MAINTAIN YOUR BRAIN DEMENTIA SEMINAR WEDNESDAY 14 AUGUST 2019 - - PowerPoint PPT Presentation

MAINTAIN YOUR BRAIN – DEMENTIA SEMINAR

WEDNESDAY 14 AUGUST 2019

DEMENTIA SEMINAR

OBJECTIVES:

• Provide information on dementia, diagnosis, treatment, research

and support services available;

• To promote active and healthy ageing and enhanced wellbeing;
• Promote early life-planning and the benefits for maintaining

independence and choice;

• To promote life-long learning; and
• To strengthen neighborhood connections and promote a

dementia–friendly community.

DEMENTIA SEMINAR

Time Item Organisation Person

9.30 - 9.35am Welcome and introduction Sutherland Shire Council Clr Steve Simpson 9.35 - 10.15am What is dementia, different types, symptoms and experiences Process of diagnosis for dementia Medical treatment available for dementia How to slow the progression of dementia Southcare Geriatricians Dr Nyein Nyein Nyi Nyi 10.15 - 10.30am Personal story of dementia Elaine Reynolds 10.30 - 11.15am Understanding dementia and memory loss How to reduce your risk of developing dementia and delay the

• nset of the disease

Living a brain healthy lifestyle Research into dementia and new treatments available Brain and Mind Centre, University

• f Sydney

Dr Catriona Ireland 11.15 - 11.40am Morning Tea 11.40am - 12pm Where to go for help and services Dementia Australia support services Dementia Australia Libby Palmer 12 - 12.25pm Brain training and its role to improve cognition and memory and to reduce the risk of dementia The Memory Workout: practical and fun brain training exercises for the audience to experience first-hand Neuroscience Research Australia Dr Kylie Radford 12.25 - 12.30pm Wrap up, service browsing and Evaluation Forms Sutherland Shire Council Jayne Gan

How do we diagnose dementia? Why do we even bother?

Dr Nyein Nyein Nyi Nyi Geriatrician Southcare, Sutherland Hospital

What is dementia?

 Disease

 Not a normal part of ageing  More common with age

 Neurodegenerative disorder

 Exact cause unknown in many cases  Progressive  Gradual decline  Variable rate

What is dementia?

 ‘Progressive decline in brain function’

 Memory impairment  Speech impairment  Judgement and planning skills  Ability to carry out daily functions  Bowel and bladder control  Walking and swallowing

 Affects daily life

What is the difference between dementia and Alzheimer’s disease?

 Dementia

 Describes someone with a progressive cognitive decline  Many illnesses cause dementia

 Alzheimer’s disease is the most common cause of dementia  Other causes of dementia

 Vascular dementia (‘Multi-infarct dementia’)  Lewy Body disease  Mixed ( Alzheimer’s disease and vascular disease)  Fronto-temporal dementia, alcohol related, sport/trauma

related.....

How do we diagnose dementia?

 History  Cognitive tests  Physical examination  Blood tests, rarely lumbar puncture  Brain scans

 CT scan  MRI scan  Nuclear medicine scans

History

 Story of the patient’s symptoms and signs  Specific problems and concerns

 Short term memory impairment, word finding difficulties,

disorientation, difficulty driving, hallucinations,....

 Story from the patient and the family

 Patients often are not aware of their problems

 MOST IMPORTANT AND HELPFUL PART OF THE

REVIEW

How do we diagnose dementia?

 Memory tests

 Mini-mental state examination  Montreal cognitive assessment, ADAS-Cog  Neuropsychological assessments

 Physical examination

 Strokes, Parkinson’s disease

 Blood tests

 Vitamin B12, Folate, thyroid function

 Brain scans

How do we diagnose dementia?

 No definitive blood tests or scans to diagnose the

different dementias (yet )  Help to confirm or exclude our clinical assessment  “brain biopsy”

 Clinical diagnosis

 Assess each patient individually

 “pattern recognition”

 Is it dementia?  What type of dementia?

Alzheimer’s disease

 Short-term memory impairment

 Repeat same statements and questions  Disoriented to time, place  Other symptoms manifest later

 Slow, gradual, steadily progressive

decline

 Physical exam normal  Brain scan shows “atrophy”- shrinkage

Vascular dementia

 History of strokes, high blood pressure  Stepwise deterioration  Poor judgement with relatively preserved

memory

 Physical and brain scan evidence of

previous strokes

Lewy body disease

 Cognitive impairment  Parkinsonian features

 Tremor, impaired walking

 Hallucinations, paranoia, delusions  Significant fluctuations

Frontal lobe dementia

 Short term memory well preserved  Change in personality  Poor insight, poor planning  Disinhibited  Brain scan may support diagnosis

Why do we bother diagnosing dementia?

