posterior cortical atrophy PCA SUPPORT GROUP www.pcasupport.ucl.ac.uk newsletter Welcome to the [PCA] Support Group Welcome to this September 2015 edition of the PCA Support Group Newsletter. As always, we hope that the content of the newsletter is of interest to our members but remain aware of the difficulties in producing information which meets everyone’s needs and in a style which they are comfortable to embrace. Please do let us have any suggestions regarding the format of the newsletter and indeed any contributions you wish to make. This newsletter can be produced in a font and format which people with PCA may find easier to read. Please let Jill Walton know if you would like to receive a copy. It will also be available as an audio recording, accessible via the website. For those of you who receive the newsletter as hard copy, we continue to make use of the ‘Articles for the Blind – Free Postage Scheme’ and assume that newsletters are successfully reaching the intended recipients! Having access to this scheme makes a considerable saving to the postage costs incurred by the MEF, and may we please remind you that if you are able to receive the newsletter electronically, we are very happy to provide it via this means. Newsletter Issue 23, Sept 2015 Behind the scenes here at UCL, significant and ongoing effort is being dedicated to securing and expanding the infrastructure upon which the support group depends for its ongoing function. With funding kindly supported by the Myrtle Ellis Fund and a plethora of your own fundraising efforts, we are able to continue existing support group activities as well as begin to look to new and expanded provision. We are currently in early stage negotiation with significant funders with a view to establishing extended regional networks and improved access to information for our members. We will of course update you in due course as these exciting possibilities develop. On a more scientific front, the Alzheimer’s Association International Conference took place in Washington USA, during July 2015, with a number of UCL Dementia Research Centre [DRC] colleagues attending and contributing to that event. Please see Dr Jon Schott’s contribution to this newsletter for a summary of the ground-breaking PCA specific research findings he was able to share at the conference. These findings will of course subsequently be published in the medical press. MEF MYRTLE ELLIS FUND supporting rare dementia The PCA Support Group is generously supported by the Myrtle Ellis Fund, as part of The National Brain Appeal (Charity number 290173). For more information on the work of the Fund or to make your own contribution to the running costs of the PCA Support Group, please contact the Foundation on 020 3448 4724. Alternatively visit www.pcasupport.ucl.ac.uk or www.justgiving.com/Myrtle-Ellis-Fund 1 intro cont’ May I take this opportunity to invite you to the forthcoming full support group meeting on Friday October 16 2015. The venue for this meeting is Wilkins Haldane Room on the UCL Gower St site, WC1E 6BT. The meeting is scheduled from 11am -2pm, with coffee available from 10.30am and lunch provided. We are delighted to welcome Professor Robert Howard, a consultant psychiatrist and leading researcher, who will provide us with a presentation entitled ‘The Psychiatry of PCA’. Prof Howard has huge experience of conducting rigorous, high quality clinical trials and studies, all with a clear and practical aim - providing powerful evidence of what works and what doesn’t. He’s a highly entertaining speaker who will gladly welcome any questions you care to throw at him. In addition to the full support group meeting listed above, and by request of support group members, we also facilitate ‘carers only’ meetings for the carers, family and friends of people affected by PCA and other rare dementia diagnoses. These meetings aim to provide an environment whereby sensitive discussions can take place within the understanding of a professionally facilitated peer group. The next ‘Carers Meeting’ is scheduled for Nov 18 2015 and further details are listed below. I look forward to seeing you at either of these meetings or indeed being in contact with you in whatever capacity is most appropriate. Jill Walton 2 forthcoming support group mtgs Future Meetings Regional Meetings Regional meetings provide an informal opportunity to meet other people affected by PCA. Regional meetings are now taking place in Oxfordshire/Central regions, Berkshire, Cambridge, Chichester, Kent and Hertfordshire and Scotland. UCL London PCA Full Support Group Meetings: Fri October 16 2015: Professor Robert Howard, a consultant psychiatrist from Kings College London will provide us with a presentation entitled ‘ The Psychiatry of PCA’. Oxford Regional PCA Support Group Oxfordshire/Central regional meetings are coordinated by Martina Wise. Please contact Martina on mrsmartinawise@gmail.com for more information. The venue for these meetings is currently under review, but they are are informal social gatherings for people affected by PCA. Please contact Martina by email or mrsmartinawise@gmail.com or 07958 668 035. Berkshire Regional Support Group Meeting: Tuesday November 24, 2.15pm4.14pm