Steven Roberts Head of dementia services Independent Nurse Prescriber [email protected]...
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Dementia An Overview Steven Roberts Head of dementia services Independent Nurse Prescriber [email protected]Lincolnshire Partnership NHS Foundation Trust
Steven Roberts Head of dementia services Independent Nurse Prescriber [email protected] Lincolnshire Partnership NHS Foundation Trust
Steven Roberts Head of dementia services Independent Nurse
Prescriber [email protected] Lincolnshire Partnership NHS
Foundation Trust
Slide 2
What is dementia? The different types. The risk factors? What
are the early signs? Benefits of diagnosis. Treatments What can we
do? Chance to ask questions. To provide an overview of:
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..an illness syndrome a collection of signs & symptoms
usually caused by disease of the brain .which is progressive
Dementia IS NOT forgetfulness due to normal aging whatever that may
be?? Decline in cognitive abilities (memory, language, perception,
attention) Changes in behaviour, mood or personality Decline in our
day to day functional ability Accumulation of abnormal proteins
that disrupt and kill brain cells and their connections Changes in
health of the blood vessels & supply of the brain It is a
chronic condition Differing patterns of onset and progression
Average duration of 8 years
Slide 5
The main causes (or types) are: Alzheimers disease > 62 %
Vascular dementia > 17 % Lewy Body Dementia > 5 % Frontal
lobe dementia > 2% Mixed dementia > 10% All effect the brain
and thus the person in different patterns and ways. Important to
diagnose important for drug treatment and understanding the
individuals behaviour and context Gradual progression >
Fluctuating cognition, visual hallucinations, parkinsonism,
REM-sleep BD, falls, neuroleptic sensitivity, autonomic
dysfunction, visuospatial deficits Step-wise progression, multiple
strokes, > seizures, unsteady gait, depression, behaviour
change, incontinence, vascular problems Gradual progression >
rare, younger onset, memory initially intact, changed social
conduct, speech reduction, early loss insight, emotional blunting,
diet/eating changes, incontinence. Gradual progression > 3
types, early onset(rare < 10%, late onset & familial (rare
< 5%); ST memory, loss of judgement, communication global
impairment A mixture of both Alzheimer type and vascular type
dementia
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Slide 7
National : Mapping the dementia gap (2010) Local : Lincolnshire
PCT (2011) Currently - 10, 877 cases in Lincolnshire But only 41-
45% have been diagnosed Number of cases set to rise by 43% in the
next 10 years By 78% in next 14 years Higher than National average
Currently > 750,000 people with dementia in the UK Over 16,000
under the age of 65 years Estimated to be over 1 million by 2021
Lincolnshire has one of the fastest growing elderly populations in
the UK
Slide 8
So, who is at risk? Main Risk-Factors: Age Advancing age is the
main risk. The incidence of dementia approximately doubles every
5yrs after the age of 65. Family History/Genetics > interact
with life style factors. A number of genes discovered that increase
the risk for AD (i.e. PS1, PS2, APOE) and Frontal lobe dementia
(FTDP-17) these effect the processing of brain proteins Family
history heightens risk BUT familial forms very rare (very early
onset 40s). Gender Alzheimers disease more females than males
Vascular dementia more males than females Diabetes & depression
(stress) Recent studies (2010) showed increased risk of dementia
associated with these due to links to the underlying biological
processes Head injury & anaesthesia Some studies indicate that
head trauma (with loss of consciousness) and anaesthesia may
represent risk factors in vulnerable individuals Predicted that up
to half of the cases of Alzheimers could be attributed to lifestyle
choices that could be modified. Including education, smoking,
physical inactivity, depression, high blood pressure, diabetes and
obesity. (University of California, 2011) Predicted that up to half
of the cases of Alzheimers could be attributed to lifestyle choices
that could be modified. Including education, smoking, physical
inactivity, depression, high blood pressure, diabetes and obesity.
(University of California, 2011) SO, risk can be modified as it is
a combination of genetic and individual lifestyle and environmental
factors. These also give us clues as to how we can help people with
dementia as well. SO, risk can be modified as it is a combination
of genetic and individual lifestyle and environmental factors.
These also give us clues as to how we can help people with dementia
as well.
Slide 9
Memory loss short-term memory, disorientation/getting lost
Difficulty with familiar tasks cooking meals, organising tasks..
Problems with language word finding, naming.. Poor judgement e.g.
dressing inappropriately for weather.. Trouble keeping track of
things conversations, finances etc Misplacing things putting things
in unusual places Changes in mood or behaviour depression, mood
swings, disinhibited Change in personality irritable, suspicious,
anxious, asocial etc Loss of initiative passive, increased
sleeping, loss of interest etc
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Enables people to understand their condition (psychoeducation)
Early access to treatment to relieve symptoms (excess disability)
To access support/carer support Access to information Opening a
door for future care Legal Power of Attorney, Wills, Living Wills
Financial planning Life planning Early & accurate diagnosis is
a National priority (NDS, 2009) .but why??