 You may NOT have dementia  Anxiety due to family history of dementia  Other conditions can mimic dementia

 Depression  Sleep apnoea  Poorly controlled diabetes  Electrolyte and hormonal disturbances,...

 These need appropriate treatments

Why do we bother diagnosing dementia?

 Explanation for the symptoms and

changes

 Knowledge and education  You are not “stupid”, you are forgetful

 Know that you are not alone facing these

challenges

 Other patients and carers  Community support  Dementia Australia

Why do we bother diagnosing dementia?

Plan for the future

Will Enduring power of attorney Enduring guardianship Living accommodations Travel and lifestyle decisions

Treatments for dementia

 There is no cure YET  Medications to slow down the progression of

dementia

 Acetyl-choline cholinesterase inhibitors  Galantamine/Reminyl  Donepezil/Aricept  Rivasigmine patch/Exelon  Memantine/Ebixa  Helpful for variable amount of time

Medications for dementia

 Not miracle cures  Slow down the progression of symptoms

 Maintain independence longer  Short-term memory same  Concentration better  Improve word finding difficulties

 Side-effects

Treatments for dementia

 Symptomatic treatments

 Depression and anxiety  Hallucinations, paranoia and delusions  “Sundowning” with agitation,

aggression

 Insomnia, altered day-night cycle

Treatments for specific types

• f dementia

 Alzheimer’s disease

 Acetylcholine esterase inhibitors  Memantine

 Lewy body disease

 Rivastigmine patch

 Vascular dementia

 Prevent further strokes

 Frontal lobe dementia

 Forward planning

Treatments for dementia

 To slow down progression of

disease:

 Physical exercise  Socialising  Keeping active and busy  Maintain good physical health

Southcare “One stop shop in Aged Care”

 Medical/ Geriatricians

 8 Geriatricians  Out-patient clinics at Southcare  Acute in-hospital care  Acute assessment in Sutherland Hospital

Emergency Department

 In-patient care  Behavioural unit  Rehabilitation  Orthogeriatric service  Medical consultations

Southcare

 Mobility clinic  Individual physiotherapy assessments  Occupational therapy  Podiatry  Dietician  Continence nurses

Southcare

 Aged Care Assessment Team (ACAT)

 My Aged Care

 Aged care facility liason  Community nurses  Dementia Home Monitoring  Community options

Southcare

 The Cottage (Dementia Day Care)  The Retreat (Frail Aged Day Care)  Pulmonary Rehabilitation gym  Sutherland Heart-lung team (SHALT)  Sutherland transitional care (STACS)  Equipment lending pool

Southcare

 Geriatric Flying Squad

 Treat acute medical problems in the nursing homes)

 Southcare Outreach Service (SOS)

 Acute issues at home

 Southcare : 9540 7175  Geriatrician’s office: 9540 7109

DEMENTIA SEMINAR

Elaine Reynolds

Personal Story living with Dementia

“Sometimes I wonder if people think I am contagious

• r I have lost my power of speech because of the

dementia.” “This is why I am becoming more passionate about trying to speak for people with dementia and making it not taboo. I would like to see the stigma removed and people to be able to openly discuss dementia. “I have dementia, but I also have a life! I keep busy and engaged and doing everything I can to keep my mind active.”

HEALTHY BRAIN AGEING

UNDERSTANDING MEMORY LOSS AND HOW TO REDUCE THE RISK OF DEMENTIA DR CATRIONA IRELAND BRAIN AND MIND CENTRE, SYDNEY UNIVERSITY

UNDERSTANDING MEMORY LOSS AND DEMENTIA

• What is normal as we age?
• What might affect memory that isn’t dementia?
• When should someone see the doctor about their brain

function?

NORMAL AGEING

• Occasionally losing things, forgetting appointments or being unsure

why you went into a room

• Occasional “Tip of tongue” word finding troubles, blanking on a name
• r calling your children by the wrong names…or the dog’s name!
• Needing a little more time to think through a route
• Being a little more distractible and less able to multi-task
• More trouble learning new things
• Slower processing and reaction times

WHAT CAN AFFECT MEMORY

• Illness
• Delirium
• Being too overloaded or too bored
• Stress, anxiety and depression
• Poor sleep, diet, exercise
• Medications

WHEN TO SEE THE DOCTOR

• You are concerned or someone else has expressed concerns
• Progressive problems
• Function getting difficult
• Not aware of forgetting
• Getting lost
• Unable to communicate like before
• Strange things!