Berkshire regional meetings are coordinated by Helen Shepherd. Please email Helen on Helen@shepherdcharles. com for more information. These meetings are held at Barkham COAMHS, Wokingham Hospital. These meetings are organised in conjunction with the ‘Young People With Dementia’ Berkshire West group. Hertfordshire Regional Support Group Meeting: 9th September, 2015 Hertfordshire regional meetings are coordinated by Di Garfield. Please contact Di on myrtleellisfund@outlook.com for more information. Kent Regional Support Group Meeting: Dates to be confirmed Kent regional meetings are coordinated by Betty Fernee. Please contact Betty on betfernee@aol.com for more information. Chichester Regional Support Group Meeting: Dates set until Dec 2015 Chichester regional meetings are coordinated by Fiona Chabaane. Please contact Fiona on or fchaabane@hotmail. co.uk for more information. Please contact Jill for more information about any of these meetings. Disclaimer: Please note that you assume full responsibility and risk when attending support group meetings, and also in the use of the information contained on our website, in our newsletters and at support group meetings. Fri February 5 2016: agenda tbc Fri June 10 2016: agenda tbc The venue for these meetings is Wilkins Haldane Room which is located in the Wilkins Building, UCL, Gower St, London WC1E 6BT. The meeting is scheduled from 11am-2pm, with coffee available from 10.30am and lunch provided. UCL London Carers Meetings: In addition to the full support group meetings listed above, and by request of support group members, we also facilitate ‘carers only’ meetings for carers, family and friends of people affected by a rare dementia diagnosis. These meetings aim to provide an environment whereby sensitive discussions can take place within the understanding of a professionally facilitated peer group. The venue for these meetings is the Front Quadrangle Events venue, which is the white marquee type structure inside the main university quadrangle at the Gower St site, WC1N 6BT. The meetings run from 11am until 2pm with coffee available from 10.30am and lunch provided. Carer meetings are currently scheduled for : November 18 2015 Dr Liz Sampson is a Senior Clinical Lecturer at the Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London and will join us to share her expert knowledge and facilitate a discussion on palliative and end of life care in dementia. July 7 2016: agenda tbc Minutes: The minutes of the UCL meetings are published at the back of the newsletter. 3 directions Directions for forthcoming UCL meetings Wilkins Main/Front Quadrangle, University College London, Gower Street, London WC1E 6BT Underground Rail Travel The closest underground stations to UCL are Euston Square on the Circle, Metropolitan and Hammersmith and City Lines, Goodge Street on the Northern Line and Warren Street on the Northern and Victoria Lines. London Underground Infoline: 020 7222 1234. Disabled Persons Railcard scheme. A person is eligible for the scheme either as a result of being registered as having a visual impairment or by virtue of being in receipt of attendance allowance or disability living allowance/personal independence payment. The railcard entitles the holder and a friend to 1/3 off train fares. Passenger assistance is also available to rail users. Visit www.disabledpersons-railcard.co.uk London Underground - Did you know that you can ring London Underground Customer Services on 0845 330 9880 the day before you are due to use a service? They arrange for someone to meet you in the entrance area of the station at which your journey begins, accompany you down to the platform and onto your train. They then radio ahead to an official at the relevant station to assist with any required platform changes or take you up to ground level. Disabled Persons Railcard scheme. A person is eligible for the scheme either as a result of being registered as having a visual impairment or by virtue of being in receipt of attendance allowance or disability living allowance/personal independence payment. The railcard entitles the holder and a friend to 1/3 off train fares. Passenger assistance is also available to rail users. Visit www.disabledpersons-railcard.co.uk Buses UCL’s Gower Street site is served by many Transport for London bus routes. Buses travelling from north to south stop in Gower Street, immediately outside UCL’s main gate, while those travelling from south to north stop outside Warren Street station, about five minutes’ walk from UCL. Services to these stops include route numbers: 10, 14, 24, 29, 73, 134, 390. London Buses Infoline: 020 7222 1234 Parking UCL Helpline 020 7974 4651 or 020 7974 4655 (Staffed Monday -Friday 9.00 am to 5.00pm) We are very conscious that travelling to and around London can seem a daunting prospect. Be aware that pre-booked travel is generally cheaper than tickets purchased on the day and that the Myrtle Ellis Fund provides help with travel costs where required. Contact Jill for further details. 