Dementia awareness for surgeries - powerpoint presentation by Dr Nicola Decker, GP.

1. Dementia
Produced by Wessex LMCs
in partnership with:
Wessex AHSN
Dr Nicola Decker, GP
Alzheimer’s Society

2. Contents:
Why are we here?
Understanding
Dementia
The Brain
Symptoms – four main
dementias
Case Studies
Models
Visual problems
Communication
Further Resources
Questions

3. This is designed as an interactive session to use in
general practice to increase the understanding of a
condition that affects many of your patients and
has a significant impact on their family.

4. Becoming a………
Dementia Friendly Practice

6. Figures
• 1 in 14 people over 65 have dementia.
• 1 in 6 people aged 80 and over have dementia.
• 850,000 people live with dementia in the UK today.
• 14,000 people living with dementia in Dorset
• ?? people diagnosed with dementia at the Atrium Hea

7. Facts
• Two thirds of people with dementia are women
• At end of life, one third of people will have dementia
• Dementia is most common in older people but
younger people (under 65) can get it too.
40-64 years: 1 in 1,400
65-69 years: 1 in 100
70-79 years: 1 in 25
80+ years: 1 in 6

8. What is Dementia?

9. 1. Alzheimer’s Disease
2. Vascular Dementia
3. Dementia with Lewy Bodies
4. Fronto-Temporal Dementias (inc Pick’s disease)
Creutzfeldt-Jakob Disease
Korsakoffs Syndrome
PCA – Posterior Cortical Atrophy

10. The occipital lobe
dementia in this part of
the brain leads to PCA or
Posterior Cortical Atrophy.
This affects the visual
processing – recognition
of colours/shapes, faces
and ability to read.
1. Frontal Lobe controller:
damage to the frontal
lobes can lead to the
individuals no longer
being aware of what
actions seen by others are
inappropriate
2. The non-dominant
parietal lobe
Our 3D ‘centre’. Makes
objects being viewed look
3D. It also helps our
understanding of space –
to locate objects, e.g.
when picking something
up.
3. The dominant parietal
lobe
Our body sense: knowing
our left from our right,
sensing where a limb is,
putting things together
into a structure such as
reading and calculation
4. The temporal lobe:
damage to this area of the
brain causes the individual to
have problems with short
term memory and over time
the term memories may also
fade as the damage increases
further into the deeper
regions of the brain
5. The occipital lobe
Dementia in this part of the
brain leads to PCA or
Posterior Cortical Atrophy.
This affects the visual
processing, so recognition of
colours/shapes, faces and
ability to read.

11. Alzheimer’s disease
• Most common cause of dementia
• A physical disease affecting the brain

12. Alzheimer’s disease
• Most common cause of dementia
• A physical disease affecting the brain
• Protein ‘plaques’ and ‘tangles’ develop in the
structure of the brain, leading to the death of
brain cells ) often in the temporal lobe).
• It also leads to a shortage of some important
chemicals in the brain.
• Over time more parts of the brain are damaged
and the symptoms become more severe.

13. Symptoms of Alzheimer’s disease
People with Alzheimer’s disease may
• Become confused and frequently forget names,
appointments and recent events.
• Experience mood swings, feel sad or angry, or scared
and frustrated.
• Become more withdrawn, due to either a loss of
confidence or to communication problems.
• Have difficulty carrying out everyday activities –
checking their change at the shops or how to work
the TV remote.

14. Vascular Dementia
• The second most common
form of dementia.
• Caused by problems in the
supply of blood to the
brain due to damage to
the vascular system (the
network of blood vessels).
• Damage to the vascular
system could be caused by
strokes, high blood
pressure, heart problems,
high cholesterol and
diabetes.

15. Symptoms of Vascular Dementia
People with vascular dementia may experience
• Problems concentrating and communicating.
• Depression accompanying the dementia.
• Physical weakness or paralysis.
• Memory problems.
• A ‘stepped’ progression with symptoms remaining at
a constant level and then suddenly deteriorating.
• Seizures.
• Periods of acute confusion.

16. Dementia with Lewy bodies
• Around ten per cent of
cases of dementia.
• Lewy bodies are tiny,
spherical protein deposits
found in nerve cells.
• They disrupt the brain’s
normal functioning,
interrupting the action of
important chemical
messengers.

17. Symptoms of Dementia with
Lewy bodies
• May have problems with:
attention and alertness,
spatial disorientation,
planning ahead
co-ordinating mental activities.
• Memory is often affected less
than in Alzheimers
• May develop symptoms of
Parkinson’s disease:
Slowness, shuffling gait
limb tremor, muscle stiffness,
loss of facial expression
change in voice strength
• May experience detailed
and convincing visual
hallucinations.
• May have fluctuating
abilities daily or even
hourly.
• May fall asleep easily by
day yet have restless
disturbed nights.
• May faint, fall or have
‘funny turns’.

