Dementia
An Overview
Steven Roberts
Head of dementia services
Independent Nurse Prescriber
Steven.roberts@lpt.nhs.uk
Lincolnshire Partnership NHS Foundation Trust
Aims of the Session
To provide an overview of:
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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.
Dementia is…..
….not a single disease, but…
• ..an illness ‘syndrome’ – a collection of signs & symptoms
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Decline in cognitive abilities (memory, language, perception, attention)
Changes in behaviour, mood or personality
Decline in our day to day functional ability
• …usually caused by disease of the brain
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Accumulation of abnormal proteins that disrupt and kill brain
cells and their connections
Changes in health of the blood vessels & supply of the brain
• ….which is progressive
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It is a chronic condition
Differing patterns of onset and progression
‘Average’ duration of 8 years
Dementia ‘IS NOT’ forgetfulness due to normal
aging…whatever that may be??
There are different types…
The main causes (or types) are:
 Alzheimer’s disease > 62 %
 Vascular dementia > 17 %
 Lewy Body Dementia > 5 %
 Mixed dementia > 10%
 Frontal lobe dementia > 2%
Gradual progression > 3 types, early onset(rare < 10%, late
onset & familial (rare < 5%); ST memory, loss of judgement,
communication – global impairment
Step-wise progression, multiple strokes, > seizures, unsteady gait,
depression, behaviour change, incontinence, vascular problems
Gradual progression > Fluctuating cognition, visual
hallucinations, parkinsonism, REM-sleep BD, falls, neuroleptic
sensitivity, autonomic dysfunction, visuospatial deficits
A mixture of both Alzheimer type and vascular type dementia
Gradual progression > rare, younger onset, memory initially
intact, changed social conduct, speech reduction, early loss
insight, emotional blunting, diet/eating changes, incontinence.
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
Impact on our brain…
So how big is the problem?
National: Mapping the dementia gap (2010)
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
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
Lincolnshire has one of the fastest growing elderly populations in the UK
So, who is at risk?
Predicted that up….well,
to half of thewe
casesall are…
of Alzheimer’s could be attributed to
lifestyle choices that could be
Mainmodified.
Risk-Factors:
Including education,
Age
smoking,
physical
inactivity,
Advancing age is the main
risk. The incidence
of dementia
approximately doubles every 5yrs after the age
of 65.
depression, high blood pressure,
SO, risk can be modified as it is a
Family History/Genetics
> interact
with ‘life style’ factors.
diabetes and
obesity.
combination of genetic and individual
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Gender
A number of genes discovered that increase the ‘risk’ for AD (i.e. PS1, PS2, APOE) and Frontal lobe
lifestyle
andproteins
environmental factors.
dementia (FTDP-17) – these effect the processing
of brain
(University
of
California,
2011)
Family history heightens risk BUT ‘familial’ forms very rare (very early onset – 40’s).
These also give us clues as to how we
can help people with dementia as
well.
Diabetes & depression (stress)
Alzheimer’s disease – more females than males
Vascular dementia – more males than females
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
What are the early signs?
 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
Are there benefits of early diagnosis?
Early & accurate diagnosis is a National priority (NDS, 2009)…
….but why??
 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
Are there drugs to treat dementia?
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
‘Anti-dementia’ drugs….
What are they? Cholinesterase Inhibitors
• Donepezil (Aricept), Rivastigmine(Exelon) Galantamine (Reminyl)
What are they for?
• Mild to moderate Alzheimer’s 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 Alzheimer’s 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)
Yes…The ‘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…...
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.
…stay healthy…
Researchers looking at memory loss in older adults are becoming
increasingly interested in the role played by diet and exercise….
1: Physical Activity:
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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…………………..
2:Nutrition:
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!
Nutrition
can help
Avoid: saturated fats, processed
meats, simple
carbohydrates, salt;
manage vascular riskPile on: fruits, veggies, complex carbohydrates,
factors & diabetes
grains & nuts, Oily fish & Omega-3 fatty acids
Mediterranean diet – fruit, veg,
olive oil, legumes, grains and fish –
associated with reducing risk of
dementia.
associated with
dementia
Anti-oxidants: links with dementia :
• Vitamins E & C – diet rich in fruit &
veg, green tea, blueberris, red-wine,
ginko biloba etc…
..use your mind & connect..
3: Mental stimulation
‘Exercise’ your brain….
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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!’
4: Socialisation
..remain socially connected.
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Humans are social creatures
Appropriate socialization
Work with known difficulties not against
Trust in and inform others to help.
Things socialisation does for your brain:
• Lowers your blood pressure > risk of stroke
• Improves immune function
• Lowers memory loss by keeping mind active
…and manage stress and spirit..
As dementia emerges your emotional life grows..
5: Creativity, attitude & spirit:
Just as your brain dictates your feelings, your feelings affect your brain > stress hormones!!.
Manage and be aware of stress:
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Antidepressants (depression as risk factor)
Aromatherapy,
diet and exercise (e.g. tai chi, yoga etc.)
Meditation (mindfulness – the here and now)
Be creative – be human!
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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
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
Summary…at last!! 
 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 – not one thing alone – genes & lifestyle/environment.
 Important to identify early – to plan, understand, manage and support.
 Drug treatments – currently limited to symptom relief – do not cure!
 Lifestyle changes can reduce risks & maximise wellbeing – there are
things we can all do NOW!
…..if you are you still awake??? 