WHAT IS DEMENTIA

• Gradual and Progressive changes in memory and thinking

skills

• Function is no longer independent
• Can be just language or just altered behaviour with

normal memory

• Can be young but rare

WHAT CAUSES DEMENTIA

• Alzheimer’s Disease
• Vascular disease
• Frontotemporal dementia
• Lewy Body Dementia
• Rare things

WHAT CAUSES DEMENTIA

• Neurodegeneration in excess of neuroregeneration
• Vascular- many
• Inflammation
• Metabolic
• toxicity

RISK REDUCTION

• WHO May 2019
• Victorian policy paper July 2019
• Central is the need for multiple factors to be addressed
• Benefits extend well beyond dementia reduction and many are

immediate

• Significant overlap with risk reduction strategies for heart disease,

stroke, cancer, falls, chronic lung disease- as 2nd most feared diagnosis this may motivate!

• Individualised to health, availability, acceptability etc
• A process over time- needs patience, perseverance and help

RISK REDUCTION

• 30% of cases of dementia could be prevented or

delayed

• Massive cost savings
• Massive personal, family and community opportunity

EDUCATION

• Stay at school
• Keep learning in all sorts of ways throughout life
• Take care at work
• Take care at retirement
• Remember the brain likes novelty and challenge…and fun!

SMOKING

• Don’t smoke!!
• Get help to quit

PHYSICAL INACTIVITY

• Exercise has endless benefits- we are designed to move!
• Neurotrophic factors are released by adequate exercise
• Vascular benefits
• Weight management
• Less cancer, depression, diabetes etc
• Reduces falls and frailty

EXERCISE PRESCRIPTION

• Check with doctor if unsure
• Find the best options (accessible, affordable, fun, social,

involves a skill, variety) and aim to include both aerobic and strength training

• Build up slowly to avoid inflammation or injury…but do

build up!

• Listen to your body
• Aim for at least 150 minutes of moderate intensity week

GOOD MENTAL HEALTH

• Good physical health and sleep
• Engagement in things you care about
• Relationships and activities that nourish
• Healthy thinking and stress management
• Talk to your doctor if concerned

HIGH BLOOD PRESSURE, DIABETES AND OBESITY

• Lifestyle and genetics
• Exercise
• Diet
• Early intervention…so health checks for cardiovascular

risk assessment

• These things affect the blood supply and metabolism of

the brain as well as contributing to low grade inflammation

DIET

• Mediterranean diet
• Social factors
• Weight loss in later life
• Hydration
• Alcohol
• What about the gut-brain connection?

SLEEP

• Ideally 7-9 hours
• Napping?
• Sleep Apneoa and other things that disturb sleep
• Things that help sleep
• Watch caffeine and alcohol
• Don’t take sleeping pills (but don’t stop them suddenly if

you do)

HABIT CHANGE

• What is one thing I can do easily
• Or am I up for a complete overhaul?
• What do I already do that is healthy
• What are my biggest issues affecting my health or

happiness

• Who can support me/what are my resources
• How have I succeeded before

RESEARCH

• Media coverage
• Lots of research into many possible treatments, some in

advanced trial stages

• Still waiting…but hopefully
• Keep main focus on living a cognitively healthy lifestyle
• Get linked into a clinic

DEMENTIA SEMINAR

Morning Tea Break

20 minutes

UPCOMING SENIORS EVENTS

Caring for Carers Workshop Friday, 27 September, 10am – 2pm Bookings essential. Tel: 9542 6292 Seniors in Shorts – Short-film Festival Friday, 4 October, 5.30 – 8.30pm GU Filmhouse Cronulla Bookings essential. www.sutherlandshire.nsw.gov.au/seniorsinshorts Walk the Walls – Seniors Wall November 8, 9, 10 Munroe Park, Cronulla Seniors Christmas Concert Friday, 29 November, 1:30 – 4.15pm Sutherland Entertainment Centre Tickets $15. Bookings essential. Tel: 9521 8888

OUR SERVICES

THE MEMORY WORKOUT

Acknowledgements: Exercises based on Making The Most of Your Memory: An Everyday Memory Skills Program, published by the Australian Society for the Study of Brain Impairment

