24 - Dementia Flashcards
Is dementia a disease in its own right?
No, umbrella term for lots of different conditions. Does not affect the brain uniformly.
What is dementia?
- Syndrome due to disease of the brain
- Chronic /progressive
What characterises dementia?
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.
What are the most common dementia syndromes?
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%
What characterises ‘mild’ dementia?
Cognitive decline limits functional activities but independent living is possible
What characterises ‘moderate’ dementia?
Seriously inhibited functional activity. Familiar material retained but independent living not possible.
What characterises ‘severe’ dementia?
Complete inability to retain new info. Assistance required for all daily living activities. Very limited communication
What is demography?
The study of statistics such as births, deaths, income, or the incidence of disease, which illustrate the changing structure of human populations.
What is correlation between learning disabilities and dementia?
Increased risk of dementia in learning disabilities (e.g. Down’s Syndrome)
How many people are currently living with dementia in UK?
Around 885,000 people
- 2/3 are women
What was Kitwood’s ‘Enriched Model of Dementia’?
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.
What are the 5 overlapping psychological needs of people with dementia?
- Neurological impairment
- Health and physical fitness
- Biography / life history
- Personality
- Social psychology
What is the aim for changing the views of dementia?
Old:
- Disease
- CT scans
- ‘us and them’
- Living death
- Problem behaviours
New:
- Disability
- Care plans
- ‘all of us’
- Living well
- Communication
What is vascular dementia caused by?
Multiple mini strokes
What was Kitwood’s idea of ‘personhood’?
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.
What was the PM’s five year challenge in 2015 for dementia?
Commitments broken into 4 themes:
- Risk Reduction / Prevention
- Research (cure or disease-modifying)
- Health and care delivery quality (workforce training)
- Dementia awareness and social action
How do acetylcholinesterase inhibitors work?
Inhibit acetylcholinesterase enzyme from breaking down ACh, increasing level and duration of neurotransmitter
What are examples of acetylcholinesterase inhibitors?
Donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl)
How can acetylcholinesterase inhibitors ease dementia symptoms?
May temporarily improve memory
Used in mild to moderate Alzheimer’s disease
What drugs can be used to manage Alzheimer’s?
- Acetylcholinesterase inhibitors (mild - severe)
- NMDA receptor antagonist (moderate - severe)
How do NMDA receptors usually work?
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.
How can NMDA receptor antagonists be used to manage Alzheimer’s?
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.
What are side effects of antipsychotics in dementia?
Increased stroke risk, increased cardiovascular risk, Parkinsonian side effects, falls, additional deaths
Does the UK place a greater emphasis on home or state care for dementia?
Greater individual or family support with around 64% of people with dementia living at home
What is the social model of disability?
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.
How can the social model of disability be used to improve dementia care?
- Person-centred care (individualised plans, perspective of person with dementia)
- Dementia friends
- Dementia-friendly communities (increased knowledge and awareness)
