Dementia Care Wendy Burnett CNS for Older People

What is Dementia

Prevelance 820,000 people in the UK diagnosed with Dementia and 35 million worldwide. In 2025 there will be over 1 million people in UK.

What is Dementia Dementia is an umbrella term which describes a serious deterioration in mental functions, such as memory, language, orientation and judgement.

Alzheimer's Disease There are many types, but Alzheimer's disease, which accounts for two thirds of cases, is the most well-known. It is named after the German scientist Alois Alzheimer who identified the condition over a century ago. Alzheimer had studied a patient at the Frankfurt Asylum called Auguste Deter. He first saw her in 1901 and followed her case until her death in She displayed short-term memory loss and disorientation and, after her death, an examination of her brain showed she had the tell-tale protein deposits of amyloid plaques and tau tangles which characterise Alzheimer's disease.

Amyloid Plaques Plaques consist of a protein called beta amyloid, or A-beta. These proteins are actually split from a larger protein molecule know as APP. The A-beta protein begins to accumulate causing certain enzymes and other molecules to be overwhelmed. Those molecules have the job to clear the A-beta protein a way, but are unable to because of the high concentration. When unable to clear the A-beta away this agitates and begin to stick together causing the amyloid plaques

Tau Tangles Tangles are made out of a protein called tau, which occurs in normal nerve cells. In Alzheimer's disease the tangles become altered, and they begin to pile up in large amounts similar to what you would imagine to be thread-like tangles. The tau protein's role initially is nerve sprouting acting as a form of self-repair. It also has the job of maintaining a type of railway track system of nerve cells. In Alzheimer's these tangles begin to accumulate, and eventually choke cells. The first casualties are nerve endings.

Cross section comparison

Forms of dementia Another form of the condition is vascular dementia, which develops when the oxygen supply fails and brain cells die. Fronto-temporal dementia affects personality and behaviour more than memory.

Dementia with Lewy Bodies Lewy Body dementia occurs when small structures develop in nerve cells, causing the degeneration of brain tissue.

How might someone with Lewy-Body dementia present? Visual hallucinations (often people or animals) Fluctuation in cognitive abilities (may last hours or weeks) Risk of falls (due to muscle rigidity) Night-time disturbance

All forms of dementia are progressive: as the brain becomes increasingly damaged over time, so a person's symptoms will become worse. Although the elderly are primary victims of the disease - about a third of people over 65 die with a form of it - it also affects about 15,000 people under the age of 65.

Rarer causes of Dementia There are many other rarer diseases that may lead to dementia, including progressive supranuclear palsy, Korsakoff's syndrome, HIV/AIDS, and Creutzfeldt−Jakob disease (CJD). Some people with multiple sclerosis, motor neurone disease, Parkinson's disease and Huntington's disease may also develop dementia as a result of disease progression.

Korsakoff's syndrome

Drugs used Cholinesterase inhibitors Donepezil (Aricept) Mild to Moderate Galantamine (Reminyl) Mild to Moderate Rivastigmine (Exelon) Mild to Moderate NMDA receptor antagonist Memantine Moderate to Severe

Acetylcholinesterase inhibitors

Pain continues to be under treated in people with Dementia. People with advanced Dementia are on a third of the analgesia of their peer group with similar health status. Parmalee1996,Morrison 2000,Pauolo 2003,Herr 2006

If a person with dementia has unexplained changes in behaviour and/or shows signs of distress, health and social care professionals should assess whether the person is in pain, using an observational pain assessment tool if helpful. However, the possibility of other causes should be considered. NICE

This pain behaviour tool is used to assess pain in older adults who have dementia or other cognitive impairment and are unable to reliably communicate their pain verbally PAINAD

Promoting person-centred care I

Care Plan

swallow

Top Tips I