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 Sutherland Shire Clr Steve Simpson Welcome and introduction Council 9.30 - 9.35am What is dementia, different types, symptoms and experiences Southcare Dr Nyein Nyein Nyi Nyi 9.35 - 10.15am Process of diagnosis for dementia Geriatricians Medical treatment available for dementia How to slow the progression of dementia 10.15 - 10.30am Personal story of dementia Elaine Reynolds Understanding dementia and memory loss Brain and Mind Dr Catriona Ireland 10.30 - 11.15am How to reduce your risk of developing dementia and delay the Centre, University onset of the disease of Sydney Living a brain healthy lifestyle Research into dementia and new treatments available Morning Tea 11.15 - 11.40am Where to go for help and services Dementia Australia Libby Palmer 11.40am - 12pm Dementia Australia support services Brain training and its role to improve cognition and memory and Neuroscience Dr Kylie Radford Research Australia 12 - 12.25pm to reduce the risk of dementia The Memory Workout: practical and fun brain training exercises for the audience to experience first-hand Sutherland Shire Jayne Gan Wrap up, service browsing and Evaluation Forms 12.25 - 12.30pm Council
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 of 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 or 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 or 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
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