Module 2
Understanding dementia
2. Understanding dementia
This module covers:
2.1 How does our brain work?
2.2 What is the condition of dementia?
2.3 Alzheimer’s Disease and other diseases
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Learning outcomes
At the end of this module you will be able to
• Explain what the condition of dementia is
•
Identify the main conditions that cause dementia
•
Identify common changes as dementia progresses
•
List the common types of dementia
•
Explain the link between brain changes and changes in the person’s
behaviour and abilities
•
Identify common changes as dementia progresses
•
Describe the impact of dementia can have on a person and discuss
the uniqueness of people living with dementia.
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2.1 How does our brain work?
•
Our brain linked to our behaviour
•
Our brain is divided into parts
•
Chemical messages between our
brain cells and to and from our brain cells to parts of our body
•
Later … What happens if brain affected by diseases or trauma?
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Our brain is divided into partsParietal Lobe
Frontal Lobe
Planning, insight,
learning,
interpretation,
behaviour
Temporal lobe
Memory
Patterns e.g.
language,
arithmetic,
everyday tasks
Limbic region
Sleep, appetite,
emotions
4
Nerve cell
body
How does the
brain work at
the
microscopic
level?
Synaptic
terminal
Axon
Dendrites
Healthy brain cell (neuron)
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Normal healthy ageing and
confusion
• Our brain ages as we age.
• Our memory may not be as good
and we may not remember things
as quickly or accurately
• We still manage our lifestyle and have the ability
to think up strategies e.g. lists and reminders etc.
• Confusion due to dementia or major cognitive
impairment is different – it disrupts lifestyles
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Confusion in the older person
• Increased sensory impairment or loss e.g. sight
and/or hearing
• Anxiety and/or depression
• Unfamiliar surroundings
• Grief or loss (of significant person, role, ability or
social function)
• Medication – over, under, mix or change
• Infection e.g. urinary tract infection
• A full bladder, constipation, incontinence
• Acute confusion - delirium
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2.2 What is the condition of
dementia?
Dementia ...
• is a condition that affects the brain and causes a
progressive decline in a person’s functioning over
time.
• Is an umbrella term for a large
group of illnesses
• Can be caused by one illness
or a mixture of illnesses
• at present, cannot be cured.
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Physical changes to the brain
Q. What are
some common
signs or
symptoms of the
condition of
dementia?
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attention
memory
language
insight &
reality
emotions
planning &
organising
Dementia:
common changes
physical
abilities
behaviour
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How are these signs displayed
individually ?
Personality
Progression of
Life experiences
dementia
and narrative
General health
Family background
Hobbies and
Likes and dislikes
interests
Contribution to the community
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What causes dementia?
Alzheimer’s disease – approximately 70% *
Vascular disease – approximately 20% *
Other illnesses
– approximately 10%
[* 20% - 30% mixed]
There are over 60 other causes for the condition of
dementia
To date no medical cure for condition of dementia.
Remember….it is very common for the symptoms
of the condition of dementia to be caused by
mixtures of illnesses that affect the brain
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Dementia statistics and current research
• Around 269,000 people in Australia have
dementia. As Australia's population ages, more
people will be affected by dementia.
• Dementia is the third leading cause of death in
Australia, after heart disease and stroke.
• In 2011, there were 1500 new people in Australia with
dementia each week.
• That is expected to grow to 7,400 each week in 2050.
• Without a significant breakthrough this number expected to
go to 1 million by 2050.
Alzheimer’s Australia 2011
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How
common is
dementia?
After 65yrs of age dementia doubles every five years.
Over 85 yrs of age , one in four chance of developing dementia.
But remember that two out of three people over the age of
90yrs of age do not have dementia.
So … dementia is not a normal part of ageing
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Current research in dementia
Medical research
• Younger onset dementia
• Understanding how diseases form
(e.g. plagues and tangles)
• Medications – limit progression of diseases
• Gene therapy, stem cell research – repair or
grow new brain cells
• Prevention – risk factors
Non –pharmacological interventions
• Support and education for carers and staff
• Validation, music, social history narrative & reminiscence
• Enabling environments
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• Alzheimer’s
disease
• Lewy body disease
•Alcohol-related
• e.g. Korsakoff’s disease
•Genetic
•e.g. Huntington’s disease
• Vascular dementia
• Fronto-temporal
dementia e.g. Pick’s
disease
• Parkinson’s disease
• Younger onset dementia
• Infection
e.g. AIDS complex
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2.3 Alzheimer’s Disease
The brain of a person with Alzheimer’s disease
shows significant loss of brain cells
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Alzheimer’s disease
•
Brain cells in the memory centre of the brain become damaged i.e.
develop “plaques” and “tangles”
•
Brain cells have increasing difficulty “talking” to each other and
transmitting messages effectively
•
A loss of connection between cells
•
Brain cells die and the brain shrinks.
