DementiaDementia

Lynn FlanniganLynn Flannigan

Lanarkshire Care Home Liaison Lanarkshire Care Home Liaison

PhysiotherapistPhysiotherapist

Lynn.Flannigan@lanarkshire.scot.Lynn.Flannigan@lanarkshire.scot.

nhs.uknhs.uk

01698 37781201698 377812

DementiaDementia

What is it?

The History of Dementia

The Symptoms

The National Picture

Useful resources

The Challenges for rehab

Some facts and figures

Types of Dementia

Stages of Dementia

What is it?What is it?•• Defines a group of syndromes Defines a group of syndromes characterised by progressive cognitive characterised by progressive cognitive decline decline

•• Dementia occurs as a result of changes to Dementia occurs as a result of changes to the structure of the brain and progressive the structure of the brain and progressive damage to the brain cellsdamage to the brain cells

•• This leads to a decline in mental and This leads to a decline in mental and physical abilitiesphysical abilities

•• The word dementia is derived from the The word dementia is derived from the Latin Latin demensdemens meaning meaning ““without mindwithout mind””

•• Over 200 subtypes have been definedOver 200 subtypes have been defined

Facts and FiguresFacts and Figures

•• 85,807 people with dementia in Scotland, 85,807 people with dementia in Scotland, 3,201 under 653,201 under 65

•• Prevalence will double in next 25 yearsPrevalence will double in next 25 years

•• Affects approx 24 million people in the Affects approx 24 million people in the worldworld

•• Predicted to reach 81 million by 2040 due Predicted to reach 81 million by 2040 due to our aging populationsto our aging populations

•• 1:20 >651:20 >65’’s 1:5 >80s 1:5 >80

Types of dementiaTypes of dementia•• AlzheimerAlzheimer’’s disease s disease –– most common most common (~50%). Loss of neurones, brain atrophy, (~50%). Loss of neurones, brain atrophy, neuriticneuritic plagues and plagues and neurofibrillaryneurofibrillary tanglestangles

•• Vascular dementia Vascular dementia –– 10%. Caused by 10%. Caused by blockages to the brainblockages to the brain’’s small blood s small blood vesselsvessels

•• Dementia with Dementia with LewyLewy bodies bodies -- 20% 20% abnormal neuronal protein plaguesabnormal neuronal protein plagues

•• Mixed AlzheimerMixed Alzheimer’’s/vascular s/vascular –– 10%10%

•• Others Others –– 10%10%

Common SymptomsCommon Symptoms

•• MemoryMemory

•• Thinking speedThinking speed

•• Mental agilityMental agility

•• LanguageLanguage

•• UnderstandingUnderstanding

•• JudgementJudgement

Stages Of Dementia Stages Of Dementia •• Mild Mild –– forgetfulness, repeat stories, forgetfulness, repeat stories, disorientated to time, loses interest, stops disorientated to time, loses interest, stops doing complicated tasks, mild word finding doing complicated tasks, mild word finding difficultiesdifficulties

•• Moderate Moderate –– increasing memory problems, increasing memory problems, getting lost, getting lost, forgetingforgeting family friends family friends names, repeating questions, neglects names, repeating questions, neglects personal hygiene. Difficulty functioning personal hygiene. Difficulty functioning indepindep

•• Severe Severe –– full assistance required, physical full assistance required, physical decline, little speech, decline, little speech, dysphagiadysphagia, mobility , mobility problemsproblems

The History of DementiaThe History of Dementia•• References to dementia can be found in References to dementia can be found in

Roman medical textsRoman medical texts

•• More common usage in the 18More common usage in the 18thth Century Century

when it implied a lack of competence and when it implied a lack of competence and

an inability to manage onean inability to manage one’’s affairss affairs

•• 1919thth Century Century –– usually associated with old usually associated with old

ageage

•• 1907 1907 –– AloisAlois Alzheimer described brain of Alzheimer described brain of

