Dementia Overview Gail Wilson

Types of Common Dementia Alzheimer's disease is the most common cause of dementia- parts of the brain become damaged. Vascular dementia-problems in the supply of blood to the brain. Dementia with Lewy bodies (DLB) is a form of dementia that shares characteristics with both Alzheimer's and Parkinson's diseases – Protein deposits in the nerve cells Fronto-temporal dementia-damage to the frontal lobe and/or the temporal parts of the brain- behaviour, emotional responses and language skills

Occipital Lobe: Process information about colour , shapes and movement Frontal Lobe: Language, planning, organising, learning tasks, regulating behaviour, initiating and stopping actions, personality Parietal Lobe: remembering the sequence of actions, body sense, calculations, sentence construction, problems interpreting visual information e.g not recognising people, locating objects Occipital Lobe: Process information about colour , shapes and movement Temporal Lobe; Remembering recent events, learning new information, visual memory (faces) verbal memory (names) attention MME exam. Use MME in groups.

The progression of dementia All types of dementia are progressive. The structure and chemistry of the brain become increasingly damaged over time. The person's ability to remember, understand, communicate and reason gradually declines. How quickly dementia progresses depends on the individual. Each person is unique and experiences dementia in their own way. * MME*

The later stages of dementia During the later stages of dementia most people will become increasingly frail, becoming totally dependent on others. Knowing what to expect can help everyone to prepare, and can enable the person to write an informed advance decision ,so they can have a say about how they wish to be cared for

Buijussen .H (2005) Refers to a slide back to a child/baby state “when someone looses the ability to smile death will be soon” “However always treat the person with dementia as an adult.”

Piagets Theory of child development Sensory –motor 0-6 weeks ( follows light with eyes, has not learnt to smile, starts to vocalise mm, gurgles) 0-8 mths ( primary reflexes, starts to separate own self from the world, start to swallow rather than suck) Skip to slide 19.

Memory loss Memory loss is likely to be very severe in the later stages of dementia. People may be unable to: recognise those close to them or even their own reflection. find their way around familiar surroundings or identify everyday objects. However, they may occasionally experience sudden flashes of recognition Forget how to get dressed, sequences. BE PATIENT – ALLOW EXTRA TIME DO NOT INTRODUCE NEW THINGS

The person may live in a time from their past, and may search for someone or something from that time. It can be helpful for those around them to use this as an opportunity to talk about the past and try to reassure the person. Even if a person has severe memory loss, they may still be able to appreciate or respond to outside stimuli such as music, scent and touch

There are four common areas in which people with memory loss often experience difficulty: remembering recent events taking in new information remembering people separating fact from fiction.

Communication problems understanding what is being said and what is going on around them. difficult to communicate with other people. They may gradually lose their speech, or they may repeat a few words or cry out from time to time. The person's expression and body language may give clues about how they are feeling. Those around the person should continue talking to them as though they understand. This helps to preserve their dignity. There may still be moments when the person seems to make an appropriate response.

Loss of mobility Many people with dementia gradually lose their ability to walk and to perform everyday tasks unaided. One of the first signs of this is that they shuffle or walk unsteadily. They may also seem slow or clumsy and be more likely to bump into things, drop objects or fall. Some people with dementia eventually become confined to a bed or chair.

Most people with dementia lose weight in the later stages of the illness. need help and encouragement with eating and drinking. chewing and swallowing are a problem, due to weak muscles and reflexes ,the person may choke on food or develop chest infections. The GP may be able to refer the person to a speech therapist, or to a nutritional specialist for advice on a special diet

Incontinence Many people lose control of their bladder in the later stages of dementia. Some also lose control of their bowels

Puzzling Behaviours Become more agitated React aggressively if they feel threatened or cannot understand what is going on around them May rock backwards and forwards, repetitive movements or keep calling out the same sound or word. Experience hallucinations, in which they see, smell, hear, taste or feel things that are not really there. develop delusions, in which they experience distorted ideas about what is happening.

Become restless because they need more physical activity. Have excessive hand activity, constantly wrings their hands, pulls at their clothes, taps or fidget Have periods of physical inactivity during which the person remains still, with their eyes open but not focused on anything

Prognostic Indicators for EOL Unable to walk without assistance, and Urinary and faecal incontinence, and No consistently meaningful verbal communication, and Unable to dress without assistance Barthel score < 3 Reduced ability to perform activities of daily living Plus any one of the following: 10% weight loss in previous six months without other causes, Pyelonephritis or UTI, Serum albumin 25 g/l, Severe pressure scores eg stage III / IV, Recurrent fevers, Reduced oral intake / weight loss, Aspiration pneumonia

Hand out

The life expectancy of a person with dementia is unpredictable, and the disease can progress for up to around ten years. Although dementia is a life-shortening illness, another condition or illness (such as bronchopneumonia) may trigger death and be given as cause of death on the death certificate.