Dementia

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Dementia Alzheimers Disease

• Dr Peter Bowie
• Consultant and Clinical Director in Old Age
  Psychiatry

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Overview

• What is Dementia
• How common is Dementia
• What are the causes and symptoms
• How do we make a diagnosis
• What treatment might be offered
• What help is available

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What is Dementia?

• Global deterioration of higher intellectual
  functioning occurring in an alert patient.
• The organic deterioration of intelligence, memory
  and orientation.
• Static or progressive
• Reversible or irreversible

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Dementia How Common is it?

• 2007
• UK 700,000
• Sheffield 6,500
• 2035
• UK 1.4 Million
• Sheffield 13,000

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Dementia UK Results
Costs - the answer
Total cost of dementia in the UK 17 billion per
annum
Projected increase in costs of dementia
Total cost of dementia projected in the UK in 30
years 51 billion per annum
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Dementia UK Results
Costs - the main elements
Accommodation 41
Informal care 36
Social care 15
NHS 8
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The Dementia Spectrum
Normal Ageing
Mild Cognitive Impairment (MCI)
Fronto-temporal Dementia
Vascular Dementia
Mixed Dementia
Alzheimers Disease
Lewy Body Dementia
Dementia in Parkinsons
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Dementia main types

• Alzheimer's 50
• Vascular 5
• Mixed 25
• Lewy Body 5-15
• Fronto-temporal 5-15
• others 5

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Secondary Dementias

• Head Injury
• Brain tumour
• Brain infection
• Blood Clot on Brain
• Hydrocephalus
• Lack of Oxygen to Brain

• Endocrine Disease
• Kidney Disease
• Liver Disease
• Anaemia
• Cancer
• Blood Chemistry Disorders
• Depression

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1 year Incidence by Age Group
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Point Prevalence by Age Group
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Risk Factors for Alzheimers

• Family History RR3.5 (2.6-4.6)
• Family History of Parkinsons 2.4
  (1.0-5.8)
• Family History of Downs 2.7 (1.2-5.7)
• Head Injury 1.8 (1.3-2.7)
• Hypothyroidism 2.3 (1.0-5.4)
• Depression 1.8 (1.2-2.9)
• Smoking 0.8 (0.6-1.0)

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Assessment Diagnosis
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Dementia-Diagnosis

• CLINICAL diagnosis
• History
• Informant History
• Mental State
• Cognitive Tests
• Physical Examination
• Investigations

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History

• Duration
• Nature of progression
• Risk Factors
• Genetics
• Medical History
• Background

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Cognitive Assessment

• Orientation
• Time
• Place
• Person
• Attention Memory
• Immediate recall
• Recent memory
• Distant memory
• Focal neurological deficits

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Assessment investigations

• Physical Examination
• Blood tests
• haematology (blood count, B12/folate, PV/ESR)
• biochemistry (kidney, thyroid, liver, calcium,
  sugar)
• Radiology
• CT/ MRI scan
• chest x-ray
• Other
• ECG
• Microbiology (urine, sputum)

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Dementia drug treatment

• Cholinesterase Inhibitors
• Donepezil, Rivastigmine, Galantamine
• prolong AcetylCholinine activity in brain by
  preventing breakdown
• Delay symptom progression
• work for some patients, not all

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SHSC Services

• Memory Service
• Community Mental Health Teams
• Rapid Response Team
• In-Patient ward G1
• Resource Centres
• Accelerated Discharge Team / Intermediate Care
• Community Dementia Support Service

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Social Support

• Domiciliary support via home care
• Day Centre
• Respite
• Domiciliary
• Day care
• Residential
• Residential Nursing Homes
• Self Help Community Activity

• Safe environment
• Social Contact
• Occupation/recreation
• Personal care
• Support relief for carers

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Thank YouQuestions?