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Nerve
cell
body
Synaptic
terminal
Axon
Healthy brain cell
Dendrite
s
Sticky plaques form
around nerve endings
What happens
to the the
brain at the
microscopic
level?
Tangles appear in
the cell body
Damaged brain cell will eventually die
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Brain damage in
Alzheimer’s
Disease
Normal brain
section
(viewed from above)
Brain section damaged by
Alzheimer’s Disease
(viewed from above)
Slides courtesy of Duke University
Medical Centre, Durham, North
Carolina
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Vascular dementia
•
•
•
•
Damage caused by collapse of blood vessels (tiny strokes) which
interrupt blood supply to the brain cell and causes brain cell to die
These tiny strokes accumulate over time
Symptoms depend on where tiny
strokes occur in the brain
Also known as “multi-infarct”
dementia i.e. many ‘dead’ brain cells
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Other causes of dementia
•
Combination of Alzheimer’s disease
and Vascular dementia
•
Lewy body disease
•
Fronto-temporal dementia e.g. Pick’s disease
•
Alcohol related dementia e.g. Korsakoff’s
•
Infections that affect the brain e.g. HIV/ AIDS complex, ‘Mad cow
disease’ (CJD)
•
Younger people with dementia
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Younger people with Dementia
• Dementia can also occur in younger people
• ‘Younger onset dementia’ refers to people aged under 65 who are
living with dementia
• Today, in Australia 15,000 people (estimated) and projected to rise
more than 19,000 by the year 2020.
(Access Economics 2009)
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Progression of dementia
• The symptoms of dementia become worse over time
• How quickly it gets worse varies from person to person
• Abilities tend to fluctuate from day to day … like a faulty
light switch
• Some parts of the brain might be unaffected
for many years …what can the person still
do and still enjoy?
• Older people with dementia commonly have
multiple health problems
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How is dementia diagnosed?
• A proper diagnosis is very important
• A screening process to rule out other causes:
• Review of changes over time
• Medical history
• Physical check-up
• Cognitive tests e.g. Mini mental exam
• Hard to pinpoint when it starts (gradual onset; denial)
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Remember – depression and delirium?
3 D’s – Dementia, Depression, Delirium
• Dementia 
• Depression or anxiety
• Delirium = acute confusion
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Depression
Intense or prolonged feelings of unhappiness
• Older people are particularly prone to depression
because of a range of life events including:
• physical illness
• isolation,
• chronic pain,
• bereavement and loss
(e.g. moving to residential aged care).
• Signs or changes
• Can be mistaken for physical illness.
• Supporting people who are depressed
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Delirium
A ‘sudden’ state of severe confusion, often with
hallucinations and physical agitation
•
•
•
•
•
Delirium has a cause – and will not improve until the
cause is treated.
People with existing brain damage such as dementia
are at increased risk of delirium
Delirium is treatable
Symptoms
Possible causes
Supporting people with delirium
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Key Messages
1. Not all confusion is caused by the condition of
dementia
2. The condition of dementia is caused by different
illnesses that affect the brain
3. Dementia is progressive but some skills can be
retained for quite a while
4. Dementia is not a normal part of ageing
REMEMBER…We cannot change the progression of
dementia but we can change the way we respond to
the unique person behind the disease
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What do you think?
1.
“The doctor said my friend has Alzheimer’s disease. I’m glad it’s not
dementia!”
True or False
2.
“If you’ve seen one person with dementia you’ve seen them all”
True or False
3.
“All old people eventually become senile”
4.
“People with dementia would do better if they just tried harder”
True or False
5.
“Once someone has dementia it’s important to take over and do
everything for them”
True or False
6.
“Not every older person will get dementia.”
True or False
True or False
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