DR JOHAN SCHOEMAN ACTING CONSULTANT PSYCHIATRIST OLDER PEOPLE’S MENTAL HEALTH SERVICES (SOUTH BEDFORDSHIRE AND LUTON) Basics of Dementia

Atrophy in Alzheimer’s Disease Back Front Diseased

Description of Dementia It is a brain disorder which is progressive and irreversible caused by the death of neurons higher brain functions losses and executive dysfunction

Dementia Definition - 2 Difficulties Activities Higher Brain Working BPSD Change in person’s role Increased Dependence Decreased Quality of Life Decreased Autonomy BPSD – Behavioural and Psychological Symptoms of Dementia

Behavioural and Psychological Symptoms of Dementia Behavioural and Psychological Symptoms of Dementia: - Hallucinations (often visual) - Activity Disturbances e.g. wandering, hiding things, purposeless activities - Irritability/Frustration/Aggression - ‘Sundowning’ and Sleep-Wake reversal - Low mood (tearfulness, ‘life not worth living) - Increased Anxiety (being left alone, upcoming events)

Higher Brain Functions Memory Thinking Orientation Comprehension Language Judgement Calculation Writing Reading

Executive Dysfunction Cognitive process that regulates a person's ability to: - organize thoughts and activities - prioritize tasks - manage time efficiently - make decisions - have insight into cognitive deficits

Others Dementia with Lewy Bodies Dementia in Parkinson’s disease ‘Reversible’ dementia Frontotemporal dementia Alcohol dementia Dementia in Huntington’s disease Dementia in Multiple Sclerosis AIDS dementia Types of Dementia

Lois Alzheimer ( ) In 1906 Alzheimer gave a lecture in which he identified an 'unusual disease of the cerebral cortex' which affected a woman in her fifties, causing memory loss, disorientation, hallucinations and ultimately her death at only 55. Emil Kraepelin, the head of the lab at the University of Munich Medical School where Alzheimer worked at the time, named the disease Alzheimer's.

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Common to Dementias – Loss of Nerve Cells

Who suffers from Dementia

Who suffers from dementia Both male and female All ethnic groups All religious groupings Vegetarians and non-vegetarians Manual labourers Professional persons Industrialised and developing countries

Who suffers from Dementia

Cost to Society

Scale of the problem 800,000 persons in UK Over 17,000 under 65 years Over 11,500 from BME groups One-third over 90 have dementia 66% live at home, 33% in care homes One-third live alone at home

Cost to Society

Natural History of Dementia Phase One : Early symptoms to diagnosis Phase Two : Increasing deficits Phase Three : Dependence – most activities

MMSE Phase One Phase Two Phase Three Years Symptoms Diagnosis Loss of Functional Independence Behavioural Problems Nursing Home Placement Death

Dementia Life Expectancy Diagnosis to death about 8 years Varies greatly – 2 to 20 years Women – better life expectancy Death 3-5 higher than in persons without dementia Earlier death for those sufferers with severe Behavioural and Psychological Symptoms of Dementia Cause of death – Infections and Accidents

Medication and Dementia No cure for any dementia Cognitive Enhancing Drugs (CED) slow down progression of illness process CED only licensed for Mild to Moderate Degree of Alzheimer’s disease Effect is modest Names of CEDs: Aricept, Reminyl, Exelon Ebixa licensed for Moderate to Severe Alzheimer’s disease. Trust does not allow prescription

Good afternoon Sir. I’ve seen you before, but I am afraid I have forgotten your name. The ‘Mirror Sign’ in advanced dementia ‘Mirror Sign’ in dementia

Dealing with Difficult Behaviour (BPSD) Every effort to use non medication means first One licensed drug available Use drugs with calming effect in other mental illnesses (psychosis, manic depression) Drugs: antipsychotics antidepressants anticonvulsants sedatives Drugs have unfortunate adverse effects

Adverse Effects of these drugs Increased likelihood of falls Can cause drowsiness Some drugs shaking, slowed movements and shuffling walking Evidence that it slows higher brain functions Occasionally causes agitation and restlessness More than expected ‘sudden deaths’ More than expected strokes and ‘mini strokes’

Approach to person with dementia Continues to deserves love, respect, support and to be treated with dignity Brain function has slowed down but continues to be an intelligent person Is still part of God’s creation Talk slowly, clearly facing the person Use ‘chunking’ when talking Doing things with a person with dementia rather than doing things for the person Gentle hand touching is reassuring and comforting Carer (relative) deserving of our prayers and support

Essence of Care person with Dementia Person with dementia

? Questions & Answers Thank You Dr Johan Schoeman