Image source: https://s3-eu-west-1.amazonaws.com/application-clc/eie1.jpg

Dr Kylie Radford

Clinical Neuropsychologist & Research Fellow, NeuRA

ENCODING Getting the information IN

Our memory capacity is limited – we can never take in all the information! Can be affected by:

• attention
• arousal level
• mood
• sensory/perceptual

abilities

• brain function

STORAGE Holding on to the information

Levels of retention:

• seconds
• following distraction
• hours, days, years

(short-term & long- term memory) Can be affected by:

• intervening events
• brain function

RETRIEVAL Getting the information OUT (remembering)

Aspects of retrieval:

• remembering

information correctly

• remembering to do

something at the right time Can be affected by:

• effort
• cues/prompts
• brain function

Lifestyle & other factors

• Sleep
• Stress and depression
• Alcohol and some medications
• Physical activity

MAKING THE MOST OF YOUR MEMORY

External Aids

• Calendars
• Lists
• Alarms/reminders
• Routine

MAKING THE MOST OF YOUR MEMORY

Internal strategies

• Imagery
• Association
• Rehearsal
• Spaced Retrieval

MAKING THE MOST OF YOUR MEMORY

• 1. Story Method
• 1. Chunking & clustering
• 1. Method of Loci

EXERCISE

Try to memorise these pictures by making up a story that involves each item

Write down as many of the items as you can remember

How did you go?

STORY METHOD

• You connect the different pictures so

that recalling one of them helps you to recall several others

• Elaboration (making up a story,

visualising, imagination, etc.) utilises more of your brain

Try to remember this list by finding ways of categorising or grouping the words together…

• Spanner
• Reflect
• Cow
• Overalls
• Shift
• Purse
• Pout
• Daisy
• Swim
• Mushroom
• Stirrup
• Roast
• Hook
• Sunglasses
• Barramundi
• Bucket

Count backwards from 100 by 3s… 100, 97, 94...

Write down as many of the words from the list as you can remember

How did you go?

Spanner Reflect Cow Overalls Shift Purse Pout Daisy Swim Mushroom Stirrup Roast Hook Sunglasses Barramundi Bucket

CHUNKING & CLUSTERING

• Less is more… reduce the load on

memory by finding ‘links’ between items

• Easier to remember a few categories than

lots of individual items!

• Later, use categories to prompt your

memory for the items

METHOD OF LOCI

• Often mentally retrace our steps to help us

remember things

• Method of Loci (Journey Method): visualise a

familiar location and associate information with various landmarks

• Use your own home – select 10 or so familiar

locations on a route through the house or apartment

• It doesn’t have to be your own home but it must be

somewhere very familiar to you

Shopping List:

• Lettuce
• Ice cream
• Cat food
• Spaghetti
• Fish
• Corn flakes
• Broccoli
• Bin liners
• Detergent
• Orange juice

Take a minute to picture yourself leaving the house and travelling to the supermarket…

Write down as many items from the list as you can

How did you go?

• 1. Lettuce
• 2. Ice cream
• 3. Cat food
• 4. Spaghetti
• 5. Fish
• 6. Corn flakes
• 7. Broccoli
• 8. Bin liners
• 9. Detergent

10.Orange juice

METHOD OF LOCI

• What do you think of this method?
• What sort of mental techniques are

involved here?

• Evidence that practicing this technique

can change the brain

DEMENTIA PREVENTION?

• Cognitive challenges important
• ACTIVE Trial of cognitive training – some

persisting benefits 10 years later (but not for memory training)

• Computerized brain training
• Don’t forget: social & physical activity

USEFUL LINKS

• Dementia Australia: www.dementia.org.au
• Southcare: https://www.seslhd.health.nsw.gov.au/sutherland-hospital/services-

clinics/directory/southcare-aged-and-extended-community-care

• Brain and Mind Centre: http://sydney.edu.au/brain-mind
• Neuroscience Research Australia: https://www.neura.edu.au
• My Aged Care: http://www.myagedcare.gov.au
• Sutherland Shire Council: www.sutherlandshire.nsw.gov.au/Community/Community-

Support-Services/Seniors

• For More Information

Community Services - Sutherland Shire Council Tel: 9710 0333 Email: communities@ssc.nsw.gov.au Website: www.sutherlandshire.nsw.gov.au

• Seniors Reference Group volunteers
• Community organisations for the amazing work you do
• For participating in this seminar we hope the

information was helpful

• For filling in your Evaluation Form!

DEMENTIA SEMINAR