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Tier 2: Dementia identification, assessment and diagnosis

Tier 2: Dementia identification, assessment and diagnosis. Aims of webinar session. Types of dementia and their causes, signs and symptoms The importance of early diagnosis The progressive nature of dementia The process of gaining a diagnosis

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Tier 2: Dementia identification, assessment and diagnosis

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  1. Tier 2: Dementia identification, assessment and diagnosis

  2. Aims of webinar session • Types of dementia and their causes, signs and symptoms • The importance of early diagnosis • The progressive nature of dementia • The process of gaining a diagnosis • How to appropriately refer patients to access specialist services @NHS_HealthEdEng

  3. Types and causes of dementia • Dementia is not a single condition or disease; it is a term used for a number of conditions which impact on brain function, e.g.: • Memory • Spatial awareness • Language • Problem solving • Causes and symptoms of dementia vary according to the type of dementia and the part of the brain affected • Most common types of dementia are: • Alzheimer’s disease - Vascular dementia • Mixed dementia - Dementia with Lewy bodies • Frontotemporal dementia @NHS_HealthEdEng

  4. Pause for a poll What is the most common type of dementia? • Vascular dementia • Frontotemporal dementia • Alzheimer’s disease • Mixed dementia @NHS_HealthEdEng

  5. Alzheimer’s disease • This is the most common type of dementia • Caused by changes in the brain chemistry particularly the build-up of proteins in and around brain cells • Symptoms vary, with a loss of memory often the first symptom • A number of risk factors are associated with Alzheimer's disease @NHS_HealthEdEng

  6. Vascular dementia • Approximately 150,000 people have vascular dementia (NHS, 2018c) • Vascular dementia is caused by a reduction of oxygen to the brain • Symptoms are often related to issues with problem solving, concentration and can result in confusion • Vascular dementia is often associated with mixed dementia @NHS_HealthEdEng

  7. Frontotemporal dementia • This form of dementia affects the front parts of the brain, the frontal and temporal lobes • Changes in behaviour, personality and language are the most common first symptoms • Four main types of Frontotemporal dementia • Risk factors are associated with family history of dementia @NHS_HealthEdEng

  8. Dementia with Lewy bodies • Dementia with Lewy bodies is caused by deposits of the protein alpha-synclein in the nerve cells of the brain • Strongly associated with Parkinson’s disease • Symptoms are similar to Alzheimer's disease and Parkinson’s disease • People with Parkinson’s disease are at an increased risk of developing dementia with Lewy bodies @NHS_HealthEdEng

  9. Other dementias • There are over 100 types of dementia, most quite rare. • Those which are more likely to occur are: • Alcohol related dementia • Creutzfeldt-Jakob disease (CJD) • HIV related dementia • Huntington’s disease • Niemann-Pick disease type C • Head injury related dementias • There is a strong association with dementia and learning disabilities @NHS_HealthEdEng

  10. Progressive nature of dementia • There is currently no cure for dementia • Dementia is a progressive condition • Depending on the type of dementia, the level of decline will vary • Maintaining an active and healthy lifestyle may slow the level of decline @NHS_HealthEdEng

  11. Importance of early/timely diagnosis • Rule out other conditions • Getting access to appropriate services and support • ‘A gateway to making informed personal life choices’ (Burns & Buckman, 2013) • Being able to manage future decisions • Be part of their advance care planning • Meeting government’s strategy to improve diagnosis, assessment and care of people living with dementia (Prime Minister’s Challenge on Dementia 2020) @NHS_HealthEdEng

  12. Gaining a diagnosis • Diagnosis is complex • No direct diagnostic tests • Diagnosis is often a result of ruling out other conditions so that the likely cause is dementia • Depression • Brain trauma • MRI scans are supporting diagnosis • Clinical diagnosis is important e.g. taking a person’s history • Diagnosis is usually made by after referral to a specialist @NHS_HealthEdEng

  13. Gaining a diagnosis: At risk groups • Dementia risk is now a part of the NHS Health Check • Help those to reduce the risk of developing dementia • Modifiable risk factors such as lifestyle • Non modifiable risk factors such as age, gender, ethnicity @NHS_HealthEdEng

  14. Pause for a poll Would you be in favour of making an early diagnosis? • Yes • No • Not sure @NHS_HealthEdEng

  15. Referral, information & signposting • After a diagnosis, patients and families should be referred or signposted to appropriate local/national services: • Memory clinics • Specialist • Dementia charities and support groups • Carer services • Advocacy services • Information sources • People should know where and how to get support and information as their condition develops/changes • Inform people about potential research which they could take part in @NHS_HealthEdEng

  16. Resources and useful links • Age UK – https://www.ageuk.org.uk/ • Alzheimer’s Research UK – Genes and dementia: https://www.alzheimersresearchuk.org/about-dementia/helpful-information/genes-and-dementia/ • Alzheimer’s Society Resources for GPs - https://www.alzheimers.org.uk/dementia-professionals/resources-professionals/resources-gps • Alzheimer’s Society – Information on genetic forms of dementia: https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/genetics-of-dementia • Carers Trust - https://carers.org/ • Carers UK - https://www.carersuk.org/ • Citizens Advice - https://www.citizensadvice.org.uk/ • Dementia UK - https://www.dementiauk.org/ • Dementia Evidence Toolkit - https://toolkit.modem-dementia.org.uk/ • Down’s syndrome association - https://www.downs-syndrome.org.uk • Gov.UK Prime Minister’s Challenge on dementia 2020: https://www.gov.uk/government/publications/prime-ministers-challenge-on-dementia-2020 • Gove.UK Dementia and driving - https://www.gov.uk/dementia-and-driving • Health Education England, Dementia training resources - https://www.hee.nhs.uk/our-work/dementia-awareness/resources-tier-one-two-three • Health Education England, Dementia guide for carers and care providers e-book, available from: iBooks, the Kindle Store, and Smashwords. It is also available as a standalone app through the Apple App Store. @NHS_HealthEdEng