18. Symptoms of Fronto-Temporal
Dementia
• Poor judgement
• Loss of empathy
• Socially inappropriate
behaviour
• Lack of inhibition
• Repetitive compulsive
behaviour
• Inability to concentrate or
plan
• Frequent, abrupt mood
changes
• Speech difficulties
• Problems with balance or
movement
• Memory loss

20. Case Studies

21. “Aggressive” Behaviour
• May be verbally abusive
• Physically, hitting, kicking,
pinching and lashing out
This may be caused by:
• Feeling frightened or humiliated
• Feeling frustrated about their lack
of understanding or
communication problems
• Dementia may have eroded their
judgement and control
• Loss of inhibitions and decreased
awareness of appropriate
behaviour

22. Bookshelf model
Memory without dementia
Memories like books on a
bookshelf
Stored over time
Most recent on top

23. Person with dementia
Bookcase wobbles Top shelf books
affected first
Progressively
lower books fall

24. Feedback
from focus
groups
Clarity
about roles
A priority
approach
for carers
Consistency
in every
practice
Accessible
information
Training for
staff
We didn’t know
where she was
from, or what
she did
He got lost - this
happened a few
weeks after the
doctor said he
was fine
I find it difficult to
ask people for help.
We just carry on -
they don’t offer, but
then I don’t demand
The nurse turned
to me and said, “Is
she compos
mentis?” I was
angry, and upset
The GPs can be quite
patronising - they talk to
him as though he doesn’t
understand anything
Some staff can be
aggressive towards him
- they seem to think
they have nothing to
learn
It’s just places to go and
people to be with we need
The GP tests him every
year, and that’s really
helpful.” “The GP said that
they wouldn’t have time
We can’t always see the
same GP – it’s
frustrating when you
have to go over it all
again and again
The toilets do need to be
clearly marked –
sometimes you need
them in a hurry
Living with it or
suffering it?
Well, you’ve got
to do both,
haven’t you?”
(Carer)
There was this flurry of
activity, and lots of
information just after the
diagnosis, but then
nothing - it felt as if we
were just left to get on
with it

25. Small Changes…… Big Differences…..
1.Make sure all health-care staff know whether a
patient has dementia before they are seen
2.Remember! People living with dementia may need a
longer appointment
3.Don’t let people with dementia fall out of the system
if they don’t keep appointments (NB If someone
without a dementia diagnosis repeatedly forgets to
attend appointments, it may be a sign that they
should be screened)
4.If possible, send appointment reminders to both
patient and carer

26. Small Changes…… Big Differences…..
5. Where appropriate, include family carers in decision
making
6. Ensure family members have copies of relevant
documents – letters, monitoring equipment,
appointments, changes to medication etc
7. Continuity of care is very important to the person
with dementia – it is better to be seen by the same
health-care professional on each visit

27. Visual Difficulties
• Hallucinations: an experience of something that is
not really there. They can occur for all the senses,
though visual hallucinations are the most common.
• Visual Misperception: when the individual mistakes
something for something else.

28. This mirror at the bathroom entrance has caused
residents to leave, thinking it was occupied although
they were seeing their own reflections.

29. A lady says there is a mouse in the
bin

30. This carpet in a Dementia unit was mistaken
for a pond with goldfish and lilies

31. The lift looks a corridor to somewhere

32. Does this floor look slippery, wet or
confusing?

33. Communication
• Before you speak
• When you speak
• What to say
• Listening
• Body Language and Physical Contact

34. People with dementia feel that
their community could help by:
• Better understanding of dementia and less social
stigma
• More public awareness of the condition
• More local activities and opportunities to socialise
• More tolerance and patience from others
• More community spirit
Source: Alzheimer’s Society Dementia 2012 Report

35. Risk factors for developing
dementia
• Age
• Lack of physical exercise
• Obesity
• Mental activities in mid life
• Diabetic
• Current Smoking
• Excess alcohol
• Genetics
• Learning disabilities

36. Modifiable Risk Factors

37. Diagnosis – the earlier the better
Only 1/3 of people with dementia have a proper
diagnosis.
Early diagnosis means that:
• There is more time to plan ahead and support self
management
• The carer is able to cope for longer
• The need for placement of the patient away from
their home is delayed

38. Support for Carers and Family
• Registering as a carer with GP
• Age UK
• Carers assessment
• Information and resources
• Alzheimer’s Society
• Memory advisors and support teams
• Adult services

39. NHS Commitment to raising
awareness
• Awareness – understanding symptoms, recognising
signs, challenging behaviour.
• Knowledge of the condition – types of dementia,
differences between dementia, delirium, depression
etc.
• Communications, listening skills and supporting
people with dementia.
• Person centered care – sign posting to advice and
guidance, medication, ethics, impact on families.

40. What can we do?
• Become “dementia friends”
• (see ’Video about dementia friends’ if access to the
internet is available)
• Support national campaigns
• Become a ‘Dementia Friendly Practice’

41. Our role as a dementia friendly
practice
• Maximise health and well-being and help people to
remain independent
• Improve patient and carer experience
• Improve teamwork
• Improve clinical consultations – better prescribing &
improved referrals
• Improved care planning for the future
• Improved quality of life for our patients
• Know & be able to sign post patients to available
services

42. Where can you find more
information?
• www.alzheimers.org.uk
• www.dementia.org.uk.
• www.dementiafriends.org.uk
• www.scie.org.uk (e-learning)

43. So…………
What do we want to do as a practice?