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Presentation by Andrea Melding May 2009

True or False
‡ Dementia is a disorder of later life, affecting those only over 65. ‡ Our risk of dementia may be reduced if drink less alcohol and exercise regularly. ‡ It is an inevitable consequence of old age ‡ If you have dementia, as it progresses you will lose your ability to speak.

The population is getting older. Over the next 30 years, the number of people aged over 90 in the UK is predicted to double from the value recorded in 99 (Woodford, 07) As physiotherapists working in medical elderly rehab, this is obviously going to have a massive impact on the demands of our service. With dementia affecting approximately 10% of people over 65 in the Western World, it¶s vital that we have a greater understanding of the disease than ever before.

What is dementia?
‡ Dementia is an umbrella term used to describe a syndrome which may be caused by a number of illnesses in which there is a progressive disturbance in multiple areas of brain function. ‡ This can have a consequential impact on social and/or occupational function. ‡ Behavioural and psychological symptoms may also coincide. ‡ Each individual¶s presentation can be completely different, with varying degrees of severity in any particular domain. Its rate of progression also depends on the individual.

Cognitive Deficits
Dementia can affect: - Memory - Reasoning - Communication - Calculation It can also cause: - Confusion - Visuospatial problems - Agnosia - Praxia

Behavioural and psychological changes
Dementia can affect: - Personality - Sleep - Food preferences - Sexuality It can also cause: - Depression - Anxiety

‡ Dementia can affect men and women in all social groups. ‡ It is predominantly a disorder of later life, but there are at least 15,000 people under the age of 65 who have the illness. ‡ Its incidence and prevalence rise exponentially with age. ‡ It is not an inevitable consequence of old age

Risk Factors
Our risk of dementia may be reduced or its onset delayed if we protect our general health, for example: ‡ ‡ ‡ ‡ Eating a healthy diet Stopping smoking Exercising regularly Drinking less alcohol

Basically, trying to protect the brain from injury. Hypertension, cholesterol, and diabetes are also thought to have an influence.

There are many different types and therefore causes of dementia, including:
Alzheimer¶s Disease Vascular Dementia Fronto-temporal dementia Creutzfeldt-Jakob disease Alcohol-Induced Dementia Lewy body dementia


Semantic Dementia

Alzheimer·s Disease
‡ This is the most common form of dementia - 50-60% of dementia cases. ‡ It was first described in 1906 by Alois Alzheimer after autopsy of a 51 year old lady with memory loss and disorientation. Pathological changes mainly affect the cortex and include: ‡ Neurofibrillary tangles ‡ Amyloid Plaques ‡ Extensive cell death in the cortex and enlargement of the ventricles of the brain. ‡ Remaining cells lose many dendrites.

Mental state and physical examinations: Physical ‡ General medical assessment, in particular looking for signs of neurological and vascular disease. ‡ Frontal release signs, e.g. Grasp reflex± if present suggests cerebral damage ‡ Dyspraxia tests ± asking patient to mime tasks Mental ‡ 10 point Abbreviated Mental Test ‡ 30-point Mini Mental ‡ Formal neuropsychological testing Domains tested include attention, memory, language, visuospatial skills and execute function to localise deficits within the brain.

-Disinhibition -Apathy -Incontinence -Emotional lability -µRelease signs¶

- Dysphasia - Gerstmann Syndrome - Dressing apraxia

- Memory loss - Auditory hallucinations

- Cortical blindness -Visual hallucinations

MDT Involvement
Many professionals are involved in the assessment, treatment and care of patients with dementia: ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Psychiatrist Doctor Nurse PT OT Social Worker SALT Pharmacist Counsellor Voluntary Sector eg. The Alzheimer¶s Society

General Management
Installing safety devices (smoke alarms)
daytime activity and exercise to wandering Calm, familiar settings

Label rooms to chance of getting lost Avoid caffeine, alcohol and daytime naps to avoid affecting sleep patterns Medication is usually ineffective Aromatherapy

Management of dementia

Daily routine

Carers should avoid contradicting, arguing, and confrontation. Address at eye level and from the front Sensory stimulation e.g soft background music

Physiotherapy Intervention
AIMS: ‡ Increase mobility ‡ Maximise and promote independence to reduce the risk of falls ‡ Maintain function Rx: ‡ Balance, stretching and strengthening exercises ‡ Provision of walking aids ‡ Functional Tasks ± transfers, walking, stairs ‡ Liaise with OT re: equipment and adaptations to maximise independence and safety within the patient¶s home.

Dementia ² The stigma
µI¶m just a bit forgetful, there¶s nothing the GP can give me for that¶ - (person with dementia) Problem: Many people do not realise that there are ways of supporting and treating people with dementia. µIt¶s as problems arise you need to know that there¶s other people out there suffering the same problems and how they¶ve overcome it¶ ± (carer) Problem: Patients¶ and carers often find it hard to accept a diagnosis of dementia and lack understanding regarding prognosis. They need to be made aware of the services that are available and so when they feel they need help, they know where to go.

µSometimes they think of you as if you are gaga: [speaking slowly] ³can you do this?´¶ (person with dementia) µEverybody I have met has been amazed that I can still talk.¶ (person with dementia) Problem: The public view of dementia is very misguided ± there is lack of awareness and understanding, which can be patronising, demeaning and ignorant to people with dementia. Dementia can present in different ways. AIMS 1. Ensure better knowledge about dementia and remove the stigma 2. Ensure early diagnosis, support and treatment for people with dementia and their family and carers. 3. Develop services to meet changing needs better (The National Dementia Strategy Feb 09- 3 key steps in a 5year-plan)

Thank you
Andrea Melding

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