Working With People With Dementia

Learning Outcomes

• Clear understanding of what dementia is

• Knowledge of what Alzheimer’s Disease

• Understand the progression of Alzheimer’s Disease

• Knowledge of medication prescribed to people with Alzheimer’s

Disease.

• Knowledge of what Vascular Dementia is

• Understand the progression of Vascular Dementia

• Knowledge of some of the medications prescribed to people with

vascular dementia

• Understanding of the carer’s perspective

• Understanding of the role of Alzheimer Scotland

Dementia Day 1

What Is Dementia?

“Dementia is a group of progressive diseases of the brain that slowly affect all functions of the mind and lead to a deterioration in the person’s ability to remember, reason and concentrate. It can affect every area of human thinking, feeling and behaviour”

(Murphy 1990)

Dementia is an umbrella term

Common types of dementia in Scotland

55%

20%

10%

15% Alzheimer'sDiseaseVascularDementiaLewy BodyDementiaOthers

Who is affected?

• Dementia affects both men and women and exists

world-wide

• It is most common in older people, but can affect

people in their 30’s 40’s and 50’s

• Approximately 82,000 people are currently living

with dementia in Scotland (2011)

• It is predicted that this figure will rise to 164,000

by 2031 – a rise of 100%

Alzheimer’s Disease

• Brain cells make large numbers of protein. If too

much protein is made or not enough broken down,

then this causes the cell to die

• In Alzheimer’s Disease these proteins build up.

• They form tangles and plaques, which make it

difficult for the cells to communicate with each

other

Alzheimer’s Disease

Alzheimer’s Disease – Risk Factors

• A combination of factors

• Age

• Environment

• Lifestyle

• Genetic inheritance

• Down’s Syndrome

Alzheimer’s Disease – No Cure

• Low levels of the neurotransmitter acetylcholine

• Medication can be prescribed for Alzheimer’s

Disease. The common drugs are:

• Aricept (Donepezil)

• Reminyl (Galantimine)

• Exelon (Rivastigmine)

• Ebixa* (Memantine)

Alzheimer’s Disease - Early Stage

• forget about recent conversations and events

• repeat themselves

• become slower at grasping new ideas or lose the thread of

what is being said

• sometimes become confused

• show poor judgment or find it harder to make decisions

• lose interest in other people or activities

• develop a readiness to blame others for mislaid items

• become unwilling to try out new things or adapt to change

Alzheimer’s Disease-Middle Stage

• becoming confused about where they are or

walking off and becoming lost

• becoming muddled about time and getting up at

night because they are mixing up night and day

• putting themselves or others at risk by not

lighting the gas cooker

• behaving in ways that may seem unusual, such

as going outside in their night clothes

• experiencing difficulties with perception and in

some cases hallucinations

Alzheimer’s Disease- Late Stage

• The person may become increasingly frail. They may start to

shuffle or walk unsteadily, eventually becoming confined to a

wheelchair

• Other symptoms may include:

• difficulty eating and sometimes swallowing

• considerable weight loss – although some people eat too

much, and put weight on

• incontinence, losing control over their bladder and sometimes

their bowels as well

• gradual loss of speech though they may repeat a few words or

cry out from time to time

Vascular Dementia

• There are different types of vascular dementia

• Two types are: • Multi-infarct dementia

• Sub-cortical vascular dementia

• A person can have both Vascular Dementia and

Alzheimer’s Disease-this is known as a mixed

dementia

Vascular Dementia-causes

• The most common type of vascular dementia is

multi-infarct dementia

• It is caused by a series of small strokes. These

strokes can be so small that the person does

not even notice them.

Vascular Dementia-causes

Stroke

IschaemicStroke(Clot)

Haemorrhagic Stroke (Bleed)

Vascular Dementia –Risk Factors

• The risk factors for vascular dementia are the

same as for stroke

• High blood pressure

• High cholesterol

• Diabetes mellitus (type 2)

• Cardiovascular disease

• Obesity

• Increased age

• Genetic risk factors (rare)

No specific medication is available

• Aspirin and Warfarin are used to prevent clots and

lessen the risk of further strokes

• Blood pressure, cholesterol and diabetes will be

controlled by drugs

• Antidepressants and sleeping pills may also be

prescribed

Progression of Dementia

Lewy Body Dementia

• After Alzheimers Disease and Vascular Dementia, it is the 3rd most common form of dementia

• like A.D. is caused by a build up of protein, in this case lewy body

• like the plaques & tangles seen in A.D. they interrupt the cells ability to communicate and cells die

Lewy Body Dementia –risk factors

• Age

• Genetics- can develop in people with no family history however, having a relative with this type of dementia increases the risk

• Can develop in combination with Alzheimers Disease and Parkinson’s Disease

Dementia Day 1

Lewy body Dementia - symptoms

• similar to A.D.

• problems forming new memories or recalling past memories

• becoming easily confused and/or inappropriate decisions/actions

• similar to Parkinsons disease

• moving slowly, shuffling or shaking as they walk

• falls

• blank expression (can be mask like)

• walking or standing stiffly with legs and arms flexed

• relatively unique to LBD

• fluctuation in symptoms from hour to hour, moment to moment

• hallucinations and delusions

• R.E.M. sleep disorder - lots of movement/ acting out dreams in sleep

Lewy Body Dementia -medication

• there is no specific medication for Lewy Body Dementia

• Benefits seen in people prescribed medication for A.D.

People with LBD are particularly sensitive to certain neuroleptic medication –can result in death

The Family

A carer is any partner, relative, friend or neighbour who provides or has provided care or support in any way or for any amount of time. They may or may not live with the person with dementia who may live in the community or long stay care or the person who received care may have died.

The experience of partners and family members

• getting the diagnosis

• difficulties with daily living

• changed relationships

• emotional and behavioural aspects

Our Role

• working in partnership

• empowering, supporting, informing

• mutually respectful relationship including

confidentiality

• providing quality services