ABC of Dementia

Bernard Coope, Felicity A. Richards, Bernard Coope, Felicity A. Richards

• Publisher: Wiley-Blackwell
• Year: 2020
• ISBN:
  9781119599333
• Edition: 2
• Topic: Medicine
• Subtopic: Internal Medicine & Diagnosis

ABC of Dementia is a practical guide, written with the needs of professionals in training in mind. Its aim is to enable readers to explore attitudes towards dementia, and find the knowledge and skills required in the important task of supporting the lives of people with dementia and their carers. This new edition is designed to assist students and practitioners working within both primary and secondary care settings with the diagnosis, treatment and provision of care. It covers the causes of dementia, diagnostic assessment, early intervention, pharmacological treatment, person-centred care, legal and ethical issues, and more.

This resource has been thoroughly revised to reflect the most recent research and evidence-based practice. New and expanded content addresses dementia and frailty in care homes, explores the role of technology in the treatment of dementia, discusses working with minority groups, and examines case studies.

• Aids healthcare professionals in developing the knowledge, skills and confidence to care for those with dementia
• Highlights the importance of person-centred care and the effects of dementia on families and carers
• Describes the cognitive changes and neurological disorders central to dementia
• Addresses the needs of younger people developing dementia
• Provides guidance on managing dementia in primary care, the acute hospital and end-of-life care settings
• Covers the Neuropsychiatric Symptoms of Dementia (NPSD)
• Features numerous full-colour photographs and illustrations

ABC of Dementia is a must-have for healthcare students, general practitioners, and other healthcare professionals caring for people with dementia. It will also be of interest to members of the general public who wish to know more about dementia.

CHAPTER 1
Dementia in the UK

Bernard Coope

Dorset HealthCare University NHS Foundation Trust, Dorset, UK

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OVERVIEW

• There are currently 835 000 people with dementia in the UK.
• Dementia is the most expensive healthcare issue the country faces. The economic impact for 2014 was over £26 billion, more than heart disease, stroke and cancer combined.
• The syndrome of dementia consists of impairment of cognitive skills, resulting from disease of the brain, which is severe enough to impair daily functioning.
• There is more to dementia than memory impairment.
• Not all old people have dementia and not all people with dementia are old.

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Introduction

Dementia is a clinical syndrome. This chapter examines the definition of ‘dementia’ and explores a number of issues related to dementia as it is experienced in the UK.

Definition: The syndrome of dementia
The syndrome of dementia consists of three components: impairment of cognitive skills, resulting from disease of the brain, which are severe enough to impair daily functioning.

It is worth taking time to look at the implications of this definition.

• Dementia as a syndrome. Central to the definition is a change in mental skills. To diagnose dementia, these changes need to be confidently identified, which usually means obtaining a careful history supported by an assessment of mental skills. Dementia relates to how well a person’s brain is working rather than the presence of pathology, and can’t be diagnosed from a brain scan any more than a plain X‐ray of an arthritic joint can show pain. The diseases that cause dementia are covered in Chapter 2.
• Cognitive functions are a diverse assortment of brain activity. The term ‘cognitive functions’ covers memory encoding, long‐term stores of knowledge, word finding, language comprehension, face or object recognition, planning and organising of activity and judgement. Different brain diseases lead to different patterns of cognitive change. There is more to dementia than memory impairment.
• To diagnose dementia, there must be good reason to suspect disease of the brain. Brain imaging may help, but in practice, brain disease is usually inferred from change in mental skill.
• It is quite possible to have brain pathology without dementia. As imaging techniques develop, it may soon be common to diagnose Alzheimer’s disease years before any symptoms have developed. Vascular changes on imaging are very common, and on their own, don’t mean vascular dementia.
• Impairment of daily functioning is an important but imprecise term. Very minor changes in mental skills are not usually referred to as dementia, although there may be a difference of opinion among patient, carer and clinician about when the change of functioning has occurred. For those with some detectable changes in mental function that are not impacting on daily functioning, the term ‘mild cognitive impairment (MCI)’ is sometimes used.
• When discussing dementia, we should be careful not to use syndrome and pathology as interchangeable concepts.

Terminology

In the 1970s, the late geriatrician Bernard Isaacs encouraged the use of the term ‘chronic brain failure’ as an alternative to ‘dementia’. The aim was to emphasise organ failure and to bring the definition in line with other commonly used terms, such as heart failure. ‘Acute brain failure’ represented delirium. Ultimately, the term was dropped as it had too many negative connotations, but the principle is worth reflecting on. Dementia is what we experience when changes in brain function impact our day‐to‐day life.

The National Audit Office, in its groundbreaking report Improving Services and Support for People with Dementia, took a more blunt approach and chose the simple term ‘progressive and terminal brain disease.’ Whilst this may not respect the syndrome/pathology distinction, it had the merit of communicating the seriousness of dementia to a wide range of opinion formers and politicians.

Prevalence and demography

The Alzheimer’s Society collated the following facts about dementia in 2014.

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• There are currently 835 000 people with dementia in the UK.
• There are over 25 000 people with dementia from black and minority ethnic groups in the UK.
• Two‐thirds of people with dementia are women.
• There are 670 000 carers of people with dementia in the UK.
• Family carers of people with dementia save the UK over £11 billion a year.
• Approximately 69% of people living in care homes have a form of dementia.
• Two‐thirds of people with dementia live in the community, while one‐third live in a care home.
• There is significant variation in diagnosis rates, ranging from one‐third in some areas to >75% in others.

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Economic impact

Until the National Audit Office published its report on dementia in 2007, dementia had never been considered a priority. It was the impact of dementia on the UK highlighted in this report that brought about a new political will to address the condition. The report detailed the real situation about dementia – not only how much the NHS and Social Services were spending on dementia, but also what individuals spent on their own care and how much lost earnings could be attributed to carers taking time off work to provide care. The answer was a little over £17 billion.

The significance of this sum was that if other conditions underwent the same analysis, dementia cost the UK more than heart disease, stroke, and cancer combined. Dementia is the most expensive healthcare issue the country faces, and it will continue on an upward trajectory. The economic impact for 2014 was over £26 billion; 670000 people act as carers in the UK, saving the state £11 billion/year.

Who has dementia?

The diseases that cause dementia get more common as age advances, so the majority of those living with dementia are over age 80. But not all old people have dementia, and not all people with dementia are old. Dementia can occur in people under 65, when specialist skills are needed to address the complexities of diagnostic diversity, complex personal and family responses and age‐related issues such as employment. The needs of younger people and their families are examined in Chapter 9.

As men tend to die younger than women, two‐thirds of those with dementia are women. Age discrimination is gender discrimination! This can mean that care settings for people with dementia may have a greater proportion of woman – both residents and staff. Male residents may feel less comfortable in these environments, and are more likely to be perceived as challenging.

Dementia in learning disability is another area that requires specialist skills – from diagnosis to helping that person live well. Dementia is more likely to develop at a young age in tho...