Dementia Flashcards
What is Dementia?
Dementia is a syndrome (collection of symptoms)– includes:
* Progressive cognitive impairment (e.g. language, numeracy, logical thinking, ability to learn, motor coordination) due to decreasing cortical function
* Particular impact on short term memory (also progressive) but can include confusion with long term memory
* Behavioural and psychological symptoms that impair social and daily functioning (Hubert, 2023)
* How is it different to normal memory loss due to age? Normal memory loss still allows people to function independently, although they may need reminders or prompts (Hubert, 2023)
* What about mild cognitive impairment? MCI is minor loss of cognitive function affecting daily life to some extent but not severely. May progress onto dementia. (Alzheimer’s Society, 2022)
How common is it?
* 50 million worldwide
* Projected to double every 20 years, especially in low and middle income countries
* Incidence may be decreasing in high income countries over time (improvements in risk factors?)
* Global costs estimated to be ~USD$1 trillion BUT actual numbers increasing due to people living longer (Livingston et al, 2020)
* Huge impact on carers and social care as well as health
* 10% >65s have dementia (Hubert, 2023)”
What causes or trigger Dementia?
Number of subtypes:
* Alzheimer’s disease (most common – ~60-70%)
* Vascular dementia
* Mixed (commonly AD and VD)
* Frontotemporal
* Lewy body dementia (~5%)
* Young onset dementia
* Parkinson’s dementia
12 modifiable risk factors make up 40% dementia causes - a lot of focus on this
Early life - Education Level
Mid-life
* Hearing loss (hearing aids protective)
* Traumatic brain injury (number and severity)
* Hypertension
* Exercise/Physical activity
* Type 2 diabetes
* Excessive alcohol consumption (minimal protective)
* Being obese
Later life
* Smoking
* Depression (reverse causation?)
* Social contact - the more the lower the risk
* Air pollution
Other factors:
* Sleep (<5 or >10hrs, longer sleep symptom?)
* Diet mixed evidence - may help through modifying CV risk factors, no particular supplements have evidence of risk reduction)
What are the signs and symptoms of Dementia?
- Memory loss/forgetfulness – particularly of recent events
- Losing track of time
- Becoming lost in familiar places
- Confusion
- Behavioural and psychological symptoms (typically later) e.g. wandering, repeated questioning, anxiety and depression
- Increasing dependency (e.g. for personal care, mobility difficulties)
- Communication difficulties
- Need for personal care support
- In later stages may have difficulty recognising friends and relatives and become unaware of time and place
What is the pathophysiology of Alzeimers and Vascular Dementia?
Pathophysiology – Alzheimer’s
* Not well understood
* Involves neurofibrillary tangles in neurones and plaques containing beta- amyloid and deficit of acetyl cholinesterase (ACh) (Hubert, 2023)
* Amyloid beta proteins accumulate as plaques in the brain HOWEVER these have also been found in normal older people – suggestion is that lower soluble amyloid beta 42 in cerebrospinal fluid is the cause of worsening brain function (Sturchio et al, 2022)
* Autoimmune role? Beta-amyloid is a substantial contributor to the brain’s immune response – suggestion of autoimmune reaction and inflammation (Meier-Stephenson et al, 2022)
Pathophysiology – vascular dementia
* Second most common type of dementia
* Typically occurs after multiple small transient ischaemic attacks or strokes
* Blood flow to brain blocked, death of some nerve cells
* Sharper declines in functioning
* Onset includes memory loss, apathy, inability to manage daily routines (Hubert, 2023)
What is conventional diagnosis and treatment for Dementia?
Diagnosis
* Memory test/assessment (usually primary care)
* Referral to specialist clinic for diagnosis
* Memory assessments, MRI, CT
Conventional treatment - pharmacological
* Acetylcholinesterase inhibitors (AChE) (donepezil, galantamine and rivastigmine) for AD -> slow decline
* Memantine in AD where moderate/severe or AChEs are contraindicated.
* Neither should be offered in frontotemporal dementia or in vascular dementia unless comorbid DLB, AD or PDD.
* Antipsychotics should be avoided where possible unless people are really distressed or at risk of harming self or others.
* Reducing cholinergic drugs – common drugs can add to anticholinergic burden at put people at risk of falls or delirium e.g. warfarin, metoprolol, furosemide (Green et al, 2019)
How can herbs/ holistic treatment help with Dementia?
- Can be a gap in support after diagnosis until start having severe care needs.
- A big postcode lottery here though – services delivered by a combination of primary care, secondary care, voluntary sector, community organisations and private sector. Particularly lacking psychological support (Frost et al, 2020).
- People may be managed by specialist memory services or primary care.
NICE (2018) recommends:
Providing:
* Wellbeing activities
* Cognitive stimulation therapy
* Carer education and support
Considering:
* Cognitive rehabilitation (functional)
* Group reminiscence therapy
NICE (2018) does not recommend:
* Acupuncture
* Herbs - but obviously we think there is to support a wide range of symptoms
* Cognitive training
* Interpersonal therapy
* Transcranial magnetic stimulation
