1. DEMENTIA

2. Outline What is Dementia? What is Dementia? Who gets it? Who gets it? What are the symptoms? What are the symptoms? How do we diagnose it? How do we diagnose it? How do we treat it? How do we treat it? Impacts Impacts What can I do? What can I do?

3. What is Dementia? Condition of the brain – gradual loss of mental ability – includes memory, understanding, language. Also personality and social interaction can be affected. Condition of the brain – gradual loss of mental ability – includes memory, understanding, language. Also personality and social interaction can be affected. Can affect our ability to look after ourselves. Can affect our ability to look after ourselves. Many causes – commonest are Alzheimer’s, Vascular and Lewy Body Dementia – not always easy to tell apart. Many causes – commonest are Alzheimer’s, Vascular and Lewy Body Dementia – not always easy to tell apart. It is NOT due to ageing. It is NOT due to ageing.

4. Types Alzheimer’s (about half the cases) – shrinkage of brain with less nerve fibres and chemicals. Alzheimer’s (about half the cases) – shrinkage of brain with less nerve fibres and chemicals. Vascular – (about a quarter) – Blood vessels Vascular – (about a quarter) – Blood vessels Lewy Body – (about 1 in 6) – proteins in brainstem – can cause similar problems to Parkinson’s. Lewy Body – (about 1 in 6) – proteins in brainstem – can cause similar problems to Parkinson’s. Lots of others, and we can also get ‘mixed dementia’ Lots of others, and we can also get ‘mixed dementia’

5. Who gets Dementia? UK - After age 65 – 1 in 20 will get a form of it. UK - After age 65 – 1 in 20 will get a form of it. Over 85yrs – 1 in 5 people have it. Over 85yrs – 1 in 5 people have it. (Early onset – before 65) (Early onset – before 65) At risk groups – Parkinson’s Disease, Cardiovascular Disease, less active people, many more. At risk groups – Parkinson’s Disease, Cardiovascular Disease, less active people, many more.

6. Symptoms Loss of mental ability – Loss of mental ability – forgetfulness (most recent events) forgetfulness (most recent events) difficulty finding words, language problems (eg understanding) difficulty finding words, language problems (eg understanding) confusion and disorientation in new surroundings, losing track of time, planning confusion and disorientation in new surroundings, losing track of time, planning Behavioural/Personality changes – Behavioural/Personality changes – Irritable, moody, cheerful (unaware), disinhibition Irritable, moody, cheerful (unaware), disinhibition Problems with Daily Activities Problems with Daily Activities Driving, cooking, shopping, medicine, eating. Driving, cooking, shopping, medicine, eating.

7. Diagnosis Can be difficult to diagnose as it develops very slowly Can be difficult to diagnose as it develops very slowly Usually relatives who have concerns will ask the person to visit the doctor Usually relatives who have concerns will ask the person to visit the doctor At the doctors – if it is suspected – screening questions, blood tests At the doctors – if it is suspected – screening questions, blood tests Referral to specialist to confirm diagnosis – they may do scans of the brain Referral to specialist to confirm diagnosis – they may do scans of the brain

8. Treatment 1 There is no cure for dementia. There is no cure for dementia. No medicine can reverse it. No medicine can reverse it. Certain medicines can help symptoms in some types of dementia. Certain medicines can help symptoms in some types of dementia. 1- To help with thinking and memory 1- To help with thinking and memory Acetylcholinesterase inhibitors – Donepizil, Rivastigmine Acetylcholinesterase inhibitors – Donepizil, Rivastigmine Memantine – severe Memantine – severe 2- To help with mood and behaviour symptoms 2- To help with mood and behaviour symptoms Antidepressants, etc Antidepressants, etc

9. Treatment 2 By far the most important – SUPPORT AND CARE By far the most important – SUPPORT AND CARE Maintain independence as much as possible, for as long as possible. Maintain independence as much as possible, for as long as possible. Family, carers Family, carers District Nurses, Occupational Therapists, Physotherapists, Psychiatric Nurse, Social Services District Nurses, Occupational Therapists, Physotherapists, Psychiatric Nurse, Social Services Levels needed change over time Levels needed change over time Residential or Nursing Homes Residential or Nursing Homes

10. Impacts Person Person As we discussed – mental ability, behaviour, depression, ability to look after self As we discussed – mental ability, behaviour, depression, ability to look after self Family Family Can be enormous – spouse/children/other relatives may become carers (full/part time), difficult if person unaware or disinhibited. Problems with memory, ability to look after self – risk. Can be enormous – spouse/children/other relatives may become carers (full/part time), difficult if person unaware or disinhibited. Problems with memory, ability to look after self – risk. Society Society We are an ageing population – more and more people will develop dementia. We are an ageing population – more and more people will develop dementia.

11. What can we do? Modifying risk factors. Modifying risk factors. Especially lifestyle choices – exercise, smoking, fatty foods, moderate alcohol intake) Especially lifestyle choices – exercise, smoking, fatty foods, moderate alcohol intake) Keep both the body and mind active. Keep both the body and mind active. New hobbies, learning a language, playing a musical instrument. New hobbies, learning a language, playing a musical instrument.