  17. Resources and useful links • Hayo, H., Ward, A. and Parkes, J. (2018) Young onset dementia, A guide to recognition, diagnosis and supporting individuals with dementia and their families. London: Jessica Kingsley Publishers. • Join Dementia Research - https://www.joindementiaresearch.nihr.ac.uk/ • Lewy Body Society - http://www.lewybody.org • Mencap - https://www.mencap.org.uk • NHS Choices, The Eatwell Guide - http://www.nhs.uk/Livewell/Goodfood/Pages/the-eatwell-guide.aspx • NHS Choices, Health Tools - http://www.nhs.uk/Tools/Pages/Toolslibrary.aspx • NHS – Dementia Guide: https://www.nhs.uk/conditions/dementia/about/ • NHS – Advance Care Planning for people with dementia in all care settings - https://www.england.nhs.uk/publication/my-future-wishes-advance-care-planning-acp-for-people-with-dementia-in-all-care-settings/ • NICE Dementia Guidelines: Assessment, management and support for people living with dementia and their carers: https://www.nice.org.uk/guidance/ng97/chapter/recommendations • Parkinson’s UK - https://www.parkinsons.org.uk • Public Health England – Dementia Profile: https://fingertips.phe.org.uk/profile-group/mental-health/profile/dementia • Rare Dementias Support - http://www.raredementiasupport.org • Social Care Institute for Excellence: https://www.scie.org.uk/dementia • University of Nottingham, Improving Dementia Education and Awareness (IDEA) - https://idea.nottingham.ac.uk/resources • Wessex Academic Health Science Network, Creating dementia friendly GP surgeries - http://wessexahsn.org.uk/projects/45/creating-dementia-friendly-gp-surgeries-ispace • YoungDementia UK - https://www.youngdementiauk.org/ @NHS_HealthEdEng

  18. References: All-Party Parliamentary Group on Dementia (2013) Dementia does not discriminate: The experiences of black, Asian and minority ethnic communities. London: House of Commons. Alzheimer’s Association (2018) https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/mixed-dementia Alzheimer’s Research UK (2017) https://www.dementiastatistics.org/statistics/different-types-of-dementia/ Alzheimer’s Research UK (2018) https://www.alzheimersresearchuk.org/about-dementia/types-of- Alzheimer’s Research UK (2018b) dementia/frontotemporal-dementia/ftdabout/ https://www.dementiastatistics.org/statistics/deaths-due-to-dementia/ Alzheimer's Society (2018) https://www.alzheimers.org.uk/about-dementia/types-dementia Alzheimer's Society (2018b) https://www.alzheimers.org.uk/about-dementia/types-dementia/dementia-with-lewy-bodies Alzheimer's Society (2018c) https://www.alzheimers.org.uk/about-dementia/types-dementia/alcohol-related-brain-damage Burns, A. and Buckman, L. (2013) Timely diagnosis of dementia: Integrating Perspectives, Achieving Consensus. BMA and NHS England. Caspi, E. (2017). Trust at stake: Is the “dual mission” of the U.S. Alzheimer’s Association out of balance? Dementia, 0, 1-22. Clemerson, G., Walsh, S. and Isaac, C. (2014) ‘Towards living well with young onset dementia: An exploration of coping from the perspective of those diagnosed.’ Dementia 13, 4, 451-466. Dhedhi, S.A., Swinglehurst, D. and Russell, J. (2014) ‘Timely’ diagnosis of dementia: what does it mean? A narrative analysis of GPs’ accounts. BMJ Open doi:10.1136/bmjopen-2013- 004439. @NHS_HealthEdEng

  19. References: Hayo, H., Ward, A. and Parkes, J. (2018) Young onset dementia, A guide to recognition, diagnosis and supporting individuals with dementia and their families. London: Jessica Kingsley Publishers. Lincoln, P., Fenton, K., Alessi, C., Prince, M., Brayne, C., Wortmann, M., Patel, K., Deanfiled, J. and Mwatsama, M. (2014) ‘The Blackfriars Consensus on brain health and dementia.’ The Lancet 383, 1805-1806. NHS (2018a) https://www.nhs.uk/conditions/dementia/causes/ NHS (2018b) https://www.nhs.uk/conditions/alzheimers-disease/causes/ NHS (2018c) https://www.nhs.uk/conditions/vascular-dementia/ NHS (2018d) https://www.nhs.uk/conditions/frontotemporal-dementia/ NICE (2018) Dementia Guidelines: Assessment, management and support for people living with dementia and their carers: https://www.nice.org.uk/guidance/ng97/chapter/recommendations Phillips, J., Pond, C.D., Paterson, N.E., Howell, C., Shell, A., Stocks, N.P., Goode, S.M. and Marley, J.E. (2012) Difficulties in disclosing the diagnosis of dementia: a qualitative study in general practice. Br J Gen Pract 2012; 62 (601): e546-e553. DOI: https://doi.org/10.3399/bjgp12X653598 Social Care Institute for Excellence (2015) Getting a dementia diagnosis: https://www.scie.org.uk/dementia/symptoms/diagnosis/getting-a-diagnosis.asp Social Care Institute for Excellence (SCIE) (2015) Black and minority ethnic (BME) communities and dementia. London: SCIE. Accessed on 01/07/17 at http://www.scie.org.uk/dementia/living-with-dementia/bme/ @NHS_HealthEdEng

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