Case 4: Dementia Flashcards
which form of dementia is the most common and what percentage is it?
60-70%, alzheimers
definition of dementia
Dementia is a syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing.
hallmarks of dementia
It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.
symptoms of early stage of dementia
forgetfulness
losing track of the time
becoming lost in familiar places.
symptoms of middle stage of dementia
becoming forgetful of recent events and people’s names
becoming lost at home
having increasing difficulty with communication
needing help with personal care
experiencing behaviour changes, including wandering and repeated questioning.
symptoms of late stage dementia
becoming unaware of the time and place
having difficulty recognizing relatives and friends
having an increasing need for assisted self-care
having difficulty walking
experiencing behaviour changes that may escalate and include aggression.
what are the major forms of dementia
Alzheimers. Other major forms include vascular dementia, dementia with Lewy bodies (abnormal aggregates of protein that develop inside nerve cells), and a group of diseases that contribute to frontotemporal dementia (degeneration of the frontal lobe of the brain). The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
how many people have dementia worldwide?
50 million
what percentage of people with dementia live in middle and low class countries?
60%
every year, how many new cases of dementia are there?
Every year, there are nearly 10 million new cases.
Estimated proportion of general population aged 60 and over
The estimated proportion of the general population aged 60 and over with dementia at a given time is between 5-8%.
How many people are projected to have dementia in 2030 and 2050?
The total number of people with dementia is projected to reach 82 million in 2030 and 152 in 2050.
principle goals for dementia care
early diagnosis in order to promote early and optimal management
optimizing physical health, cognition, activity and well-being
identifying and treating accompanying physical illness
detecting and treating challenging behavioural and psychological symptoms
providing information and long-term support to carers.
risk factors for dementia
age exercise smoking depression alcohol weight diet blood cholesterol blood sugar blood pressure low educational attainment social isolation cognitive inactivity
global societal cost of dementia
1.1% of global gross domestic product (GDP)
what are the negative ways of treating dementia in some countries?
In many countries, physical and chemical restraints are used extensively in care homes for older people and in acute-care settings, even when regulations are in place to uphold the rights of people to freedom and choice.
what is mild cognitive impairment?
Mild cognitive impairment (MCI) is a condition in which someone has minor problems with cognition - their mental abilities such as memory or thinking. In MCI these difficulties are worse than would normally be expected for a healthy person of their age. However, the symptoms are not severe enough to interfere significantly with daily life, and so are not defined as dementia. In some people, MCI is a pre-dementia condition.
what percentage of people over the age of 65 have MCI?
It is estimated that between 5 and 20% of people aged over 65 have MCI. It is not a type of dementia, but a person with MCI is more likely to go on to develop dementia.
symptoms of MCI?
memory - for example, forgetting recent events or repeating the same question
reasoning, planning or problem-solving - for example, struggling with thinking things through
attention - for example, being very easily distracted
language - for example, taking much longer than usual to find the right word for something
visual depth perception - for example, struggling to interpret an object in three dimensions, judge distances or navigate stairs.
Differences between MCI and normal ageing?
Most healthy people experience a gradual decline in mental abilities as part of ageing. In someone with MCI, however, the decline in mental abilities is greater than in normal ageing. For example, it’s common in normal ageing to have to pause to remember directions or to forget words occasionally, but it’s not normal to become lost in familiar places or to forget the names of close family members.
What can sometimes be causing symptoms of MCI?
Some people with MCI will turn out to have a different, often treatable, cause following assessment by a doctor. This could include depression, anxiety or stress. The same symptoms could also be caused by a physical illness (such as constipation, infection), poor eyesight or hearing, vitamin or thyroid deficiencies, or the side effects of medication. Where this is the case, the person will be diagnosed with this condition – a thyroid deficiency or depression, for example – rather than MCI.
medications for MCI
MCI is more likely to progress to dementia if the person has a poorly controlled heart condition or diabetes, or has strokes. Therefore, treatment for MCI will often include medication for any heart condition a person may have, or tablets to reduce high blood pressure, prevent clots or lower cholesterol. If depression is diagnosed this will also be treated, with medication, talking therapies or both.
ways to reduce risk of MCI
A person with MCI will also be encouraged to lower their risk of developing dementia by adopting a healthy lifestyle. People who smoke should try to stop and people who drink alcohol should keep to recommended levels. Regular physical exercise also seems to reduce the risk of dementia. Eating a healthy diet and keeping to a healthy weight may also help. Ask the GP or primary care team for advice on all of these.
It is strongly recommended that someone with MCI keeps active, both mentally (for example by doing puzzles, or reading) and socially (for example by seeing friends).
What is the assessment process for MCI?
The assessment is the same as for suspected dementia. The GP will talk to the person about their symptoms, when they started and how they are affecting their daily life now. The person will have their physical health and any medication they are taking reviewed, and take tests to assess depression and mental abilities.
The GP may be able to make a clear diagnosis at this stage, or they might need to refer the person for more specialist assessment, often at a memory service. Diagnosis may require more than one appointment and may include more detailed assessment by a psychologist. A brain scan may be done, particularly if other potential causes (for example a brain bleed or tumour) are suspected.