Dementia Flashcards
What are the attitudes and language which categorise ageism?
- ugly and useless
- an elder vs. the elderly
- grey hordes
- plague of wrinkles
What is ageism?
prejudice or discrimination on the grounds of a person’s age
If you ask someone what they are most worried about in later life, how does this vary to if you asked someone over 65 what they were most worried about?
A younger person says that they are most worried about cancer
Someone over 65 will say that they are most worried about dementia
Why is dementia not described as a disease?
It is a causal condition
There is an underlying pathology that leads to dementia
How does dementia affect an individual and the brain?
It causes a deterioration in intellectual functioning and social behaviour
It does NOT affect the brain uniformly
How does ICD-10 define dementia and its nature?
It is a syndrome due to disease of the brain
It is chronic or progressive in nature
According to ICD-10, how does dementia affect the brain?
There is disturbance of multiple higher cortical functions
e.g. decline in memory, thinking, learning capacity, judgement
According to ICD-10, how does dementia affect consciousness and emotion?
Consciousness is not clouded
Dementia is accompanied by deterioration in emotional control, social behaviour or motivation
what are the different dementia syndromes and how many cases do they account for?
Alzheimer’s disease - 62%
Vascular dementia - 17%
Mixed dementia (AD and VaD) - 10%
Dementia with Lewy bodies - 4%
Fronto-temporal dementia - 2%
Parkinson’s dementia - 2%
Other dementias - 3%
What are the characteristics of mild dementia?
Cognitive decline limits functional activities but independent living is possible
What are the characteristics of moderate dementia?
There is seriously inhibited functional activity
Familiar material is maintained but independent living is not possible
What are the characteristics of severe dementia?
Complete inability to retain new information
Assistance is required for all daily living activities
There is very limited communication
How many people in the UK have dementia?
How many of these are under 65?
850,000 people in the Uk have dementia
42,000 are under 65
What proportion of dementia patients are female?
Why?
2/3 of people with dementia are female
This is because women live longer than men
What proportion of people in care homes have dementia?
2/3 of people in care homes have dementia
Which group of people have an increased risk of developing dementia?
People with learning disabilities
e.g. Down’s syndrome
What is Kitwood’s enriched model of dementia?
it articulates what dementia means by formulating a mathematical hypothesis
It shows how dementia affects all aspects of a person’s life
What is Kitwood’s equation for the enriched model of dementia?
Dementia = NI + H + B + P + SP
NI - neurological impairment
H - health/physical fitness
B - biography, life history
P - personality
SP - social psychology
What is the old view of dementia?
Dementia is a disease that can only be confirmed through CT scans
“us and them” approach saw patients as the “living dead”
What is the modern view of dementia?
Dementia is a disability
Care plans are made to put the patient at the centre of their care
Most people are living well in the community
What model does the modern view of dementia follow?
The social model of disability
Why is it difficult to determine the onset of dementia?
The onset is very subtle
It is only after diagnosis that someone may be able to recognise some of the behaviours that may have signalled dementia
Why is dementia often under-detected?
There is a symptom under-reporting as people don’t attend GP surgeries over minor symptoms
They also have a lack of self-awareness
What is the underlying change in dementia?
A gradual loss of self or ‘personhood’
What is meant by “personhood”?
A status that is bestowed upon one human being, by others, in the context of relationship and social being
It implies recognition, respect and trust
What are the signs and symptoms of dementia relating to memory?
- struggling to remember recent events, but recalling things from the past
- forgetting the names of friends or everyday objects
- other people commenting on your forgetfulness
- repeating yourself or losing thread of what you are saying
- feeling anxious, depressed or angry about forgetfulness
What are the other symptoms and signs of dementia?
- finding it hard to follow a conversation or TV programme
- problems with thinking and reasoning
- a decline in the ability to talk, read or write
- confused even when in a familiar environment
What were the 4 areas of focus in the PM’s 5-year challenge of 2015?
- prevention - healthy living for all
- quality - care across the disease pathway
- research - cure or disease-modifying
- social action - employers, carers
What is the NHS’s approach to dementia?
They have the “well pathway” for dementia
What are the 5 aspects of the well pathway for dementia?
- preventing well
- diagnosing well
- supporting well
- living well
- dying well
What are the 2 main pharmacological treatments for dementia?
- acetylcholinesterase inhibitors
2. NMDA receptor antagonist (glutamate)
What are examples of acetylcholinesterase inhibitors?
What are the effects of this drug?
What type of Alzheimer’s disease does it treat?
donepezil, rivastigmine, galantamine
They may temporarily improve memory
Used for mild to moderate Alzheimer’s disease
What is an example of an NMDA receptor antagonist?
What type of dementia are they used to treat?
Memantine
It is used in moderately severe to severe Alzheimer’s disease
What other types of drugs are used for treating dementia?
Drugs for the problems associated with dementia
e.g. depression, behaviour problems (restlessness, aggression)
What is the outline of the Banerjee report?
There is an overuse of antipsychotics in dementia
They are NOT licensed for use in dementia
They make unruly patients much more manageable and placid
What are the side effects of using antipsychotics in dementia?
Side effects are greater in older people
- increased stroke risk
- increased cardiovascular risk
- Parkinsonian side effects
How many people in nursing homes with dementia are antipsychotics?
20-30% of people in nursing homes with dementia are on antipsychotics
This is inappropriately
How much does dementia cost the UK a year?
How much of this cost falls to the state?
£26.3 billion a year
1/3 of the costs are paid by the state, the other 2/3 must come from the patient and their family
Approximately what % of people with dementia live at home?
64%
What are the 4 main positive aspects of care-giving?
- reciprocity and mutual affection (returning partners past care)
- companionship
- job satisfaction
- sense of duty
How does the social model of disability relate to dementia care?
Person-centred care
This involves individualised plans form the perspective of the person with dementia
