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  • 1. Professor Tony Elliott Clinical DirectorSSS Foundation Trust
  • 2. Dementia Vs Alzheimer’s Disease? Dementia is the medical syndrome of memory loss, functional loss, personality change, and psychiatric symptoms Alzheimer’s disease is the commonest illness to cause dementia Vascular dementia FrontoTemporal dementia Lewy Body dementia
  • 3. DEMENTIA Lewy Body Dementia Other Dementias •Metabolic Vascular Alzheimer’s (Multi- •Drugs/toxic •White matter disease Disease infarct) Fronto- •Mass effects Dementia Temporal •Infections•Early onset Lobe •Parkinson’s Dementias•Normal onset
  • 4. How common is it?Prevalence doubles every 5 years afterage 65– 5% over age 65– 16% over age 85– 32% over age 90– (prevalence rate = total number of patients in the population at a point in time)Younger age groups can be affected700,000 in the UK have AD. With an ageingpopulation this figure is set to rise overthe next 25 years.
  • 5. Effect of demographic drift on dementia prevalence over the next 20 years 2028 2023 2018 2013 2008 0 2000 4000 6000 8000 10000 12000 Estimated Dementia Prevalence
  • 6. Clinical Features
  • 7. Cognition: Memory Loss– Immediate memory information is remembered from the previous few seconds affected early in Alzheimers disease– Short-term memory information is remembered from the prior few minutes or hours affected early in Alzheimers disease– Long-term (remote) memory information is remembered from many years ago affected in later stages of Alzheimers disease
  • 8. Activities of Daily Living: Self-Neglect and Physical Deterioration– Gradual decrease in abilities Washing Dressing Feeding Mobilty Continence– Physical deterioration Unsteadiness, falls muscle rigidity seizures and muscle spasms in about 10% of severe patients
  • 9. The Progress of Alzheimer’s Disease 30 Early diagnosis Mild-moderate Severe Cognitive symptoms 25 20 Loss of ADL MMSE score 15 10 Behavioral problems 5 Nursing home placement Death 0 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 YearsFeldman H, Gracon S. In: Clinical Diagnosis and Management of Alzheimer’s Disease. 1996:239-253. Ashford et al., 1995
  • 10. What is happening in the Brain?
  • 11. Effect on the brain
  • 12. AD and the Brain The Changing Brain in Alzheimer’s Disease No one knows what causes AD to begin, but we do know a lot about what happens in the brain once AD takes hold. Pet Scan of Normal Brain Pet Scan of Alzheimer’s Disease Brain Slide 19
  • 13. Senile Plaques
  • 14. Normal Brain Cells Neurotransmitters (AChE)– being sent – message being communicated to the next cell
  • 15. Normal Brain Cells Once the message is sent, then enzymes lock onto the messenger chemicals and take them out of circulation so a new message can be sent
  • 16. Brain Cells with Alzheimer’s Less neurotransmitter Further to go to get to the plaques next cell tangles Enzymes (AChE inhibitors) – get to them BEFORE they deliver their message
  • 17. Risk Factors and Causes of Alzheimer’s Disease
  • 18. Risk FactorsAgeGenderGenetic– family history– apolipoprotein E4 – chromosome 19– genetic mutations - chromosomes 1, 14, 21Down’s syndromeHead trauma?High CholesterolHypertension
  • 19. Preventative FactorsBalanced dietExerciseMentally active2 glasses of red wine a day…
  • 20. Treatments for Alzheimer’s Disease Anti-dementia drugs eg Aricept Memantine Aspirin Ginkgo Biloba Vit E Aromatherapy?
  • 21. What do Alzheimer’s drugs DO? Alzheimer’s drugs provide FAKE messenger chemicals that distract the enzymes. They attach to the Fake AChE & the message can get thru Aricept, Exelon, Reminyl
  • 22. Anti-Dementia Drug Prescribing October 2008 – December 2008Birmingham ECoventry TeachingDudleyHeart of BirminghamHerefordN. StaffordshireSandwellShropshire CountyS. BirminghamStoke on TrentTelford & WrekinWalsall TeachingWarwickshireWolverhampton CityWorcestershireS StaffordshireSolihullWarwickshireCentral and EasternHaveringBromleyWorcestershireWessexBexley Care TrustWestern CheshireS.E.Essex 0.00 0.125 0.25 0.375 0.50 0.75 0.875 Patients 65 yrs and over
  • 23. Memory Service National Accreditation ProgrammeTo assess and accredit memory servicesfor people with dementiaInvolves external accreditation review ofMemory Service
  • 24. MSNAP Process Telford & WrekinCommenced April 20103 Month period of self review askingcarers and service users about the servicePeer Review October 2010Telford and Wrekin Memory Serviceaccredited with excellence January 2011
  • 25. AromatherapySeveral Placebo –Controlled trials(Holmes et al 2003)Significant efficacy few S/EsMelissa (lemon balm) or Lavender OilMethod of delivery variableProlonged massage not necessarycomponent of treatment
  • 26. Aims of Interventions for Carers in Telford and Wrekin Increase awareness Support person with dementia and carers in own home Mobilise available community resources Increase links with Agencies eg Alzheimer’s Society Aim to reduce “CARER STRESS”
  • 27. Protective factors •Practical support •Family help Dementia •Problem focused coping Dependency and problem Exacerbating behaviours factors•Social isolation Burden on caregiver•Lack of knowledge•Poor Skills•Immature coping•Guilt Caregiver strain•Poor relationship -Psychological - physical•High expressed emotion - financial - social
  • 28. What about local services and developments?
  • 29. Dementia WorkstreamMulti professional groupMonitoring community developments fordementia specific teamsAim to treat people in place of residenceand reduce avoidable admissionsTelford Dementia Home Treatment teamin placeConsultant Psychologist appointed
  • 30. Increasing Healthcare staff for People with DementiaMarch/April 2011Mental Health Community team has beenstrengthened by recruitment of additional7 workers3 Band 6 nurses2 Band 5 nurses2 support workersInduction and training has taken place forthe new team members
  • 31. Recent Service Achievements• Primary Care Liaison Worker - appointed• Admiral Nurse - appointed• Strategic Commissioning Group for Dementia- established• Investment in Additional resources in Carer’s Respite
  • 32. Working with patients 5 Dementia Advisers from Alz Societyhave started in Jan 2011 to link in withCommunity Teams and signpost theservice users and carers to local servicesRegular monthly clinic in the LightmoorView care homePositive impact in reducing the number ofadmissions to Shelton Hospital
  • 33. Involving our Service usersUser/carers involved in the recruitment ofstaff for dementia teams“Speak out Forums” – updates on servicedevelopmentsUsers/carers representatives are involvedin the new hospital build
  • 34. “DARE to make a difference”Dementia Awareness Raising andEducationRaising awareness of the dementiasamong local school children andbusinessesDeveloped with funding from the PCTLed by Dr Ejaz Nazir ConsultantPsychiatrist
  • 35. Environmental Design in the New Hospital
  • 36. Inpatient unit Finland
  • 37. "Only put off until tomorrow what you arewilling to die having left undone." Pablo Picasso 1881-1973, Artist
  • 38. Professor Tony Elliott Clinical DirectorSSS Foundation Trust