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Dementia – everything you need to know but were afraid to ask
Dr. Shehram Moghul Consultant in OPMH Liaison Psychiatry Southampton General Hospital Nuffield Wessex Hospital, Chandler’s Ford
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Biography Consultant in Hampshire since 2003 GMC examiner
Medical member for Ministry of Justice Board of Royal College of Examiners Private Consultant for memory problems at Wessex Nuffield Hospital and Priory Hospital (private sec )
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Learning outcomes Dementia vs old age (‘normal ageing’)
Different types How it ideally should be diagnosed How it can be helped Some tips Time for questions
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Learning outcomes Dementia vs old age (‘normal ageing’)
Different types How it should* be diagnosed How it can be helped Some tips Time for questions *Increasingly difficult due to NHS pressures
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What is normal ageing vs dementia?
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Dementia vs normal ageing
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What’s normal for you?
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Learning outcomes Dementia vs old age (‘normal ageing’)
Different types (dementia vs Alzheimer’s) How it ideally should be diagnosed How it can be helped Some tips Time for questions
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What’s the difference between dementia and Alzheimer’s
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Umbrella term DEMENTIA Alzheimer’s disease Vascular dementia
Lewy Body dementia Frontotemporal dementia Others e.g. Huntingdon’s disease, Creutzfeld Jakob disease Alcohol
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Vascular dementia – clinical features
Patchy cognitive deficits, cardiovascular disease Abrupt onset, stepwise decline Vascular dementia Focal neurological symptoms and signs
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Lewy Body Dementia LEWY BODY DEMENTIA Neuroleptic sensitivity
Spontaneous motor Parkinsonism, Falls Complex visual hallucinations LEWY BODY DEMENTIA
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Umbrella term DEMENTIA Alzheimer’s disease Vascular dementia
Lewy Body dementia Frontotemporal dementia Others e.g. Huntingdon’s disease, Creutzfeld Jakob disease Alcohol
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Frontotemporal Dementia
Speech abnormalities Impaired judgement Disinhibition, Coarsened social behaviour e.g. sexual FRONTOTEMPORAL DEMENTIA
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Umbrella term DEMENTIA Alzheimer’s disease Vascular dementia
Lewy Body dementia Frontotemporal dementia Others e.g. Huntingdon’s disease, Creutzfeld Jakob disease Alcohol
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Learning outcomes Dementia vs old age (‘normal ageing’)
Different types How it ideally should* be diagnosed How it can be helped Some tips Time for questions *Recognise can be difficult due to NHS pressures
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How do I diagnose dementia?
History (duration, pattern of symptoms) Examination (physical, neuro, cognitive) MMSE – 25/30 Blood screen (thyroid, alcohol, kidney, B12) Maybe a brain scan
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Dementia gets worse over time
5 10 15 20 25 30 1 2 3 4 6 7 8 9 MMSE Years Cognitive symptoms Early Loss of functional independence Mild-moderate Behavioural problems Nursing home placement Verbally explain differences seen in the natural history of VaD compared with AD. Severe Death Feldman H and Gracon S in: Clinical Diagnosis and Management of Alzheimer’s Disease. 1st ed. Martin Dunitz Publ London, England: Taylor & Francis Group; 1998
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The spectrum of BPSD Psychotic symptoms Affective symptoms
Hallucinations Delusions Misidentifications Affective symptoms Depression Apathy Elation Anxiety Disinhibition Behavioural Symptoms Aberrant motor behaviour Irritability/Aggression Agitation Sleep disturbance Stereotypies Hyperorality Eating disturbance Hypersexuality Mega et al. Neurology 1996
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Learning outcomes Dementia vs old age (‘normal ageing’)
Different types How it should be diagnosed How it can be helped Some tips Time for questions
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Current treatment There is a cure for dementia? True or false?
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false!
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Approaches to management
Management of dementia Licensed medication Unlicensed medication Non-pharmacological approaches Acetylcholinesterase inhibitors, Memantine Antipsychotics, antidepressants, Benzodiazepines e.g. activity, one to one care, aromatherapy
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Memantine mechanism of action
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What Does AD Treatment Mean for the Patient?
Untreated, patients will decline rapidly, become severely dependent on caregivers leading to early admissions to nursing homes Mild Successful treatment Global Symptom Severity Untreated Severe Time
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How do you prevent dementia?
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Die young!
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How to prevent dementia?
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Learning outcomes Dementia vs old age (‘normal ageing’)
Different types How it should be diagnosed How it can be helped Some tips Time for questions
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Senses - sight Peripheral vision
180 degrees reduced to 35…equivalent to glaucoma Be within field of vision Don’t speak until you are within field! Colour perception drops (rods and cones)– ignore good taste and glam up! Bright plates, presentation darling Food dye (Westacre RH)
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hearing Reduction of high frequency receptors
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Worsened in dementia Natural loss worsened in dementia
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LOWER THE TONE OF YOUR VOICE!
Low, familiar tones, spoken slowly…
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Taste and smell Bitter and sweet are the last receptors to deteriorate
Therefore reconsider foods if appetite seems poor Sherbert lemons, humbugs, don’t worry about diet
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The case of the tidy room
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Learning outcomes Dementia vs old age (‘normal ageing’)
Different types How it should* be diagnosed How it can be helped Some tips Time for questions *Increasingly difficult due to NHS pressures
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Don’t worry! It’s not genetic!* *Ahem, actually it is sometimes…
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Biography Consultant in Hampshire since 2003 GMC examiner
Medical member for Ministry of Justice Board of Royal College of Examiners Private Consultant for memory problems at Wessex Nuffield Hospital and Priory Hospital (private sec )
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Dementia – everything you need to know but were afraid to ask
Dr. Shehram Moghul Consultant in OPMH Liaison Psychiatry Southampton General Hospital
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