1. Professor Tony Elliott
Clinical Director
SSS Foundation Trust

5. Dementia Vs Alzheimer’s Disease?
Dementia is the medical syndrome of
memory loss, functional loss, personality
change, and psychiatric symptoms
Alzheimer’s disease is the commonest
illness to cause dementia
Vascular dementia
FrontoTemporal dementia
Lewy Body dementia

6. DEMENTIA
Lewy Body
Dementia Other Dementias
•Metabolic
Vascular
Alzheimer’s (Multi-
•Drugs/toxic
•White matter disease
Disease infarct) Fronto-
•Mass effects
Dementia Temporal •Infections
•Early onset Lobe •Parkinson’s
Dementias
•Normal onset

7. How common is it?
Prevalence doubles every 5 years after
age 65
– 5% over age 65
– 16% over age 85
– 32% over age 90
– (prevalence rate = total number of patients in the population at a point in time)
Younger age groups can be affected
700,000 in the UK have AD. With an ageing
population this figure is set to rise over
the next 25 years.

8. Effect of demographic drift on dementia prevalence over
the next 20 years
2028
2023
2018
2013
2008
0 2000 4000 6000 8000 10000 12000
Estimated Dementia Prevalence

9. Clinical Features

10. Cognition: Memory Loss
– Immediate memory
information is remembered from the previous few
seconds
affected early in Alzheimer's disease
– Short-term memory
information is remembered from the prior few minutes
or hours
affected early in Alzheimer's disease
– Long-term (remote) memory
information is remembered from many years ago
affected in later stages of Alzheimer's disease

11. Activities of Daily Living: Self-
Neglect and Physical Deterioration
– Gradual decrease in abilities
Washing
Dressing
Feeding
Mobilty
Continence
– Physical deterioration
Unsteadiness, falls
muscle rigidity
seizures and muscle spasms in about 10% of severe
patients

12. The Progress of Alzheimer’s Disease
30 Early diagnosis Mild-moderate Severe
Cognitive symptoms
25
20
Loss of ADL
MMSE score
15
10 Behavioral problems
5 Nursing home placement
Death
0
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9
Years
Feldman H, Gracon S. In: Clinical Diagnosis and Management of Alzheimer’s Disease. 1996:239-253. Ashford et al., 1995

13. What is happening in the
Brain?

14. Effect on the brain

15. AD and the Brain
The Changing Brain in
Alzheimer’s Disease
No one knows what causes AD to begin,
but we do know a lot about what happens
in the brain once AD takes hold.
Pet Scan of
Normal Brain
Pet Scan of Alzheimer’s
Disease Brain
Slide 19

16. Senile Plaques

17. Normal Brain Cells
Neurotransmitters (AChE)– being
sent – message being communicated
to the next cell

18. Normal Brain Cells
Once the message is sent, then
enzymes lock onto the messenger
chemicals and take them out of
circulation so a new message can be
sent

19. Brain Cells with Alzheimer’s
Less
neurotransmitter Further to go to get to the
plaques next cell
tangles
Enzymes (AChE inhibitors) –
get to them BEFORE they
deliver their message

20. Risk Factors and Causes of
Alzheimer’s Disease

21. Risk Factors
Age
Gender
Genetic
– family history
– apolipoprotein E4 – chromosome 19
– genetic mutations - chromosomes 1, 14, 21
Down’s syndrome
Head trauma
?High Cholesterol
Hypertension

22. Preventative Factors
Balanced diet
Exercise
Mentally active
2 glasses of red wine a day…

23. Treatments for Alzheimer’s Disease
Anti-dementia drugs eg Aricept
Memantine
Aspirin
Ginkgo Biloba
Vit E
Aromatherapy?

24. What do Alzheimer’s drugs DO?
Alzheimer’s drugs provide
FAKE messenger chemicals
that distract the enzymes.
They attach to the Fake
AChE & the message can get
thru
Aricept, Exelon, Reminyl

25. Anti-Dementia Drug Prescribing
October 2008 – December 2008
Birmingham E
Coventry Teaching
Dudley
Heart of Birmingham
Hereford
N. Staffordshire
Sandwell
Shropshire County
S. Birmingham
Stoke on Trent
Telford & Wrekin
Walsall Teaching
Warwickshire
Wolverhampton City
Worcestershire
S Staffordshire
Solihull
Warwickshire
Central and Eastern
Havering
Bromley
Worcestershire
Wessex
Bexley Care Trust
Western Cheshire
S.E.Essex
0.00 0.125 0.25 0.375 0.50 0.75 0.875
Patients 65 yrs and over

26. Memory Service National
Accreditation Programme
To assess and accredit memory services
for people with dementia
Involves external accreditation review of
Memory Service

27. MSNAP Process Telford & Wrekin
Commenced April 2010
3 Month period of self review asking
carers and service users about the service
Peer Review October 2010
Telford and Wrekin Memory Service
accredited with excellence January 2011

28. Aromatherapy
Several Placebo –Controlled trials
(Holmes et al 2003)
Significant efficacy few S/Es
Melissa (lemon balm) or Lavender Oil
Method of delivery variable
Prolonged massage not necessary
component of treatment

29. Aims of Interventions for Carers
in Telford and Wrekin
Increase awareness
Support person with dementia and carers
in own home
Mobilise available community resources
Increase links with Agencies eg
Alzheimer’s Society
Aim to reduce “CARER STRESS”

30. Protective
factors
•Practical
support
•Family help
Dementia •Problem
focused coping
Dependency and
problem
Exacerbating behaviours
factors
•Social isolation
Burden on caregiver
•Lack of knowledge
•Poor Skills
•Immature coping
•Guilt Caregiver strain
•Poor relationship -Psychological
- physical
•High expressed emotion
- financial
- social

31. What about local services
and developments?

32. Dementia Workstream
Multi professional group
Monitoring community developments for
dementia specific teams
Aim to treat people in place of residence
and reduce avoidable admissions
Telford Dementia Home Treatment team
in place
Consultant Psychologist appointed

33. Increasing Healthcare staff for
People with Dementia
March/April 2011
Mental Health Community team has been
strengthened by recruitment of additional
7 workers
3 Band 6 nurses
2 Band 5 nurses
2 support workers
Induction and training has taken place for
the new team members

34. Recent Service Achievements
• Primary Care Liaison Worker -
appointed
• Admiral Nurse - appointed
• Strategic Commissioning Group for
Dementia- established
• Investment in Additional resources in
Carer’s Respite

35. Working with patients
5 Dementia Advisers from Alz Society
have started in Jan 2011 to link in with
Community Teams and signpost the
service users and carers to local services
Regular monthly clinic in the Lightmoor
View care home
Positive impact in reducing the number of
admissions to Shelton Hospital

36. Involving our Service users
User/carers involved in the recruitment of
staff for dementia teams
“Speak out Forums” – updates on service
developments
Users/carers representatives are involved
in the new hospital build

37. “DARE to make a difference”
Dementia Awareness Raising and
Education
Raising awareness of the dementias
among local school children and
businesses
Developed with funding from the PCT
Led by Dr Ejaz Nazir Consultant
Psychiatrist

38. Environmental Design
in the New Hospital

40. Inpatient unit Finland

42. "Only put off until tomorrow what you are
willing to die having left undone."
Pablo Picasso 1881-1973, Artist

43. Professor Tony Elliott
Clinical Director
SSS Foundation Trust