1. DR JOHAN SCHOEMAN ACTING CONSULTANT PSYCHIATRIST OLDER PEOPLE’S MENTAL HEALTH SERVICES (SOUTH BEDFORDSHIRE AND LUTON) Basics of Dementia

2. Atrophy in Alzheimer’s Disease Back Front Diseased

3. Description of Dementia It is a brain disorder which is progressive and irreversible caused by the death of neurons higher brain functions losses and executive dysfunction

4. Dementia Definition - 2 Difficulties Activities Higher Brain Working BPSD Change in person’s role Increased Dependence Decreased Quality of Life Decreased Autonomy BPSD – Behavioural and Psychological Symptoms of Dementia

5. Behavioural and Psychological Symptoms of Dementia Behavioural and Psychological Symptoms of Dementia: - Hallucinations (often visual) - Activity Disturbances e.g. wandering, hiding things, purposeless activities - Irritability/Frustration/Aggression - ‘Sundowning’ and Sleep-Wake reversal - Low mood (tearfulness, ‘life not worth living) - Increased Anxiety (being left alone, upcoming events)

6. Higher Brain Functions Memory Thinking Orientation Comprehension Language Judgement Calculation Writing Reading

7. Executive Dysfunction Cognitive process that regulates a person's ability to: - organize thoughts and activities - prioritize tasks - manage time efficiently - make decisions - have insight into cognitive deficits

8. Others Dementia with Lewy Bodies Dementia in Parkinson’s disease ‘Reversible’ dementia Frontotemporal dementia Alcohol dementia Dementia in Huntington’s disease Dementia in Multiple Sclerosis AIDS dementia Types of Dementia

9. Lois Alzheimer (1864-1915) In 1906 Alzheimer gave a lecture in which he identified an 'unusual disease of the cerebral cortex' which affected a woman in her fifties, causing memory loss, disorientation, hallucinations and ultimately her death at only 55. Emil Kraepelin, the head of the lab at the University of Munich Medical School where Alzheimer worked at the time, named the disease Alzheimer's.

10. Augusta D

11. Common to Dementias – Loss of Nerve Cells

12. Who suffers from Dementia

13. Who suffers from dementia Both male and female All ethnic groups All religious groupings Vegetarians and non-vegetarians Manual labourers Professional persons Industrialised and developing countries

14. Who suffers from Dementia

15. Cost to Society

16. Scale of the problem 800,000 persons in UK Over 17,000 under 65 years Over 11,500 from BME groups One-third over 90 have dementia 66% live at home, 33% in care homes One-third live alone at home

17. Cost to Society

18. Natural History of Dementia Phase One : Early symptoms to diagnosis Phase Two : Increasing deficits Phase Three : Dependence – most activities

19. MMSE Phase One Phase Two Phase Three 30 30 25 25 20 20 15 15 10 10 5 0 Years123456789 Symptoms Diagnosis Loss of Functional Independence Behavioural Problems Nursing Home Placement Death

20. Dementia Life Expectancy Diagnosis to death about 8 years Varies greatly – 2 to 20 years Women – better life expectancy Death 3-5 higher than in persons without dementia Earlier death for those sufferers with severe Behavioural and Psychological Symptoms of Dementia Cause of death – Infections and Accidents

21. Medication and Dementia No cure for any dementia Cognitive Enhancing Drugs (CED) slow down progression of illness process CED only licensed for Mild to Moderate Degree of Alzheimer’s disease Effect is modest Names of CEDs: Aricept, Reminyl, Exelon Ebixa licensed for Moderate to Severe Alzheimer’s disease. Trust does not allow prescription

22. Good afternoon Sir. I’ve seen you before, but I am afraid I have forgotten your name. The ‘Mirror Sign’ in advanced dementia ‘Mirror Sign’ in dementia

23. Dealing with Difficult Behaviour (BPSD) Every effort to use non medication means first One licensed drug available Use drugs with calming effect in other mental illnesses (psychosis, manic depression) Drugs: antipsychotics antidepressants anticonvulsants sedatives Drugs have unfortunate adverse effects

24. Adverse Effects of these drugs Increased likelihood of falls Can cause drowsiness Some drugs shaking, slowed movements and shuffling walking Evidence that it slows higher brain functions Occasionally causes agitation and restlessness More than expected ‘sudden deaths’ More than expected strokes and ‘mini strokes’

25. Approach to person with dementia Continues to deserves love, respect, support and to be treated with dignity Brain function has slowed down but continues to be an intelligent person Is still part of God’s creation Talk slowly, clearly facing the person Use ‘chunking’ when talking Doing things with a person with dementia rather than doing things for the person Gentle hand touching is reassuring and comforting Carer (relative) deserving of our prayers and support

26. Essence of Care person with Dementia Person with dementia

27. ? Questions & Answers Thank You Dr Johan Schoeman