Dementia DR UMAR BEDI CONSULTANT-OLD AGE PSYCHIATRY 10/1/2018 1

Transcription

1 Dementia DR UMAR BEDI CONSULTANT-OLD AGE PSYCHIATRY 10/1/2018 1

2 TOPICS FOR DISCUSSION Man- FETCH Wife- THE DOG DIED 2 YEARS AGO HENRY 10/1/2018 2

3 TOPICS FOR DISCUSSION Dementia news What is Dementia? Why diagnose Dementia? Can Dementia be prevented? Future... 10/1/2018 3

4 Dementia News Reports the Independent: Scientists believe that ultrasound could one day be used to combat Alzheimer's. Ultrasound- Tested on mice. Cleared plaque in the brain. 10/1/2018 4

5 Dementia News Reports TheGuardian.com: Onset of Alzheimer s could be delayed by a molecule that occurs naturally in humans. Findings prove that the cycle that leads to Alzheimer s can be interrupted. 10/1/2018 5

6 TOPICS FOR DISCUSSION VP FINANCE I don t remember your name but your salary is familiar 10/1/2018 6

7 What is Dementia? A collective term for a variety of diseases that result in the progressive loss of the powers of the brain 10/1/2018 7

8 DECLINE IN: MEMORY What is Dementia? AND OTHER COGNITIVE ABILITIES: PLANNING ORGANISING PROBLEM SOLVING 10/1/2018 8

9 What is Dementia? Memory Understanding Communication Skills and tasks Emotions 10/1/2018 9

10 TOPICS FOR DISCUSSION I remember the face but I have forgotten your name 10/1/

11 Why Diagnose? BECAUSE PATIENTS WANT TO KNOW: - WHAT IS HAPPENING? - CAN YOU HELP? - WHAT IS GOING TO HAPPEN? 10/1/

12 Why Diagnose? A new report by care experts shows that dementia has now become our number one health concern, overtaking cancer for the first time. 10/1/

13 Why Diagnose? Latest estimates show that more than two million Britons will suffer from dementia by ,435 GP practices in UK 268 per practice 10/1/

14 Why Diagnose? SERVICE PLANNING ISSUES 10/1/

15 Why Diagnose? Reduces presentation in crisis Access to adequate social care Avoid inappropriate referral to acute care Put affairs in order like LPA/Finances/Driving 10/1/

16 Why Diagnose? 1 in 20 over 65 will get Dementia (5%) 1 in 5 over 80 will get Dementia (20%) 10/1/

17 AGE IS A RISK FACTOR In over 60 s -33% Those aged over 80 are the fastest growing section of the population. Increasingly common with age but not a normal part of the ageing process 10/1/

18 Why Diagnose? TO CARE FOR CARERS AVOID COMPLEX CARE PLANS - OTHERWISE ONLY OPTION IS 999 AVOIDS CRISIS! 10/1/

19 Why diagnose? PATIENTS SELDOM HAVE ONE CONDITION PATIENTS WITH DEMENTIA GET ACUTE AND CHRONIC CONDITIONS CARDIAC, STROKE, FALLS, DIABETES, WEIGHT LOSS ALL MANAGED BY YOU! 10/1/

20 Diagnosis helps TO CARE FOR CARERS AVOID COMPLEX CARE PLANS - OTHERWISE ONLY OPTION IS 999 AVOIDS CRISIS! 10/1/

21 ?Risk of Over diagnosis Reports dailymail.co.uk. Bonus scheme that pays GPs 55 every time they diagnose a case of potential dementia has been of no benefit to patients. 10/1/

22 ?Risk of Under diagnosis Reports Telegraph.co.uk Leading dementia expert has urged families who suffer a delayed diagnosis to take legal action against their family doctors, 10/1/

23 Types of Dementia syndromes Alzheimer s disease (Most Common!) Vascular dementia s Lewy-Body dementia Fronto-temporal dementia

