Dementia key facts and information
There are around 850,000 people with dementia in the UK, with numbers set to rise to over 1 million by 2025. 225,000 will develop dementia this year, that's one every three minutes. 1 in 6 people over the age of 80 have dementia (NHS UK 2017)
In the UK, 62% of people with dementia are female and 38% are male. This is likely to be a consequence of the fact that women live longer than men and age is the biggest known risk factor for the condition. For more information on actons to take in mid-life to help prevent dementia look HERE
In Dorset the figure is around 13,400 people of all ages living with dementia (NHS Dorset, 2019)
There are different types of dementia:
Alzheimer’s Dementia is the commonest type, seen in 60-80% of all cases
Vascular Dementia is seen in around 20% of all cases
(Alzheimer’s and Vascular or another type of Dementia together are often referred to as mixed dementia and are more common than previously thought)
Lewy Body Dementia (LBD) accounts for up to 15%
Fronto Temporal Lobe Dementia (FTD) accounts for around 5% of all dementia
Dementia in people with Down's Syndrome - Alzheimer's dementia has a high prevalence in people with this chromosomal abnormality and occurs in around 30% of people with Down's Syndrome during their 50s and around 50% in their 60s
Limbic-predominant age-related TDP-43 encephalopathy (LATE) - an international team of researchers has proposed a name for a type of brain disease that causes dementia symptoms and has recently been in the news: Limbic-predominant Age-related TDP-43 Encephalopathy, or LATE.
More information about the types of dementia, treatment, support and diagnosis in the UK can be accessed at https://www.nhs.uk/conditions/dementia/about/
Rarer dementias
There are other types of dementia that are much rarer, such as Posterior Cortical Atrophy, Creutzfeldt-Jakob disease and Huntington's and information and help resources can be found here: Rarer Types of Dementia
Treatments that don't involve medicines
Medicines for dementia symptoms are important, but are only one part of the care for a person with dementia. Other treatments, activities and support – for the carer, too – are just as important in helping people to live well with dementia.
Cognitive stimulation therapy
Cognitive stimulation therapy (CST) involves taking part in group activities and exercises designed to improve:
- memory
- problem-solving skills
- language ability
Evidence suggests that CST benefits people with mild to moderate dementia.
Cognitive rehabilitation
This technique involves working with a trained professional, such as an occupational therapist, and a relative or friend to achieve a personal goal, such as learning to use a mobile phone or other everyday tasks.
Cognitive rehabilitation works by getting you to use the parts of your brain that are working to help the parts that are not. In the early stages of dementia, it can help you cope better with the condition.
Reminiscence and life story work
Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music.
Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.
These approaches are sometimes combined. Evidence shows that they can improve mood and wellbeing. They also help you and those around you to focus on your skills and achievements rather than on your dementia.
You'll find more details about these treatments in the Alzheimer's Society's dementia guide
Information about medicines available for dementia from the NHS can be found at https://www.nhs.uk/conditions/dementia/treatment/
Behavioural and Psychological Symptoms of Dementia (BPSD)
The term BPSD covers a variety of behaviours and psychological symptoms, such as:
- Aggression
- Agitation or restlessness; screaming
- Anxiety
- Depression
- Psychosis, delusions, hallucinations
- Repetitive vocalisation, cursing and swearing
- Sleep disturbance
- Shadowing (following the carer closely)
- Sundowning (behaviour worsens in late afternoon/evening)
- Wandering
BPSD can also be referred to as non-cognitive symptoms of dementia. Each symptom needs to be treated specifically. More than one symptom can occur at the same time and the clinician needs to decide which symptoms need to be tackled first and by what approach. BPSD are the result of a complex interplay between the illness, the environment, physical health, medication and interactions with others. Although these symptoms can often remit spontaneously, they can also be persistent and severe, causing considerable distress to patients and carers and significantly impairing quality of life (Royal College of Psychiatrists) BPSD should be seen as a sign of distress or an attempt to communicate an unmet need. Most behavioural and psychological symptoms improve within four weeks of making simple changes, without the need for medication. (Alzheimer’s society, 2017)
Non-pharmacological
Check for and address clinical or environmental causes of BPSD before starting any intervention, including assessing the person with dementia for:
- Pain, consider trial of regular paracetamol
- Signs of infection and treat if symptomatic
- Constipation
- Signs of underlying depression or anxiety
- Are they comfortable? (e.g. warm/cold, hungry or thirsty)
- Does they require hearing aid or glasses?
- Have they had a ‘This is me’ form filled out? If so, is there anything on there which could help identify their source of distress This Is Me form
- As initial and ongoing management, offer psychosocial and environmental interventions to reduce distress in people living with dementia (NICE, 2011)
Strategies such as distraction, backing away, and leaving the room may be helpful for symptoms of aggression. (Kales et al, 2015)
Non-pharmacological care giver interventions include:
- Enhancing communication with the person with dementia
- Reducing the complexity of the physical environment
- Simplifying tasks for the person with dementia
- Tailored activities for the individual e.g. music and physical activity
- Aromatherapy
- Pet therapy
- Doll therapy
- Massage
- Music therapy
- Reminiscence therapy
- Sensory activities
Pharmacological
The following points should be considered before prescribing for BPSD:
- Target the symptoms requiring treatment.
- Carry out a risk-benefit analysis when choosing medication for an individual patient including any co-morbidities and other risk factors (e.g. diabetes, heart disease, smokers, frailty, renal/hepatic impairment, risk of VTE and falls)
- Make evidence based decisions
- Discuss treatment options and explain risks to patient and family/carers, ensure this is documented
- Titrate medication from a low starting dose and maintain the lowest possible dose for the shortest period necessary.
- Review appropriateness of treatment regularly.
- Monitor for adverse effects (Taylor et al, 2015)
References
Alzheimer’s Society. Drugs for behavioural and psychological symptoms of dementia. Factsheet 408LP. 2017
Kales et al, Assessment and management of behavioural and psychological symptoms of dementia. BMJ 2015;350:h369.
National Institute for Health and Clinical Excellence. Dementia. Supporting people with dementia and their carers in health and social care. Clinical Guideline 42, 2011. Updated March 2011. http://www.nice.org.uk/nicemedia/live/10998/30318/...
Royal College of Psychiatrists Faculty for the Psychiatry of Old Age. Atypical antipsychotics and behavioural and psychiatric symptoms of dementia. Prescribing update for older age psychiatrists.
Taylor et al. The Maudsley Prescribing Guidelines in Psychiatry, 12th Edition. Wiley 2015
Ever wondered what it is like to have dementia and try and navigate the hundreds of little things a day consists of? Try this new Alzheimer's Research - Virtual Reality app 'A Walk Through Dementia'