Module 2

Understanding dementia

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2. Understanding dementia

This module covers:2.1 How does our brain work?

2.2 What is the condition of dementia?

2.3 Alzheimer’s Disease and other diseases

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.

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• 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?

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Parietal LobePatterns e.g. language, arithmetic, everyday tasks

Temporal lobe

Memory

Limbic regionSleep, appetite, emotions

Our brain is divided into partsFrontal LobePlanning, insight, learning, interpretation, behaviour

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How does the brain work at

the microscopic level?

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•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

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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

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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.

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Physical changes to the brain Q. What are

some common signs or

symptoms of the condition of dementia?

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Dementia: common changes

memoryattention

language

emotions

behaviourphysical abilities

planning & organising

insight & reality

How are these signs displayed individually ?

PersonalityPersonality

Family backgroundFamily background

Life experiences and narrative

Hobbies and interests Likes and dislikes

Contribution to the community

General health

Progression of dementia

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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.Remember….it is very common for the symptoms

of the condition of dementia to be caused by mixtures of illnesses that affect the brain

What causes dementia?

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Dementia statistics and current research

• 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.

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• 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

How common is dementia?

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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

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

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• Vascular dementia• Fronto-temporal

dementia e.g. Pick’s

disease • Parkinson’s disease• Younger onset dementia• Infection

e.g. AIDS complex

• Alzheimer’s disease

• Lewy body disease

•Alcohol-related• e.g. Korsakoff’s disease

•Genetic •e.g. Huntington’s disease

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The brain of a person with Alzheimer’s disease shows significant loss of brain cells

2.3 Alzheimer’s Disease

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• 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

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What happens to the the brain

at the microscopic level?

Damaged brain cell will eventually die

Sticky plaques form around nerve endings Tangles appear in

the cell body

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Normal brain section

(viewed from above)

Brain section damaged by Alzheimer’s Disease

(viewed from above)

Slides courtesy of Duke University Medical Centre, Durham, North Carolina

Brain damage in Alzheimer’s

Disease

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• 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

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• 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

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• 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)

Younger people with Dementia

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• 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

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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)26

Remember – depression and delirium?

• Dementia

• Depression or anxiety

• Delirium = acute confusion 27

3 D’s – Dementia, Depression, Delirium

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

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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

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1. Not all confusion is caused by the condition of dementia

2. The condition of dementia is caused by different illnesses that affect the brain

3. Dementia is progressive but some skills can be retained for quite a while

4. Dementia is not a normal part of ageing REMEMBER…We cannot change the progression of

dementia but we can change the way we respond to the unique person behind the disease

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Key Messages

1. “The doctor said my friend has Alzheimer’s disease. I’m glad it’s not dementia!” True or False

2. “If you’ve seen one person with dementia you’ve seen them all” True or False

3. “All old people eventually become senile” True or False

4. “People with dementia would do better if they just tried harder”

True or False

5. “Once someone has dementia it’s important to take over and do everything for them” True or False

6. “Not every older person will get dementia.” True or False

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What do you think?