Dr Georgina Train Consultant Psychiatrist EMDASS service and Continuing Care.

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1 Dr Georgina Train Consultant Psychiatrist EMDASS service and Continuing Care.

2 Consultant Psychiatrist of both General adult and Old Age Psychiatry. Work with Memory Service and a Continuing Care ward. First author Publications in this area: Addressing the needs of Carers of Older People The Islington study a qualitative view of residents with dementia, their relatives and staff about work practice in long term care settings Relationship between neuropsychiatric symptoms, cognitive deficit and psychotropics in Alzheimer s disease: LASER AD study.

3 The Service model including PDS in HPFT New guidance for Dementia (NICE) A definition of Dementia How Dementia presents Physical causes and investigations Why go to Clinic? Medical treatments and other support Post Diagnostic support & advanced plans Behavioural problems and other symptoms in dementia : different techniques to use Impact on Carer health

4 Referral to a Memory clinic within EMDASS service. A Joint assessment with Nurse and Consultant in clinic or at home if needed. Person is discussed in multidisciplinary team Target time to be seen Telephone follow ups. Telephone reminders. Referral on to relevant services such as OT Referral on for Post Diagnostic support

5 Updated recommendations for drug treatment : some co treatment with memantine. Treatments being prescribed by GPs Structured skills training for carers New diagnostic tests (such as csf for Alzheimer s disease) for some patients. People with dementia should have a single health or social care professional to coordinate their care.

6 people living with Dementia in UK I in 14 people over 65 (but chances are much higher the older you get) 1 in 3 remain undiagnosed Half people did not feel they were given enough post diagnostic support

7 A set of symptoms that may include memory loss, difficult in thinking, problem solving, or language. There may be personality changes and impaired reasoning. Severe enough to affect daily functioning Can affect mood and behaviour Caused my damage to the brain such as Alzheimer s disease, vascular change or a series of strokes. Not due to acute confusion secondary to e.g an infection. (but the two can co-exist)

8 An intermediate stage between the expected cognitive decline of normal aging the more serious decline of dementia. It can involve problems with memory and thinking Daily function is preserved A higher risk of developing dementia Some may be due to physical problems, medication etc, others may actually be early dementia.

9 Alzheimer s disease late onset and young onset Vascular dementia Lewy Body Dementia Dementia in Parkinson s disease Fronto temporal dementia Alcohol related dementia Other causes e.g. Due to MS

10 Amnesia (memory problems) Agnosia (visual recognition problems) Apraxia (spatial and practical problems e.g cooking, driving, dressing) Aphasia (word finding problems) Apathy (losing volition to do things) Personality changes

11 The dementia blood screen : correctable causes such as infection, anaemia, low folic acid, impaired sugars, thyroid, syphilis serology. ECG CT scan Newer tests for complex patients.

12 To rule out other causes of brain pathology such as tumour, subdural bleed. To establish if vascular changes are present. To look for specific atrophy or shrinkage in hippocampal and temporal areas found in Alzheimer s To look for Stroke Helps to establish if medication can be used. Helps with prognosis.

13 1. for early dementia e.g. Donepezil, rivastigmine (patch), galantamine. 2. for later stage dementia with behavioural problems e.g Memantine 3. for associated symptoms e.g. Sedatives, anti psychotics (rarely), anti depressants.

14 Some notice an improvement Slowed progression of the illness Slowing of the pulse can cause symptoms and increase risk of falls Stomach problems

15 Signposting to daycentres, lunch clubs, Carer s groups Carers assessment OT assessment Application for Attendance allowance

16 What to expect, the future, legal rights. The benefits of planning ahead Lasting power of attorney (for health, welfare, property and financial affairs decisions) Advanced Statements : wishes, preferences, beliefs, values regarding their future care. Advanced decisions to refuse treatment Preferences for place of care and place of death. A chance to review and change those statements.

17 Psychological treatment : MCI groups and cognitive stimulation therapy OT input for the home, mobility SS input for both care package and carer s assessment Speech and language assessment Falls clinic a drug review Referral to other specialist e.g cardiology

18 Agitation Poor sleep day/night reversal Sundowning Paranoia e.g thinking items have been moved Depression Hallucinations commonly visual Mood disturbance elation or lack of judgement e.g. Entering competitions, buying too many things.

19 E.g. I want to go home! This is not my home, I need to set off now...

20 Correction : This is your home here, there is no other home to go to... Distraction : Ok, let s set off in a while but first can you help me take the apples out of the bag, and we will have a cup of tea... Validation: Ok let s go for a walk to get to your home... Followed by distraction Reminiscence talking about detail from the past.

21 DVLA guidelines are to inform them of the illness in both Dementia and MCI. Consultant and/or GP likely to be contacted Can drive with mild dementia Depends on how the dementia affects you Voluntary driving tests Hatfield action on disability.

22 Managing medication Cooking involvement but avoiding risks Involvement with children Crossing roads and handling money Answering telephone/ cold calls Risk of falls Operating vehicles Operating machinery DIY. Was the Person with dementia caring for you? Do you feel safe?

23 Shared information : Carers groups and talks A need for short and longer breaks :Daytime respite e.g. Crossroads Residential respite : a holiday Day centres Befriender schemes Awareness of own mental health risk of depression, and anxiety assessment of your physical and mental health.

24 Awareness of impact on family dynamics e.g siblings, children. Geographical challenges. Mindfulness techniques/yoga/sports What to do to switch off/take a break. Who to contact if things get worse. Group sessions on psychoeducation and skills training.

25 You are the experts and dementia differs. You are here because you care. Don t be afraid to say you need more support. Positive recognition of carers needs in the new NICE guidelines. Open to questions and discussion... Thank you!