DEMENTIA INFORMATION SESSION Terezie Holmerova – Westminster Dementia Adviser Housing & Care 21

Introductions Name + any experience of dementia?

Objectives By the end of this session, you should:  Understand what dementia is and how it affects people  Have a clear picture of all the main types of dementia including alcohol related dementia  Feel more confident about communicating and engaging with a person with dementia

Statements about dementia – True or False?

Facts  There are 850,000 people with dementia in the UK  There are 40,000 younger people with dementia  There will be 1 million of people with dementia in the UK by 2025  1 in 14 people over 65 has dementia, and 1 in 8 people over 80  1 in 8 people with alcoholism - W.K syndrome

Symptoms  day-to-day memory  concentrating, planning, organising  language  visuospatial skills  orientation  mood changes

The bookshelf model of memory storage

 Hyppocampus – factual memory, logic and reason, attention  Amygdala – feelings, emotional memories

Visuospatial problems

What causes dementia?  Alzheimer’s disease  Vascular dementia  Mixed dementia  Dementia with Lewy bodies  Frontotemporal dementia  Alcohol related dementias

The effects of Alzheimer’s Disease on the Brain

Alcohol related brain damage: Wernicke-Korsakoff syndrome - caused by severe deficiency of thiamine (B1) - most commonly caused by alcohol misuse but also malnutrition, HIV, anorexia - alcoholics: lack of thiamine + poor diet + alcohol interferes with the ability of the body to store vitamines (damanged stomach and liver lining) - affects younger people than A.D. and V. D - can be treated and halted

Wernicke’s encephalopathy  develops suddenly  nystagmus  ataxia  confusion, drowsiness  medical emergency, requires intravenous injection of vitamin B1, 20% die, 85% of survivors develop Korsakoff syndrome

Korsakoff syndrome  develops if K.E. untreated but also gradually  short term memory loss, ability to learn new skills  lack of insight  confabulation  changes in personality

Alcohol significantly increases risk of other, more common dementias!

Communication – practical aspects  Make sure that the person can see you clearly  Make eye contact  Minimise competing noises  Avoid asking too many direct questions  Try not to ask the person to make complicated decisions  You may need to speak at a slightly slower pace,  Don't talk about people with dementia as if they are not there or talk to them as you would to a young child

 Never stand too close or stand over someone to communicate, drop below their eye level.  Don’t interrupt them even if you think you know what they are saying  Try not to finish their sentences, look for cues  If the person says something you know to be incorrect, try to find ways of steering the conversation around the subject rather than contradicting them directly. Try to see behind the content to the meaning or feelings they are sharing.

Assumption 1 – ‘She won’t understand’

Assumption 2 – ‘She behaves like that because of dementia’

Assumption 3: ‘It doesn’t make any sense’

Tom Kitwood  founder of ‘person-centred’ approaches - ‘personhood’  Dementia equation: D = NI + PH + B + SP D= Dementia NI = Neurological impairment PH = Physical health B = Biography SP = Social psychology

Disempowerment – not allowing the person to use the abilities they have

Infantilization – treating a person very patronizingly

Labelling – using category such as ‘dementia’, ‘organic mental health disorder’ as the main basis for interacting with the person and for explaining their behaviour

Outpacing – providing information, presenting choices at a pace too fast for person to understand

Invalidation – failing to acknowledge the subjective reality of the person, and especially what they are feeling

How do we communicate?

Questions?

Thank you for your attention!