Dementia – everything you need to know but were afraid to ask

1. Dementia – everything you need to know but were afraid to ask Dr. Shehram Moghul Consultant in OPMH Liaison Psychiatry Southampton General Hospital Nuffield Wessex Hospital, Chandler’s Ford

2. Biography • Consultant in Hampshire since 2003 • GMC examiner • Medical member for Ministry of Justice • Board of Royal College of Examiners • Private Consultant for memory problems at Wessex Nuffield Hospital and Priory Hospital • www.moghulmedical.co.uk • (private sec. 02380 877524)

3. Learning outcomes • Dementia vs old age (‘normal ageing’) • Different types • How it ideally should be diagnosed • How it can be helped • Some tips • Time for questions

4. Learning outcomes • Dementia vs old age (‘normal ageing’) • Different types • How it should* be diagnosed • How it can be helped • Some tips • Time for questions *Increasingly difficult due to NHS pressures

5. What is normal ageing vs dementia?

6. Dementia vs normal ageing

7. What’s normal for you?

8. Learning outcomes • Dementia vs old age (‘normal ageing’) • Different types (dementia vs Alzheimer’s) • How it ideally should be diagnosed • How it can be helped • Some tips • Time for questions

9. What’s the difference between dementia and Alzheimer’s

10. Others e.g. Huntingdon’s disease, Creutzfeld Jakob disease Alcohol Frontotemporal dementia Lewy Body dementia Alzheimer’s disease Vascular dementia DEMENTIA Umbrella term

11. Abrupt onset, stepwise decline Focal neurological symptoms and signs Patchy cognitive deficits, cardiovascular disease Vascular dementia Vascular dementia – clinical features

12. Lewy Body Dementia Spontaneous motor Parkinsonism, Falls LEWY BODY DEMENTIA Neuroleptic sensitivity Complex visual hallucinations

13. Others e.g. Huntingdon’s disease, Creutzfeld Jakob disease Alcohol Frontotemporal dementia Lewy Body dementia Alzheimer’s disease Vascular dementia DEMENTIA Umbrella term

14. Frontotemporal Dementia Disinhibition, Coarsened social behaviour e.g. sexual FRONTOTEMPORAL DEMENTIA Speech abnormalities Impaired judgement

15. Others e.g. Huntingdon’s disease, Creutzfeld Jakob disease Alcohol Frontotemporal dementia Lewy Body dementia Alzheimer’s disease Vascular dementia DEMENTIA Umbrella term

16. Learning outcomes • Dementia vs old age (‘normal ageing’) • Different types • How it ideally should* be diagnosed • How it can be helped • Some tips • Time for questions *Recognise can be difficult due to NHS pressures

17. How do I diagnose dementia? • History (duration, pattern of symptoms) • Examination (physical, neuro, cognitive) • MMSE – 25/30 • Blood screen (thyroid, alcohol, kidney, B12) • Maybe a brain scan

18. 30 1 2 3 4 5 6 7 8 9 Dementia gets worse over time 25 20 15 MMSE Early Cognitive symptoms 10 Loss of functional independence 5 Mild-moderate 0 Behavioural problems Years Nursing home placement Severe Death Feldman H and Gracon S in: Clinical Diagnosis and Management of Alzheimer’s Disease. 1st ed. Martin Dunitz Publ London, England: Taylor & Francis Group; 1998

19. The spectrum of BPSD • Psychotic symptoms • Hallucinations • Delusions • Misidentifications • Affective symptoms • Depression • Apathy • Elation • Anxiety • Disinhibition • Behavioural Symptoms • Aberrant motor behaviour • Irritability/Aggression • Agitation • Sleep disturbance • Stereotypies • Hyperorality • Eating disturbance • Hypersexuality Mega et al. Neurology 1996

20. Learning outcomes • Dementia vs old age (‘normal ageing’) • Different types • How it should be diagnosed • How it can be helped • Some tips • Time for questions

21. Current treatment • There is a cure for dementia? • True or false?

22. false!

23. e.g. activity, one to one care, aromatherapy Management of dementia Non-pharmacological approaches Approaches to management Antipsychotics, antidepressants, Benzodiazepines Acetylcholinesterase inhibitors, Memantine Licensed medication Unlicensed medication

24. Memantine mechanism of action

25. What Does AD Treatment Mean for the Patient? • Untreated, patients will decline rapidly, become severely dependent on caregivers leading to early admissions to nursing homes Mild Successful treatment Global Symptom Severity Untreated Severe Time

26. How do you prevent dementia?

27. Die young!

28. How to prevent dementia?

29. Learning outcomes • Dementia vs old age (‘normal ageing’) • Different types • How it should be diagnosed • How it can be helped • Some tips • Time for questions

30. Senses - sight • Peripheral vision • 180 degrees reduced to 35…equivalent to glaucoma • Be within field of vision • Don’t speak until you are within field! • Colour perception drops (rods and cones)– ignore good taste and glam up! • Bright plates, presentation darling • Food dye (Westacre RH)

31. hearing • Reduction of high frequency receptors

32. Worsened in dementia • Natural loss worsened in dementia

33. LOWER THE TONE OF YOUR VOICE! • Low, familiar tones, spoken slowly…

34. Taste and smell • Bitter and sweet are the last receptors to deteriorate • Therefore reconsider foods if appetite seems poor • Sherbert lemons, humbugs, don’t worry about diet

35. The case of the tidy room

36. Learning outcomes • Dementia vs old age (‘normal ageing’) • Different types • How it should* be diagnosed • How it can be helped • Some tips • Time for questions *Increasingly difficult due to NHS pressures

37. Don’t worry! • It’s not genetic!* • *Ahem, actually it is sometimes…

38. Biography • Consultant in Hampshire since 2003 • GMC examiner • Medical member for Ministry of Justice • Board of Royal College of Examiners • Private Consultant for memory problems at Wessex Nuffield Hospital and Priory Hospital • www.moghulmedical.co.uk • (private sec. 02380 877524)

39. Dementia – everything you need to know but were afraid to ask Dr. Shehram Moghul Consultant in OPMH Liaison Psychiatry Southampton General Hospital