Alistair Burns - National Clinical Director for
Dementia
Slide one
What is the difference between dementia and Alzheimer’s disease?
Liver
Symptom Jaundice
Syndrome Liver failure
Cause
Hepatitis
Heart
Breathless
Heart failure
Atherosclerosis
Brain
Memory loss
Dementia
Alzheimer’s
Slide two
Dementia
Symptoms
Activities – independence (daily activities)
Cognition – memory loss (and orientation and language)
Emotions – psychological/psychiatric (emotions)
Cause
Alzheimer’s disease – 60%
Vascular disease – 25%
Lewy Body disease, frontal lobe dementia – 10%
Reversible causes – 5%
Normal ageing and mild cognitive impairment
Slide three
Flowchart:
Stigma of dementia prevents discussion leads to Inactivity in seeking and
offering help.
Feed up: False belief, normal part of aging and false belief nothing can
be done
Slide four
Dementia graph
Cognititive and function decline vs time
Factors: cure, maintenance of function, slowing of disease progression,
symptomatic benefit, natural progression
Slide five
Prevention of dementia
No evidence for any particular approach but perhaps ….
Physical exercise
Mental stimulation
Alcohol in moderation
Keep cholesterol and blood pressure normal
Vascular risk factors
Think young
Slide six
In the UK:
750,000 people with dementia. Cost about £20 billion per year
Image: Dementia UK full report
Image: Dementia 2010 report
Slide seven
Number of people with dementia worldwide
2001……………..24 million
2010……………..35 million
2020………….. 50 million
2030……………..65 million
2050……………113 million
Slide eight
World Alzheimer Report 2010
Cost of dementia compared to national economies
US$ billions approximate
1300
850
Canada
Mexico
600
600
550
500
400
Turkey
Dementia
Indonesia
Belgium
Sweden
Slide nine
Research spend
Investment (£) in research for every £1 million in social and health care
For every £1 million in care costs for the disease
£129,269 is spent on cancer research
£73,153 on heart disease research
£8,745 on stroke research
Just £4,882 on dementia research
Slide 10
 750,000 people with dementia
 1 in 14 people aged over 65 years has a form of dementia; 1 in 6
people aged over 80 years
 1 in 10 people aged over 75 years has significant visual impairment; 1
in 3 people aged over 90 years
 both dementia and sight loss c.100,000
 dementia may affect the way people perceive and process visual
information
 some dementias have a direct impact on vision:

Alzheimer’s disease

Dementia/ Parkinson’s disease

Lewy body dementia

Posterior Cortical Atrophy

Vascular dementia
 Charles Bonnet syndrome
The Dementia and Sight Loss Interest Group - supporting organisations
RNIB, Thomas Pocklington Trust and Alzheimer's Society
Sarah Buchanan
Clive Evers
Slide 11
Image: DH document: Quality outcomes for people with dementia:
building on the work of the National Dementia Strategy
Early diagnosis and intervention in primary care
Dementia in the General Hospital
Dementia in Care homes
Reduction of antipsychotics
Support for carers
Slide 12
Outcomes for people with dementia
Bu 2014, all people living with dementia would be able to assert with
confidence
 I have personal choice and control or influence over decisions about
me
 I have the knowledge and know-how to get what I need
 I know there is research going on which delivers a better life for me
now and hope for the future
 I know that services are designed around me and my needs
 I live in and enabling and supportive environment where I feel valued
and understood
 I know that those around me and looking after me are well supported
 I have support that helps me live my life
 I have a sense of belonging and of being a valued part of family,
community and civic life
 I am treated with dignity and respect
Slide 13
Image: DH document: Quality outcomes for people with dementia:
building on the work of the National Dementia Strategy
Early diagnosis and intervention in primary care: Circled
Dementia in the General Hospital
Dementia in Care homes
Reduction of antipsychotics
Support for carers
Slide 14
Image: DH document: Quality outcomes for people with dementia:
building on the work of the National Dementia Strategy
Early diagnosis and intervention in primary care
Dementia in the General Hospital: circled
Dementia in Care homes
Reduction of antipsychotics
Support for carers
Slide 15
Image: DH document: Quality outcomes for people with dementia:
building on the work of the National Dementia Strategy
Early diagnosis and intervention in primary care
Dementia in the General Hospital
Dementia in Care homes: circled
Reduction of antipsychotics
Support for carers
Slide 16
Counting the cost – Alzheimer’s Society
Acute Awareness – NHS Confederation
Royal College of Psychiatrist’s report
Health Service Ombudsman: Care and Compassion
Slide 17
Image: DH document: Quality outcomes for people with dementia:
building on the work of the National Dementia Strategy
Early diagnosis and intervention in primary care
Dementia in the General Hospital
Dementia in Care homes
Reduction of antipsychotics: circled
Support for carers
Slide 18
Emotional Changes
Neuropsychiatric features
Non Cognitive symptoms
Behavioural and psychological symptoms (BPSD)
Behavioural disturbances
 Agitation
 Aggression
 Wandering
 Sleep disturbances
 Inappropriate eating behaviour
 Inappropriate sexual behaviour
Psychiatric symptoms
 Depression
 Anxiety
 Delusions
 Hallucinations > psychosis
 Paranoid ideas > psychosis
 Reduplications > psychosis
 Misidentifications > psychosis
Slide 19
Use of antipsychotics in dementia
 Use of the drugs is still an integral part of clinical practice
 Changing their use is a complex challenge
 Two thirds reduction of their use is a challenge but should not be seen
in isolation - raising the standards of care for people with dementia is
the key
Slide 20
Antipsychotics in dementia
180,000 people with dementia prescribed antipsychotics
36,000 will derive some benefit
1800 additional deaths
1620 additional CVAs
Perhaps 2/3 of prescriptions are unnecessary, if appropriate support
available
High level of prescribing outweighs benefits
Image: The use of antipsychotic medication for people with dementia.
Time for Action - A report for the Minister of State for Care Services by
Professor Sube Banerjee
Slide 21
Image: Dementia Action Alliance and NHS Institute for Innovation and
Improvement logos. The Right Prescription: a call to action on the use of
antipsychotic drugs for people with dementia.
Slide 22
Image: Dementia Action Alliance and NHS Institute for Innovation and
Improvement logos. The Right Prescription: a call to action on the use of
antipsychotic drugs for people with dementia.
Please email C2Adementia@institute.nhs.uk and we will link you to the
relevant group. If you would like to find out more, please visit
www.institute.nhs.uk/dementiac2a
Help us to achieve our goal
Our goal is ambitious - it is that all people with dementia who are
receiving antipsychotic drugs will have undergone a clinical review to
ensure that their care is compliant with current best practice and
guidelines, that alternatives to their prescription have been considered
and a shared decision has been agreed regarding their future care by
31st March 2012.
Slide 23
Alzheimer's Society logo
Document:
Optimising treatment and care for people with behavioural and
psychological symptoms of dementia. A best practice guide for health
and social care professionals.
Slide 24
Image: DH document: Quality outcomes for people with dementia:
building on the work of the National Dementia Strategy
Early diagnosis and intervention in primary care
Dementia in the General Hospital
Dementia in Care homes
Reduction of antipsychotics
Support for carers: circled