AugusteAuguste D and concluded dementia could D and concluded dementia could

occur in younger peopleoccur in younger people

The History ContinuedThe History Continued•• People with dementia in asylumsPeople with dementia in asylums

•• 1948 1948 –– NHS establishedNHS established

•• Dementia still seen as old peopleDementia still seen as old people’’s diseases disease

•• 1974 1974 --Robert Robert KatzmanKatzman –– senile dementia senile dementia

and AD the same thing and the 4and AD the same thing and the 4thth leading leading

cause of death in the UScause of death in the US

•• AlzheimerAlzheimer’’s Society 1979s Society 1979

•• First branches 1980First branches 1980

•• AlzheimerAlzheimer’’s Scotland established 1994s Scotland established 1994

WhatWhat’’s Happening Now?s Happening Now?

•• Growing empowerment, equality and Growing empowerment, equality and

person centred careperson centred care

•• More carer involvementMore carer involvement

•• 2009 2009 -- The Charter of Rights for People The Charter of Rights for People

with Dementia and Their Carerswith Dementia and Their Carers

•• 2010 2010 –– ScotlandScotland’’s National Dementia s National Dementia

StrategyStrategy

•• 2011 2011 –– Standards of Care for Dementia in Standards of Care for Dementia in

ScotlandScotland

Dementia - The Challenges For Rehab• Lack of good evidence base• Reduced concentration• Reduced retention of information

• Perceptual difficulties• Dyspraxia• Anxiety/fear/depression/apathy• Difficulty following complex commands

What can we do??• Visual prompts

• Sound cues• Tactile prompting

• Repetition• Familiar previously learned tasks

• Break down tasks• Functional approach• Consider communication environment – ietoo busy, noisy, over stimulating

• Shorter sessions? Little and often

What can we do?• Positive feedback

• Meaningful activity

• Involvement of carers

• Routine

• Holistic approach – medication, nutrician, hydration, pain, infections, constipation, boredom, glasses, hearing aids

• Consider environment – lighting, signage, contrast, seating

• Orientation cues – watch, clock with time and date, clothing, notepad, journal, memory board

• Negotiation and collaboration

What Can We Do??• Be flexible

• Provide adequate time

• Simple goals – should be failure free

• Be very aware of tone of voice and non-verbal communication

• Use preferred name. Establish eye contact

• Don’t chat whilst performing tasks

• Directional cues may be a prob e.g. lean forward so may say “nose over toes”. Not turn around but “lets go back to your chair”

Positive Person Approach• Unconditional positive regard – do not make judgments

• Be a good listener• Empathic understanding of the person’s world and experience. Try to see the world as they see it.

• Genuine and honest. Be yourself. Show your human side.

• Communicate these qualities to person and carers. Be warm and present

Useful ResourcesUseful Resources•• ““Charter of Rights for People with Dementia and Charter of Rights for People with Dementia and Their Carers in ScotlandTheir Carers in Scotland”” (2009)(2009)

•• ScotlandScotland’’s National Dementia Strategy (2010)s National Dementia Strategy (2010)

•• Standards of Care for Dementia in Scotland (2011)Standards of Care for Dementia in Scotland (2011)

•• ““Promoting ExcellencePromoting Excellence”” (2011) (2011) –– The Knowledge The Knowledge NetworkNetwork

•• Dementia MKNDementia MKN

•• Realising Potential (2010)Realising Potential (2010)

•• NICE: Supporting People with Dementia and Their NICE: Supporting People with Dementia and Their Carers (2011)Carers (2011)

•• NHS Quality Strategy (2010)NHS Quality Strategy (2010)

•• Alzheimer ScotlandAlzheimer Scotland

“What I would say to theprofessionals is that – you can pullme back, give me my life back andpull me into the light. And by thesame token, ignorance, arrogance,couldn’t care less, you can shove medown into the darkness and just castme away. I can’t do it. I need yourhelp to do it.”

Promoting Excellence 2011