Module 2

1. Module 2 Understanding dementia

2. This module covers: 2.1 How does our brain work? 2.2 What is the condition of dementia? 2.3Alzheimer’s Disease and other diseases 2. Understanding dementia

3. Learning outcomes At the end of this module you will be able to • Explain what the condition of dementia is • Identify the main conditions that cause dementia • Identify common changes as dementia progresses • List the common types of dementia • Explain the link between brain changes and changes in the person’s behaviour and abilities • Identify common changes as dementia progresses • Describe the impact of dementia can have on a person and discuss the uniqueness of people living with dementia.

4. Our brain linked to our behaviour Our brain is divided into parts Chemical messages between our brain cells and to and from our brain cells to parts of our body Later … What happens if brain affected by diseases or trauma? 2.1 How does our brain work?

5. Our brain is divided into parts Parietal Lobe Patterns e.g. language, arithmetic, everyday tasks Frontal Lobe Planning, insight, learning, interpretation, behaviour Temporal lobe Memory Limbic region Sleep, appetite, emotions

6. Nerve cell body Synaptic terminal Axon Dendrites Healthy brain cell (neuron) How does the brain work at themicroscopic level?

7. Our brain ages as we age. Our memory may not be as good and we may not remember things as quickly or accurately We still manage our lifestyle and have the ability to think up strategies e.g. lists and reminders etc. Confusion due to dementia or major cognitive impairment is different – it disrupts lifestyles Normal healthy ageing and confusion

8. Confusion in the older person • Increased sensory impairment or loss e.g. sight and/or hearing • Anxiety and/or depression • Unfamiliar surroundings • Grief or loss (of significant person, role, ability or social function) • Medication – over, under, mix or change • Infection e.g. urinary tract infection • A full bladder, constipation, incontinence • Acute confusion - delirium

9. 2.2 What is the condition of dementia? Dementia ... • is a condition that affects the brain and causes a progressive decline in a person’s functioning over time. • Is an umbrella term for a large group of illnesses • Can be caused by one illness or a mixture of illnesses • at present, cannot be cured.

10. Physical changes to the brain Q. What are some common signs or symptoms of the condition of dementia?

11. Dementia: common changes attention memory language insight & reality emotions planning & organising physical abilities behaviour

12. How are these signs displayed individually ? Personality Progression of dementia Life experiences and narrative General health Family background Hobbies and interests Likes and dislikes Contribution to the community

13. Alzheimer’s disease – approximately 70% * Vascular disease – approximately 20% * Other illnesses – approximately 10% [* 20% - 30% mixed] There are over 60 other causes for the condition of dementia To date no medical cure for condition of dementia. What causes dementia? Remember….it is very common for the symptoms of the condition of dementia to be caused by mixtures of illnesses that affect the brain

14. Dementia statistics and current research • In 2011, there were 1500 new people in Australia with dementia each week. • That is expected to grow to 7,400 each week in 2050. • Without a significant breakthrough this number expected to go to 1 million by 2050. Alzheimer’s Australia 2011 Around 269,000 people in Australia have dementia. As Australia's population ages, more people will be affected by dementia.  Dementia is the third leading cause of death in Australia, after heart disease and stroke.

15. How common is dementia? After 65yrs of age dementia doubles every five years. Over 85 yrs of age , one in four chance of developing dementia. But remember that two out of three people over the age of 90yrs of age do not have dementia. So … dementia is not a normal part of ageing

16. Medical research Younger onset dementia Understanding how diseases form (e.g. plagues and tangles) Medications – limit progression of diseases Gene therapy, stem cell research – repair or grow new brain cells Prevention – risk factors Non –pharmacological interventions Support and education for carers and staff Validation, music, social history narrative & reminiscence Enabling environments Current research in dementia

17. Alzheimer’s disease • Lewy body disease • Alcohol-related • e.g. Korsakoff’s disease • Genetic • e.g. Huntington’s disease • Vascular dementia • Fronto-temporal dementia e.g. Pick’s disease • Parkinson’s disease • Younger onset dementia • Infection e.g. AIDS complex Dementia

18. 2.3 Alzheimer’s Disease The brain of a person with Alzheimer’s disease shows significant loss of brain cells

19. Brain cells in the memory centre of the brain become damaged i.e. develop “plaques” and “tangles” Brain cells have increasing difficulty “talking” to each other and transmitting messages effectively A loss of connection between cells Brain cells die and the brain shrinks. Alzheimer’s disease

20. Nerve cell body Synaptic terminal Axon Dendrites Healthy brain cell Sticky plaques form around nerve endings Tangles appear in the cell body Damaged brain cell will eventually die What happens to the the brain at themicroscopic level?

21. Normal brain section (viewed from above) Brain damage in Alzheimer’s Disease Brain section damaged by Alzheimer’s Disease (viewed from above) Slides courtesy of Duke University Medical Centre, Durham, North Carolina

22. Damage caused by collapse of blood vessels (tiny strokes) which interrupt blood supply to the brain cell and causes brain cell to die These tiny strokes accumulate over time Symptoms depend on where tiny strokes occur in the brain Also known as “multi-infarct” dementia i.e. many ‘dead’ brain cells Vascular dementia

23. Combination of Alzheimer’s disease and Vascular dementia Lewy body disease Fronto-temporal dementia e.g. Pick’s disease Alcohol related dementia e.g. Korsakoff’s Infections that affect the brain e.g. HIV/ AIDS complex, ‘Mad cow disease’ (CJD) Younger people with dementia Other causes of dementia

24. Younger people with Dementia Dementia can also occur in younger people ‘Younger onset dementia’ refers to people aged under 65 who are living with dementia Today, in Australia 15,000 people (estimated) and projected to rise more than 19,000 by the year 2020. (Access Economics 2009)

25. The symptoms of dementia become worse over time How quickly it gets worse varies from person to person Abilities tend to fluctuate from day to day … like a faulty light switch Some parts of the brain might be unaffected for many years …what can the person still do and still enjoy? Older people with dementia commonly have multiple health problems Progression of dementia

26. How is dementia diagnosed? • A proper diagnosis is very important • A screening process to rule out other causes: • Review of changes over time • Medical history • Physical check-up • Cognitive tests e.g. Mini mental exam • Hard to pinpoint when it starts (gradual onset; denial)

27. Remember – depression and delirium? • Dementia  • Depression or anxiety • Delirium = acute confusion 3 D’s – Dementia, Depression, Delirium

28. Intense or prolonged feelings of unhappiness Older people are particularly prone to depression because of a range of life events including: physical illness isolation, chronic pain, bereavement and loss (e.g. moving to residential aged care). Signs or changes Can be mistaken for physical illness. Supporting people who are depressed Depression

29. A ‘sudden’ state of severe confusion, often with hallucinations and physical agitation Delirium has a cause – and will not improve until the cause is treated. People with existing brain damage such as dementia are at increased risk of delirium Delirium is treatable Symptoms Possible causes Supporting people with delirium Delirium

30. Not all confusion is caused by the condition of dementia The condition of dementia is caused by different illnesses that affect the brain Dementia is progressive but some skills can be retained for quite a while Dementia is not a normal part of ageing Key Messages REMEMBER…We cannot change the progression of dementia but we can change the way we respond to the unique person behind the disease

31. “The doctor said my friend has Alzheimer’s disease. I’m glad it’s not dementia!” True or False “If you’ve seen one person with dementia you’ve seen them all” True or False “All old people eventually become senile” True or False “People with dementia would do better if they just tried harder” True or False “Once someone has dementia it’s important to take over and do everything for them” True or False “Not every older person will get dementia.” True or False What do you think?