Dementia
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.
Introduction
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
Epidemiology
• 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.
Aetiology
There are many different types and therefore
causes of dementia, including:
Alzheimer’s Disease Lewy body dementia
Vascular Dementia
Types
Semantic Dementia
Fronto-temporal dementia
Creutzfeldt-Jakob disease Alcohol-Induced 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.
Assessment
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 - Dysphasia
-Incontinence - Gerstmann Syndrome
-Emotional lability - Dressing apraxia
-‘Release signs’
- Memory loss - Cortical blindness
- Auditory hallucinations -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 Calm, familiar settings
to↓ wandering
Label rooms to ↓ Management of routine
Daily
chance of getting lost dementia
Avoid caffeine, alcohol and Carers should avoid
daytime naps to avoid affecting contradicting, arguing, and
sleep patterns confrontation.
Medication is usually ineffective Address at eye level and from the front
Aromatherapy 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 – The stigma
‘I’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.
‘It’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.
‘Sometimes they think of you as if you are gaga: [speaking slowly] “can
you do this?”’ (person with dementia)
‘Everybody 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 5-year-plan)
Thank you
Andrea Melding