4 Seeking Advisory Committee members! Seeking Advisory Committee members! We are still looking for interested parties to join the advisory committee board for the research project, ‘Seeing What They See’ Current members of our advisory committee include representatives from the Thomas Pocklington Trust and the College of Occupational Therapists. The purpose of the committee is to provide oversight and advice in the running of the project to ensure the results are as useful and relevant as possible. Following our first meeting in March of this year it was suggested that the input of, and the opportunity to consult with a representative of people living with PCA, typical Alzheimer’s disease and/or their carers, would be invaluable. We plan to meet twice a year with additional meetings to be scheduled where necessary. Our next meeting will be from 122pm on the 11th November in the large seminar room at the DRC. The project is led by Sebastian Crutch at UCL with collaborators from Brunel University London, Moorfields Eye Hospital and the London School of Hygiene and Tropical Medicine. It’s a four year project funded by the ESRC (Economic and Social Research Council) and National Institute for Health Research (NIHR) looking at the impact of visual impairment due to dementia on everyday life and activities. Overall, we aim to develop some home-based interventions that will help people who are affected by dementia-related visual impairment, to manage better at home. The project largely relies on the valuable insights that people with PCA can offer from describing their visual experiences. If you are interested in being a representative on the board of the committee please express your interest to Jill Walton (jill.walton@ucl. ac.uk; tel: 07592 540 555) who will be happy to discuss the next steps. The project is divided into three parts: 1. Neuropsychological testing: these help us to build a comprehensive picture of the particular patterns of visual impairment in those with dementia-related visual impairment Many thanks for reading! Emma Harding and Amelia Carton, Psychology Research Assistants, Dementia Research Centre 2. Pedestrian Accessibility and Movement Environment Laboratory (PAMELA): here we are looking at ways participants move around and carry out day-to-day tasks, such as reaching for a cup or navigating around a simulated environment. We hope to develop helpful visual cues for use in physical interaction. 3. Coping Strategies: for this part, we are conducting in-depth interviews with participants and their carers at home to get an idea of the emotional, physical and social impact of the diagnosis and the particular challenges experienced day to day 5 news and fundraising Alumni group 5 people have responded to say that they would indeed like to be part of such a group. Having discussed with Teresa, I have created an ‘alumni group’ with a shared group email address. Consent to be included in the group is required, and I can provide the appropriate consent document to anyone who may be interested. We will review the activity of the group over coming months and hope that In a previous newsletter, Teresa Jeffery suggested initiating an ‘alumni’ type network of support group members who may be finding it increasingly difficult to get to meetings, but who would value contact with other people who are caring for someone in the later stages of PCA and have a shared understanding but also an untapped resource of tips that may be useful to others. Fundraising Thank you to everyone who has made donations to the fund, and do keep an eye on the website http://www.ucl.ac.uk/drc/pcasupport/fundraising for ongoing fundraising initiatives and efforts! Support group activities are reliant upon the funding generously supported by the Myrtle Ellis Fund and a plethora of your own fundraising efforts, for which we are extremely grateful. The second annual global virtual quiz Toby Lancaster’s Alps Challenge As this will be a personal challenge for myself and the team I also wanted to use the opportunity to raise awareness and money for a charity.’ This summer Toby led a small group to climb 2 peaks over 3 days in the Ecrins region of the Alps. Before he left, he explained: The reason that Toby has chosen to raise funds for the Myrtle Ellis Fund is primarily because one of his neighbours is suffering from PCA. ‘As some of you may know I have already had some experience of climbing in the Alps, Sierra Nevada and Mongolia but this will be first time that I have organised a team and am using this as my Extended Project at Hills Rd Sixth Form College. Despite debilitating altitude sickness Toby and his team achieved a tremendous result on behalf of the support group, and we are sincerely grateful to him for initiating the event. 