24 Types of Dementia (Dementia UK report) 6% 2% 3% 10% 17% 62% Alzheimer's Vascular Mixed LB/Parkinsons FTD Other 10/1/

25 Why Diagnose? Medications for Alzheimer s disease can slow decline

26 MEMORY MEDICATION Improves cognition Improves functioning Improves behavioural symptoms 10/1/

27 Why Diagnose? BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS (BPSD) Psychiatric: delusions hallucinations depressed mood insomnia anxiety Behavioural: physical aggression agitation wandering restlessness screaming

28 MUSIC FOR BPSD Listening/singing can provide emotional and behavioural benefits for people with dementia Musical memories often preserved because brain areas linked to musical memory relatively undamaged Singing can help stimulate unique memories. Music may: Relieve stress, Reduce anxiety and depression, Reduce agitation

29 ADDRESS SLEEP PROBLEMS Patient needs to sleep Carer needs to sleep 10/1/

30 SLEEP HYGIENE Use the bed only for sleeping?? 10/1/

31 MEDICATION FOR SLEEP Hypnotics-Zolpidem/Zopiclone: Alternate nights Melatonin modified release (Circadin) Antidepressants-? Mirtazapine Antihistamine? Promethazine Benzodiazepines- Temazepam/Oxazepam 10/1/

32 CAN WE PREVENT DEMENTIA? 10/1/ /1/

33 We know what happens in Alzheimer s disease

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36 Effects of dementia on neurotransmitters transmitter effect acetylcholine choline acetyltransferase acetylcholinesterase noradrenaline serotonin GABA somatostatin

37 What causes Alzheimer s disease?

38 Alzheimer s and genes No clear contribution in 95% of cases but in 5%- Three genes confer a predisposition for Early onset form of dementia- Amyloid precursor protein Presenilin 1 Presenilin 2 One gene increases risk for Late onset AD ApoE4 10/1/ /1/

39 Risk factors for Alzheimer s Number of risk factors proposed: AGE Sex Family history Head injury High Cholesterol Hypertension Down s syndrome Diet 10/1/ /1/

40 Dementia Update Reports dailymail.co.uk: Researchers from Chicago have found that telltale signs of Alzheimer s can be seen in people as young as 20. The finding suggests that the disease starts to eat away at the brain half a century before symptoms develop. 10/1/

41 Alzheimer s Disease and : NO EVIDENCE OF DEMENTIA OR DEMENTIA 10/1/

42 CAN WE PREVENT DEMENTIA? AIM IS TO PREVENT CLINICAL EXPRESSION OF THE DISEASE 10/1/ /1/

43 PREVENTION OF DEMENTIA GOOD FOR THE HEART! is GOOD FOR THE BRAIN! 10/1/ /1/

44 PREVENTION OF DEMENTIA MENTAL EXERCISE- reduces risk PHYSICAL EXCERCISE- reduces risk ALCOHOL- MODERATE HEALTHY DIET 10/1/ /1/

45 Watch what you eat!

46 PREVENTION OF DEMENTIA THE NUN STUDY Essays predicted Alzheimer s 10/1/ /1/

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48 HOPE FOR THE FUTURE. Prophylaxis: NSAID s (angiopathy, plaque formation) Statins? (plaque formation) Treatment: Neurotrophic peptides/cerebrolysin (synaptogenesis) Statins? (plaque formation) Secretase inhibitors (plaque formation) GSK-3/ Kinase inhibitors (neurofibrillary tangles) Immunisation (plaque formation) 10/1/ /1/

49 HOPE FOR THE FUTURE The Telegraph: Addenbrooke s Hospital will recruit the first humans for testing of a drug that may be able to reverse some of the damage caused by Alzheimer's disease..will test the effectiveness of Liraglutide, which is currently a widely-used diabetes drug. 10/1/

50 News Scotsman.com: World Health Organisation projections show that Europe will face an obesity crisis of enormous proportions within the next 15 years. 10/1/

51 More News The Independent: Risk of dementia is one third higher in people with a BMI less than 20 Very obese people those with a BMI above 40 were 29% less likely to develop dementia than people of a healthy weight. 10/1/

52 Thank you! 10/1/