Living with Dementia - Kippax Hall Surgery

Our Dementia Champion is:

Alice Patrick

Please ask for Alice if you have any queries about our support – they will be happy to help and treat the conversation in strictest confidence.

Living with Dementia

Dementia Awareness:

If you or a member of your family is becoming increasingly forgetful, particularly if over the age of 65, it may be a good idea to talk to your GP about the early signs of dementia.

As people get older, memory loss may become a problem. It’s normal for memory to be affected by age, stress, tiredness, or certain illnesses and medications. This can be annoying if it happens occasionally, but if it’s affecting your daily life or is worrying you or someone you know, help should be sought from your GP.

What is dementia?

Dementia is a typically progressive clinical syndrome of deteriorating mental function significant enough to interfere with activities of daily living (ADLs). It affects cognitive domains (such as memory, thinking, language, orientation, and judgement) and social behaviour (such as emotional control and motivation).
- Impairment in mental function due to dementia is more severe than that expected with normal ageing.
For a diagnosis of dementia to be made, the person must have:
- Impairment in at least two cognitive domains (memory, language, behaviour, and visuospatial or executive function) leading to significant functional decline (enough to affect ADLs) that cannot be explained by another disorder or adverse effects of medication.
Early-onset (or young-onset) dementia is generally defined as dementia that develops before 65 years of age.
Mild cognitive impairment is cognitive impairment that does not fulfil the diagnostic criteria for dementia, for example, because only one cognitive domain is affected, or deficits do not significantly affect ADLs.

What are the signs of dementia?

Dementia can be difficult to identify as it usually has an insidious onset and non-specific signs and symptoms, which vary from person to person. People with early dementia may deny symptoms or accommodate to cognitive change and functional ability.
Suspect dementia if any of the following are reported by the person and/or their family/carer:
- Cognitive impairment, including:
  - Memory problems — the person may defer to family when answering questions, have difficulty learning new information or remembering recent events or people’s names, be vague with dates, and/or miss appointments.
  - Receptive or expressive dysphasia.
  - Difficulty in carrying out coordinated movements such as dressing.
  - Disorientation and unawareness of the time and place.
  - Impairment of executive function, such as difficulties with planning and problem solving.
- Behavioural and psychological symptoms of dementia (BPSD) tend to fluctuate, may last for 6 months or more and include:
  - Psychosis — the person may have delusions (which may be persecutory) and/or hallucinations (visual and auditory).
  - Agitation and emotional lability — the person may be easily upset, argumentative, shout, have mood swings, and/or be physically and verbally aggressive.
  - Depression and anxiety — the person may follow their carer around. The onset of depression in later life is a warning sign of dementia.
  - Withdrawal or apathy.
  - Disinhibition — the person may exhibit social or sexually inappropriate behaviour.
  - Motor disturbance — wandering, restlessness, pacing, and repetitive activity may be reported.
  - Sleep cycle disturbance or insomnia.
  - Tendency to repeat phrases or questions.
- Difficulties with activities of daily living (ADLs):
  - In the early stages of dementia this may lead to neglect of household tasks, nutrition (causing weight loss), personal hygiene, and grooming. People with dementia who are in employment may find that they are increasingly making mistakes at work.
  - In the later stages, basic ADLs such as dressing, eating, and walking become affected.

What can people do to reduce their risk of dementia?

There are many risk factors for dementia. Some cannot be reduced, these include:
- Age — older age is the strongest risk factor for dementia.
- Mild cognitive impairment — 50% of people with mild cognitive impairment subsequently develop dementia.
- Learning difficulties.
  - Estimates vary, but as many as 20% of people with intellectual disabilities aged over 65 years meet the diagnostic criteria for dementia.
  - People with Down’s syndrome are particularly affected — the prevalence rate may be up to 75% in people with Down’s syndrome aged 60 years or older.
- Genetics
  - Of families with young-onset dementia, there is a well-recognised genetic predisposition.
- Parkinson’s disease (PD).
- Low educational attainment.
- Low social engagement and support.
  - Being socially active can help to reduce dementia risk by reducing stress, depression, and loneliness.
- Stroke.
- Depression.
Risk factors that can be reduced include:
- Cardiovascular disease (CVD) risk factors (such as diabetes, smoking, hypercholesterolemia, and hypertension).
  - About one-third of Alzheimer’s disease cases worldwide may be attributable to modifiable risk factors.
  - Smoking is associated with a 50–80% increased risk of dementia.
  - Diabetes in middle or later life increases the risk of vascular and Alzheimer’s dementia by about 50%.
  - Physical activity — an analysis of population-based data estimated that in the UK, the largest influence on dementia by modifiable risk factors is physical activity. Even a low-intensity activity, such as walking, may reduce dementia risk by about 40%.
  - Multiple risk factors — dementia risk increases incrementally if multiple cardiovascular risk factors are present in middle age or several years before the onset of dementia.
- Heavy alcohol consumption 
  - Is linked to a higher risk of dementia. Reducing alcohol intake to lower levels will reduce risk.

Dementia Help and advice

Where can I signpost families and carers for help and advice?

Sources of support and information for people with dementia and their family/carers, include:

The National Institute for Health and Care Excellence (NICE) — information for the public on dementia (www.nice.org.uk/guidance/cg42/ifp/chapter/About-this-information).
The Royal College of Psychiatrists — a fact sheet on dementia (www.rcpsych.ac.uk/healthadvice/problemsdisorders/dementiakeyfacts.aspx).
NHS A–Z — a patient information article on dementia (www.nhs.uk/conditions/dementia).
The Alzheimer’s Society — information on all types of dementia (www.alzheimers.org.uk).
- A leaflet ‘This is me’ can be printed to help support people with dementia in an unfamiliar place or with unfamiliar carers.
Alzheimer’s Research UK, which provides health information relating to dementia (www.alzheimersresearchuk.org).
The Lewy Body Society, which provides information and support for families/carers affected by Lewy Body dementia (www.lewybody.org).
The Frontotemporal Dementia Support Group (formerly Pick’s Disease Support Group), which provides information and support for people with frontotemporal dementia and their family/carers (www.ucl.ac.uk/drc/support-groups/FTD-support-group).
Carers UK, which provides help for people caring for a sick, disabled, or elderly person at home (www.carersuk.org).
Dementia Pathfinders, which provides education for people working in the dementia care field, and care and support for people with dementia and their family/carers (www.dementiapathfinders.org).
The Office of the Public Guardian, which supports decision-making (within the framework of the Mental Capacity Act 2005) for people who lack capacity or would like to plan for their future (www.publicguardian.gov.uk).