6 fundraising cont’ Dave Banthorpe and Joshua Cornwell get on their bikes for PCA! July 2016 will see Dave Banthorpe cycling the London to Paris route to raise money for the Myrtle Ellis Fund. Dave’s mother in law has a diagnosis of PCA and some of you will have met his wife Helen at a recent support group meeting, selling handmade glass hearts to raise funds too. Read more about Dave’s efforts and support him at https://www.justgiving.com/ Dave-Banthorpe1/?utm_source=Facebook&utm_ medium=fundraisingpage&utm_content=DaveBanthorpe1&utm_campaign=pfp-share Meanwhile, in August 2015 Joshua Cornwell, whose grandmother has PCA will be embracing a 100 mile Charity Bike Ride from Sawtry to Felixstowe to raise money for PCA. If you would like to have a look at how his training is going, visit Joshua’s facebook site: facebook.com/ Joshuafundraiser or his just giving page at www.justgiving.com/ joshuasfundraiser/ Christmas cards printing? [we can of course acknowledge sponsorship.] It seems unnaturally early to mention the sale of Christmas cards, but owing to the sell-out success of Paul Bulmer’s bespoke designs last year, we are planning to offer these fundraising cards again. With additional designs available this year, we are currently co-ordinating plans for their sale. 2 Is anyone willing to take on the role of managing orders [receiving payment and coordinating postage ]? If you are able to help with either of the above please get in touch with Jill in the first instance We look forward to exchanging festive greetings on these extra special cards.’ We have 2 requests to make, both of which will significantly assist us in our planning: 1 Does anyone within the group have access to printing facilities which could offer us discounted or ‘no charge’ costs for 7 International Conference Alzheimer’s Association International Conference in Washington: JULY 2015 Dr Jonathan Schott, Reader in Clinical Neurology, Dementia Research Centre, UCL, along with several other members of the clinical and research team was present at the Alzheimer’s Association International Conference in Washington July 2015 and has provided the following update in respect of the presentation he gave at the event: We are delighted to report that researchers at UCL have made significant progress in understanding some of the genetic factors that might influence the development of PCA. To date, it is not clear why some individuals develop PCA, as it is not thought to run in families; and, as Alzheimer’s disease is the commonest cause of PCA, why people with PCA develop symptoms so much earlier than people with more typical, memory-led, disease. Several small studies published over the last few years have provided conflicting evidence for a role of the most common genetic risk factor for although preliminary, analysis, they also found three new genes that may subtly influence the risk for developing the syndrome. It is important to note that these findings – if replicated – do not suggest that PCA is directly heritable, and there are no implications for clinical testing. AD, known as APOE E4, but due to the relative rarity of PCA, it has been difficult to get a more definitive answer. To investigate this further, Dr Jonathan Schott and Professor Sebastian Crutch formed an international consortium of experts interested in PCA, from England, the USA, France, Italy, Spain, the Netherlands, and Australia. By pooling resources, they brought together DNA samples from 302 individuals, by far the biggest study of PCA done to date. Working closely with Professor Simon Mead at UCL who helped in the genetic analysis up of these individuals, they were able to demonstrate that APOE E4 is a risk factor for PCA, but is a weaker risk factor than for typical, memory-led, Alzheimer’s disease. In an exciting, Dr Schott presented this work at the Alzheimer’s Association International Conference in Washington, and it will shortly be submitted for publication. Efforts are underway to collect further DNA samples from patients with PCA, in an attempt to confirm if these new genes are indeed risk factors for PCA. We are very grateful to Nick and Raena Frankel-Pollen who are raising money to help with the analyses. If you would like more information about this study, please contact Keir Yong at keir.yong@ucl.ac.uk 8 British Medical Journal The Importance of Dementia Support Groups The following letter is a summarised version of the submitted on-line rapid response article which was subsequently published as a letter in the BMJ on July 23 2015. It forms part of our ongoing commitment to promote awareness and understanding of the unique challenges faced by people embracing rarer diagnoses of dementia. opportunity for one to one peer relationships that are continued outside of formal meetings. Robinson and colleagues refer to non-Alzheimer diagnoses of dementia. These less typical diagnoses pose complex problems for those with the disease and for their families, friends, and carers. When these forms of dementia affect younger people the problems can be even more challenging. Directing patients and their families to such sources of advice and support forms an important part of the post diagnosis consultation. “Rare dementia support” offers information, advice, and support to people affected by frontotemporal dementia (behavioural variant and primary progressive aphasia), posterior cortical atrophy, familial Alzheimer’s disease, and familial frontotemporal dementia. When asking the question: “What constitutes best practice in early intervention?” we must acknowledge that people living with a diagnosis of dementia generally do so in the community, Distinct from the personal and individual benefit to group members, support groups also fulfil an advocacy role on behalf of their members by raising awareness and representing the needs of supported by informal caregivers