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3 types of drug intervention.. 1: Curative where disease is
eradicated No treatments available 2: Disease Modifying where
treatment alters course of illness No treatments available 3:
Symptomatic treatment aimed at minimising impact of illness
Treatments available current level of drug therapy
Slide 13
What are they? What are they? Cholinesterase Inhibitors
Donepezil (Aricept), Rivastigmine(Exelon) Galantamine (Reminyl)
What are they for? Mild to moderate Alzheimers disease (can worsen
FTD) To improve daily functioning. Concentration ? Behaviours that
challenge What is the evidence? Controversy cost effectiveness High
potential for side-effects heart, breathing, falls, upset stomach
Modest benefit approx 40% (NNT = 14: 1 in every 14 benefit) Also:
Memantine: works by different mechanism For severe Alzheimers
disease (MMSE of 10 points or less) To improve
functioning/behaviours that challenge Modest benefit again approx
40% NNT = 14: 1 in every 14 benefit)
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YesThe Big Five for Optimal Brain Function Growing evidence
that some lifestyle practices can slow or prevent issues that
compromise mental function - The BIG FIVE: 1.Physical activity
2.Nutrition 3.Mental stimulation 4.Socialization 5.Creativity and
attitude stress reduction The very GOOD NEWS for the most part
these are issues you can do something about RIGHT AWAY, RIGHT
NOW...
Slide 16
Body & Mind For starters .What is good for your heart is
ALSO good for your brain Share common risk factors...cholesterol,
high blood pressure, obesity, arterial damage, plaque build up SO
..when you watch your cholesterol, maintain a healthy weight, and
exercise for your heart, your brain benefits too.
Slide 17
Researchers looking at memory loss in older adults are becoming
increasingly interested in the role played by diet and exercise. 1:
Physical Activity: 2:Nutrition: Daily, at least two and a half
hours per week: Daily tasks (use the stairs, gardening, vigorous
cleaning) Swimming (works joints/muscles without drag of gravity)
Dancing or aerobics (exercises brain as well, fun)
Biking/stationary bike (but protect your brain with a helmet!!)
Tai-chi, yoga, Qui gon (strength, balance, concentration,
de-stress) Walking, walking, walking.. Clutch of new studies
indicate that walking 5 miles per week associated with lower risks
of dementia (observed increased size of brain in areas associated
with memory) Uni. Pittsburgh > walking 5-6 miles a day slows the
progress of dementia in those showing MCI or AD. Basics: your brain
needs good fuel! Avoid: saturated fats, processed meats, simple
carbohydrates, salt; Pile on: fruits, veggies, complex
carbohydrates, grains & nuts, Oily fish & Omega-3 fatty
acids Anti-oxidants: links with dementia : Vitamins E & C diet
rich in fruit & veg, green tea, blueberris, red-wine, ginko
biloba etc Mediterranean diet fruit, veg, olive oil, legumes,
grains and fish associated with reducing risk of dementia.
Nutrition can help manage vascular risk- factors & diabetes
associated with dementia
Slide 18
Exercise your brain. Education is neuroprotective. Brain
trainers. Puzzles, games, sensory stimulation, crosswords, reading,
CST etc. BUT - Appropriate level - adapt to changing abilities!
`Use it or lose it! 3: Mental stimulation..remain socially
connected. Humans are social creatures Appropriate socialization
Work with known difficulties not against Trust in and inform others
to help. 4: Socialisation Things socialisation does for your brain:
Lowers your blood pressure > risk of stroke Improves immune
function Lowers memory loss by keeping mind active Things
socialisation does for your brain: Lowers your blood pressure >
risk of stroke Improves immune function Lowers memory loss by
keeping mind active
Slide 19
and manage stress and spirit.. 5: Creativity, attitude &
spirit: Manage and be aware of stress: Antidepressants (depression
as risk factor) Aromatherapy, diet and exercise (e.g. tai chi, yoga
etc.) Meditation (mindfulness the here and now) As dementia emerges
your emotional life grows.. Just as your brain dictates your
feelings, your feelings affect your brain > stress hormones!!.
Be creative be human! Music (singing for the brain) Art (art
therapy) Dancing Adapt and support in the now Mood & behaviour
as coping defences? Communication (e.g. SPECAL) adapt activities to
present abilities Adapt and support in the now Mood & behaviour
as coping defences? Communication (e.g. SPECAL) adapt activities to
present abilities Music can: Reduce anxiety, aid sleep, lower blood
pressure, reduce stress hormones. The creative brain: memory for
music and emotion are in a different part of the brain from memory
about things and is often intact much longer in even sever dementia
Music can: Reduce anxiety, aid sleep, lower blood pressure, reduce
stress hormones. The creative brain: memory for music and emotion
are in a different part of the brain from memory about things and
is often intact much longer in even sever dementia This means these
intact abilities can be tapped into in dementia
Slide 20
Dementia many different ways Dementia is a collection of signs
and symptoms presents in many different ways and people experience
it differently. Due to changes in the brain different types
Multiple risks Multiple risks not one thing alone genes &
lifestyle/environment. identify early Important to identify early
to plan, understand, manage and support. Drug treatments currently
limited to symptom relief do not cure! Lifestyle changes Lifestyle
changes can reduce risks & maximise wellbeing there are things
we can all do NOW!