What is Dementia (NU10120) [student].pdf

What is Dementia? Darren Prince NUR10120: Introduction to Professional Practice  Aims What is dementia? (definitions) What are its forms? (types) Why does it occur? (causes) What can we do? (care) Diane Mensha She is 75 years old and...

What is Dementia? Darren Prince NUR10120: Introduction to Professional Practice  Aims What is dementia? (definitions) What are its forms? (types) Why does it occur? (causes) What can we do? (care) Diane Mensha She is 75 years old and lives alone Yesterday, she forgot her way home Her daughter takes her to the doctor and asks “What’s wrong with my mum?”  Prevalence Rates 35 30 25 20 15 10 5 0 65-69 70-74 75-79 80-84 85-89 90-94 Male Female Total  Prevalence Rates Age (Years) Prevalence 40 – 65 1 in 1000 65 – 70 1 in 50 70 – 80 1 in 20 80+ 1 in 5 Recorded Dementia Diagnoses 31st July 2022 National Diagnostic Rate: 62% Benchmark Diagnostic Rate: 66.7% 62% 73% 53% 67% Dementia Attitudes Survey 2021  Defining Neurocognitive Disorders Delirium Dementia Amnestic & Syndrome diagnosis Neurocognitive Other Geriatric DSM-IV DSM V Disorders Cognitive Disorders Aetiological subtypes 70+ Subtypes (Garand & Hall 2000) 100+ Subtypes (Boyd 2013) 200+ Subtypes (Haan & Wallace 2005) ????? ???????????????????  Definition “--is a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical function including memory, thinking, orientation comprehension, calculation, learning capacity, language and judgement. Consciousness is not clouded. The impairment of cognitive function are commonly accompanied, and occasionally preceded by deterioration in emotional controls, social behaviour or motivation” WHO 1992( ICD 10)  Memory Perceptual Working Semantic Episodic Procedural representation short-term memory memory memory memory memory (Facts, (Events, (Motor and (Primary, (Memory knowledge) experiences) cognitive skill sensory span, dual-task learning) memory) performance) 3-7-5 File:Matchtosample.png 8-3-9-6 Apple 6-9-4-7-1 Table 6-3-5-4-8-2 Pen 2-8-1-4-9-7-5 Bradley V & Kapur N (2003) Neuropsychological assessment of memory disorders In: Halligan PW, Kischka U & Marshall JC (eds) (2003) Handbook of Clinical Neuropsychology Oxford University Press: Oxford (page 149)  FTD Others 10-15% 2% 5% DLB 4% Dementia UK Report (2007) VaD 17% Up to 20% DAT 62% VaD/DAT 50-75% 10% Types of Dementia: the “Big Four”  Preferred Diagnostic Criteria Dementia Preferred Alternative Alzheimer’s Disease NINCDS/ADRDA ICD & DSM Vascular Dementia NINDS-AIREN ICD & DSM Dementia with Lewy International Bodies Consensus Criteria for DLB Frontotemporal Lund-Manchester Dementia criteria; NINDS criteria for (NICE/SCIE 2006) FTD Probable Alzheimer’s Disease (NINCDS/ADRDA Criteria) 1. Dementia ▪ Decline on examination and objective testing ▪ Deficits in two or more areas of cognition 2. Gradual Progression 3. Intact Level of Consciousness 4. Onset after age 40 5. No other cause  Cognitive Decline in AD over Time Sperling RA, Aisen PS, Beckett LA, et al (2011) Toward defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging- Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease Alzheimer’s & Dementia 7(3):280-292  Vascular Dementia (NINDS-AIREN Criteria) Cerebrovascular Disease Dementia Focal signs of stroke Impairment of memory (neurological exam) AND one other domain AND evidence of relevant CVD (on CT/MRI) One of more of the following: (a) Onset of dementia within three months of stroke (b) Abrupt deterioration in cognitive functions (c) Fluctuating, stepwise progression of cognitive deficits  Dementia with Lewy bodies (McKeith et al 1996) Progressive cognitive decline interfering with functioning Two of the following are required: – Fluctuating cognition – Recurrent visual hallucinations – Spontaneous motor features of Parkinsonism Features supportive of diagnosis: – Repeated falls – Syncope/transient loss of consciousness – Neuroleptic sensitivity – Paranoid delusions – Hallucinations in other modalities  Frontotemporal Dementia (Lund-Manchester Criteria) All of the following: 1. Insidious onset and gradual progression 2. Early decline in social interpersonal conduct 3. Early impairment in regulation of personal conduct 4. Early emotional blunting 5. Early loss of insight  Progression Death from Mild Pneumonia Cognitive Alzheimer’s Disease Progression and/or other Impairment comorbidities Mild: - Loss of recent memory - Faulty judgement Moderate: - Personality changes - Aggression - Agitation - Sleep disturbances - Delusions Severe: - Loss of all reasoning - Bedridden - Incontinence 4 - 8 years (up to 20!)  Conceptualising Dementia Medical Model Psychosocial Model  Causes Biological – Chromosomes linked to dementia – Altered brain pathology  Frontal Lobe Parietal Lobe Sequences of Action Planning/Organising Sentence Actions Construction Regulating Behaviour Calculation Abstract Thought Spatial Awareness Logic Language Memory Learning New Emotion Information (not visible) Verbal Memory (eg names) Visual Memory (eg faces) Visual perception Attention Colour recognition Temporal Lobe Occipital Lobe Altered Brain Pathology  Causes Biological – Chromosomes linked to dementia – Altered brain pathology Psychosocial – Malignant social psychology Kitwood’s (1997) Psychological Needs Comfort Occup Attach ation Love ment Identity Inclusion  Malignant Social Psychology Detracts from Comfort Detracts from Occupation Intimidation Disempowerment Withholding Imposition Outpacing Disruption Detracts from Identity Objectification Infantilisation Detracts from Inclusion Labelling Stigmatisation Disparagment Ignoring Detracts from Attachment Banishment Accusation Mockery Treachery Invalidation  Causes Biological – Chromosomes linked to dementia – Altered brain pathology Psychosocial – Malignant social psychology Environmental – Lifestyle – Physical Environment  Environmental Lifestyle: Environmental: Alcohol Floor Patterns Smoking Lighting Mediterranean diet Over-stimulating (eg fish and vegetables) environments Therapeutic Implications of AD Prevention of Onset Slow Progression Treat Symptoms & Slow Decline  Prevention is Better than Cure! Lancet Commission Report (2017) Lancet (2020) Less Education Hypertension Hearing Excessive Alcohol Impairment Consumption Smoking Obesity Depression Traumatic Brain Injury Physical Inactivity Diabetes Low Social Air Pollution Contact  Slow Progression Acetylcholine Vascular Problems  Treat Symptoms Cognitive Symptoms: – Memory Behavioural & Psychological Symptoms: – Depression – Hallucinations/Delusions – Wandering – Vocalisation – Aggression Essential Resources  Living With Dementia http://www.nhs.uk/Video/Pages/Livingwithdementia.aspx