MAINTAIN YOUR BRAIN –

DEMENTIA SEMINARWEDNESDAY 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 SEMINARTime 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

onset of the disease

Living a brain healthy lifestyle

Research into dementia and new treatments available

Brain and Mind

Centre, University

of 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 - 12.30pmWrap 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

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 AGEINGUNDERSTANDING 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

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 Break20 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 RadfordClinical 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 InformationCommunity 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