typically made up of spouses, relatives, friends, and neighbours. people within the group by contributing to debates and discussions at a more strategic level. Support groups have an important role to play in offering people the opportunity to acknowledge their diagnosis and its consequences alongside peers in a similar position. Apart from the social and emotional benefits of participating, disease specific support groups enable the exchange of valuable professional and personal information and advice. They are also gateways to understanding and sharing, enabling people to cope better and for longer. Jill Walton registered general nurse, Natalie Ryan clinical research fellow, Sebastian Crutch professorial research associate, Jonathan D Rohrer honorary consultant neurologist, Nick Fox professor of clinical neurology Dementia Research Centre, Institute of Neurology, London WC1N 3AR, UK [Full response at: www.bmj.com/content/350/ bmj.h3029/rr-0. 1 Robinson L, Tang E, Taylor J-P. Dementia: timely diagnosis and early intervention. BMJ 2015;350:h3029. (16 June.) ]Cite this as: BMJ 2015;351:h3875 © BMJ Publishing Group Ltd 2015] Support groups can extend to provide supportive networks across telephone, internet, and social media platforms, as well as providing the 9 other news DEEP networks and the PCA support group Nada Savatch, who works for Innovations in Dementia, presented the work of DEEP (Dementia Engagement and Empowerment Project) at a recent PCA support group meeting. Hannah Golden explains how the main aim of this project has been to increase the voice of people with dementia so their opinions, experiences and hopes can be heard. Her organisation teamed up with the Joseph Rowntree Foundation and Comic Relief to start a project to provide links between small community groups so they would gain power in numbers. They started off with 12 regional groups and have now expanded to around 60 – totalling around 1,200 individuals with dementia. This way these combined groups can have more influence over things that affect them, such as policy and educating professionals. People with dementia are experts by experience and are the best people to ask about what it is like living with this condition! These groups have worked on a variety of projects, such as advising the House of Lords, providing more prediagnostic information and educating people that dementia is not just about memory. Some of the members have been involved in making films, and using technology that allows responding in real time to give quotes about news events related to dementia; they have also been advocating for a change in the language the mainstream media use when talking about dementia. The DEEP project helped people to find something they want to change, and join up to gain a greater influence in making the change happen. It has been noticeable how these groups have gained confidence over time; DEEP has worked to connect smaller groups and fill in geographical gaps, but otherwise most of the ideas and work have come from the groups themselves. Our rare dementia support groups are looking to get involved by perhaps making a short film and producing some information booklets detailing the personal journey to diagnosis and life with a rarer diagnosis of dementia. If you’d like to get involved please let Jill know at jill. walton@ucl.ac.uk Webinar link Dr David Tang-Wai, a practitioner based in Toronto, Canada, who wrote the most widely used current criteria defining PCA, features in this webinar entitled “Posterior Cortical Atrophy: Trying to See What They Cannot” Listen to it here https://vimeo.com/134976973 Your contributions Martina Wise wonders if Volvos new product, Lifepaint, can be helpfully put to use in ways which help people with PCA. Lifepaint is a unique reflective safety spray. Invisible in normal light it glows brightly when in the glare of headlights or other direct light source. See http://www.volvolifepaint. com/ for more information about this product! A question for our members… Is anyone aware of any digital assistance technology that might make it easier for people with PCA to continue to read and play music? Maybe The Royal College of Music or Royal Festival Hall etc.would have expertise they could share….? 10 minutes PCA Support Group Minutes for Meeting at UCL June 19 2015. Our thanks to UCL for the further use of their excellent facilities, which allow good visual contact and lighting. The use of portable mikes maximized the equally good acoustics. Jill welcomed 59 attendees and on-line contacts from the Scottish PCA support group, Canada and America. Shona Lucitt from the Alzheimer’s Society attended the meeting. Her contacts are shona.lucitt@alzheimers.org. uk or 07753 425158. 1.8 The main causes of VI are cataracts [48%], then macular degeneration and glaucoma. 8% of VI did not have a clear ophthalmological cause, and may include VI due to brain changes. 1.9 Most VI tests are possible for 80% of people with dementia. 