24 - Dementia

Question 1

Is dementia a disease in its own right?

Answer 1

No, umbrella term for lots of different conditions. Does not affect the brain uniformly.

Question 2

What is dementia?

Answer 2

• Syndrome due to disease of the brain

- Chronic /progressive

Question 3

What characterises dementia?

Answer 3

Deterioration in intellectual functioning, social behaviour, emotional functioning.

Disturbance of multiple higher cortical functions:
- Decline in memory, thinking, learning capacity, judgement

Consciousness is not clouded.

Question 4

What are the most common dementia syndromes?

Answer 4

Alzheimer’s disease - 62%

Vascular dementia - 17%

Mixed dementia (AD & VaD) - 10%

Dementia with Lewy bodies - 4%

Fronto-temporal dementia - 2%

Parkinson’s dementia - 2%

Other dementias - 3%

Question 5

What characterises ‘mild’ dementia?

Answer 5

Cognitive decline limits functional activities but independent living is possible

Question 6

What characterises ‘moderate’ dementia?

Answer 6

Seriously inhibited functional activity. Familiar material retained but independent living not possible.

Question 7

What characterises ‘severe’ dementia?

Answer 7

Complete inability to retain new info. Assistance required for all daily living activities. Very limited communication

Question 8

What is demography?

Answer 8

The study of statistics such as births, deaths, income, or the incidence of disease, which illustrate the changing structure of human populations.

Question 9

What is correlation between learning disabilities and dementia?

Answer 9

Increased risk of dementia in learning disabilities (e.g. Down’s Syndrome)

Question 10

How many people are currently living with dementia in UK?

Answer 10

Around 885,000 people

- 2/3 are women

Question 11

What was Kitwood’s ‘Enriched Model of Dementia’?

Answer 11

The model of dementia care to help give best care to dementia patients.

Tom Kitwood described five overlapping psychological needs that people with dementia have, which come together in a central need for love.

Question 12

What are the 5 overlapping psychological needs of people with dementia?

Answer 12

1. Neurological impairment
2. Health and physical fitness
3. Biography / life history
4. Personality
5. Social psychology

Question 13

What is the aim for changing the views of dementia?

Answer 13

Old:

• Disease
• CT scans
• ‘us and them’
• Living death
• Problem behaviours

New:

• Disability
• Care plans
• ‘all of us’
• Living well
• Communication

Question 14

What is vascular dementia caused by?

Answer 14

Multiple mini strokes

Question 15

What was Kitwood’s idea of ‘personhood’?

Answer 15

A standing or status that is bestowed upon one human being, by others, in the context of relationship and social being. It implies recognition, respect and trust

Kitwood claimed that personhood was sacred and unique and that every person had an ethical status.

Question 16

What was the PM’s five year challenge in 2015 for dementia?

Answer 16

Commitments broken into 4 themes:

1. Risk Reduction / Prevention
2. Research (cure or disease-modifying)
3. Health and care delivery quality (workforce training)
4. Dementia awareness and social action

Question 17

How do acetylcholinesterase inhibitors work?

Answer 17

Inhibit acetylcholinesterase enzyme from breaking down ACh, increasing level and duration of neurotransmitter

Question 18

What are examples of acetylcholinesterase inhibitors?

Answer 18

Donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl)

Question 19

How can acetylcholinesterase inhibitors ease dementia symptoms?

Answer 19

May temporarily improve memory

Used in mild to moderate Alzheimer’s disease

Question 20

What drugs can be used to manage Alzheimer’s?

Answer 20

• Acetylcholinesterase inhibitors (mild - severe)

- NMDA receptor antagonist (moderate - severe)

Question 21

How do NMDA receptors usually work?

Answer 21

NMDA allows glutamate to connect to a cell which passes calcium into the cell, carrying the electrical or chemical signal. This is important for learning and memory.

Question 22

How can NMDA receptor antagonists be used to manage Alzheimer’s?

Answer 22

If you have Alzheimer’s disease, your cells can make too much glutamate. When that happens, the nerve cells get too much calcium, and that can speed up damage to them. NMDA receptor antagonists help to oppose NMDA receptor actions.

Question 23

What are side effects of antipsychotics in dementia?

Answer 23

Increased stroke risk, increased cardiovascular risk, Parkinsonian side effects, falls, additional deaths

Question 24

Does the UK place a greater emphasis on home or state care for dementia?

Answer 24

Greater individual or family support with around 64% of people with dementia living at home

Question 25

What is the social model of disability?

Answer 25

The social model of disability is a way of viewing the world which says that people are disabled by barriers in society, not by their impairment or difference.

Question 26

How can the social model of disability be used to improve dementia care?

Answer 26

• Person-centred care (individualised plans, perspective of person with dementia)
• Dementia friends
• Dementia-friendly communities (increased knowledge and awareness)