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Dementia Conference 2014 Guildford & Waverley Clinical Commissioning Group

Dementia Conference 2014 Guildford & Waverley Clinical Commissioning Group. Dr. Lia Ali Consultant Psychiatrist to G&W Virtual Ward. What do people with advanced dementia live with?. Behavioural & Psychiatric Symptoms (BPSD). Differing dementias. McKeith & Cummings 2005. Causes of BPSD.

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Dementia Conference 2014 Guildford & Waverley Clinical Commissioning Group

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  1. Dementia Conference 2014Guildford & Waverley Clinical Commissioning Group Dr. Lia Ali Consultant Psychiatrist to G&W Virtual Ward

  2. What do people with advanced dementia live with?

  3. Behavioural & Psychiatric Symptoms (BPSD)

  4. Differing dementias McKeith & Cummings 2005

  5. Causes of BPSD Cognitive factors Biological factors Psychological factors - Neuroanatomy - Neurochemistry - Genetics Social factors Physical factors

  6. Causes of BPSD • - Amnesia • - Agnosia • Apraxia • Aphasia • Visuoperceptual • Executive function Cognitive factors Psychological factors Biological factors Social factors Physical factors

  7. Causes of BPSD Cognitive factors Psychological factors Biological factors Social factors Physical factors • Illness • Delirium • - Pain • - Medication • Fatigue • Constipation • Basic needs (dietary, toiletry)

  8. Causes of BPSD Cognitive factors Psychological factors Biological factors Social factors Physical factors • Social network • Family relationshipsSocial interactions (caregivers, residents)

  9. Causes of BPSD Cognitive factors Psychological factors Biological factors • - Premorbid • personality • Previous mental health • Previous trauma/losses • Adjustment • Lifelong coping strategies Social factors Physical factors

  10. Causes of BPSD Cognitive factors Biological factors Psychological factors Environment Social factors Physical factors

  11. BPSD: persistent throughout disease course • Prevalence of BPSD varies at different stages of the disease process Lovheim et al., (2008) Passiveness Cognition • Earlier: • Depression • Anxiety • Psychosis • Later: • Agitation • Wandering • Apathy Severity Behavioural disturbance Time

  12. ABC chart

  13. Management – other non-pharmacological Treat the underlying cause Aromatherapy (Ballard, lemon balm) Multisensory stimulation Therapeutic use of music and/or dancing Animal-assisted therapy Massage Signage

  14. The evidence suggests for Agitation in AD If you have to prescribe a drug…. Risperidone 0.5mg bd for 6/52 Less evidence for alternative antipsychotics Quetiapine – evidence of non-efficacy Cholinesterase inhibitors and memantine – not effective acutely or in prophylaxis

  15. So in conclusion – courtesy of Prof Howard • What to do • Cholinesterase inhibitors and, to a lesser extent, memantine offer modest symptomatic benefits for cognitive symptoms at all stages • Try to avoid drug treatments for behavioural symptoms and only use the licensed agent • What not to do • Don’t raise unrealistic expectations about the impact of symptomatic cognitive treatment • Benzodiazepines generally make people with dementia worse • The fewer psychotropics the better

  16. Want to know more? IMPARTS Course Mental health skills for non-mental health professionals distressed patients; confusion/dementia; substance misuse; medically unexplained symptoms; managing conflict. 29/01/2014 and 26/02/2014 with additional e-learning Lia.ali@kcl.ac.uk MSc in Advanced Care in Dementia mscacid@kcl.ac.uk

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