice Board of Royal College of Examiners Private Consultant for memory problems at Wessex Nuffield Hospital and Priory Hospital www.moghulmedical.co.uk (private sec. 02380 877524)

Dementia – everything you need to know but were afraid to ask Dr. Shehram Moghul Consultant in OPMH Liaison Psychiatry Southampton General Hospital