1.10 Mistrust of tests still exists as to a) whether people with dementia can accurately respond to them and b) whether optometrists can accurately measure VI in such people. However, physical problems need to be treated to clear the way for neurological assessment and interventions to be possible. Talk by Michael Bowen, Director of Research, the College of Optometrists 1.1 In his talk, Michael presented developments in the PrOVIDE Study (Prevalence of Visual Impairment in Dementia) into the theory and practice of how people with dementia and with visual impairment can best be helped. 1.11 Qualitative studies of eye examinations revealed that a) most participants were satisfied, but b) that carers were worried about their reliability. Hence c) Optometrists need to be informed in advance about dementia diagnoses and the presence of carers at testing is invaluable. 1.2 The starting point was around awareness that a person with dementia could not necessarily be easily assessed by standard eye tests. Assessment of their visual problems was complicated by their inability to comply with test instructions. 1.12 Successful VI treatment does raise the quality of life. 1.3 Visual acuity measured by standard tests was therefore not delivering a full picture when the interpretation of vision was impaired by dementia. 1.13 Of the 800 research participants, none knew they could have a test free in their own homes if they could not get to an optometrist. This is far less stressful. 1.4 The study aims to measure how many 1.14 Expedited cataract surgery is welcomed in dementia cases. people with dementia also have VI (Visual Impairment) 1.5 And secondly to assess the care problems involved. 1.15 Advice from research re preparing for an eye examination:- 1.6 There is in fact a higher rate of VI amongst people with dementia. 50% of them were however helped by provision of up to date spectacles. 1.7 There were problems caused by much of the existing data being 15 years old! And further by the lack of reliable information from care homes, where VI was 2-2½ times more common. 11 A) Advise the optometrist beforehand of a dementia diagnosis. B) Request flexibility; more time will be needed - possibly 2 visits. C) Choose the time of day when the person with dementia can cope best. D) Request information on home visits. E) Request carer to be present, if possible. minutes cont’ 1.16. Results indicate that changes need to be made to the 1989 Opticians Act. Lobbying is also needed re: a] greater flexibility in appointments, improvements in visual field tests, guidance for obtaining consent (i.e. whether patient or carer should give it) and b] better information on how to use your vision. Current research aims are to refine optometrists’ understanding and practice, to develop improved tests, to expedite primary care and to clarify referrals. led to a shifting of power away from professionals so that patients could set their own priorities. 2.3 How were the project’s aims to reach GPs? By those involved going to their conferences, speaking at events and arranging for mentors for new members. Tim now includes people with dementia in his conferences since there is a huge impact when a person with dementia describes what it is like for them. Responses to questions from the floor. 1.17 Free NHS home testing is available for the people over 60 years of ages. Failure to recognize PCA can delay its diagnosis for up to 5 years. The sharing of international research is increasing and further modules for post grad studies are in preparation. UCL publicity for learning around PCA is developing fast. 1.18 How to decide which optician to use: Consult College of Opticians web sites and leaflets (one on dementia is still needed). Ask about Optometrists’ specialisations. N.B. Those conducting home tests often have more experience of rare conditions. Registration (via GP):- secondary referrals allow patient to choose between optometrist or neurologist. Talk by Nada Savitch, Networking facilitator for DEEP (Dementia Engagement and Empowerment Project) 2.1 “Nothing about us without us”. The project aims to encourage the voice of people with dementia as contributors, participants, and citizens. Hence there is a need for people with dementia to share stories, to ask for help, e.g. on planes and in day groups and to write about their experiences http://www. onourradar.org/dementia/ 2.4 Considerable impact can be achieved by collective engagement. It can initiate changes in national policy e.g. via the British Psychological society, the House of Lords etc. It can usher in changes in the culture at national meetings and events about dementia. 2.5 Resources and guidance. E-mail Rachel at rachel@myid.org.uk or Nada at nada@myid.org.uk for print offs from www.dementiavoices.org.uk to give to organisations. See also http://www. dementiaaction.org.uk/ Deep offers groups with connections, mapping of interests and skills, collating and developing good practice. Celia Heath April 2015. DISCLAIMER: The information contained on our website, in our newsletters and at support group meetings is for information purposes only. You assume full responsibility and risk for the appropriate use of the information contained herein and attendance at any support group meetings. 2.2 Why Now? An original project followed 2 groups of people with early onset dementia diagnosis. During it they became empowered and engaged developing higher expectations from treatment. This 12