30 Dementia - Awareness of Possible Memory Problems or Cognitive Decline

Memory problems do not necessarily signpost dementia: depression, accidental brain injury or other conditions may be  the cause. With this in mind, as a start, much of dementia friendliness towards a person with memory difficulties hinges on a family member, friend, neighbour, or another person becoming aware of seeming memory problems. Secondly, a sensitive approach may be needed to encourage a person to seek a professional assessment, usually by their GP.

A key is a basic knowledge and understanding of the main dementias, typical symptoms, and characteristic behaviours associated with memory problems. Typically, this will come from books, the internet, and so on: other sources are to hand. Of the latter, four examples are given in this post.

They are: 

1. An awareness and information session for prospective Dementia Friends - taking about one hour which is delivered by a Dementia Friends Champion
2. Trained staff at a NHS Health Check conducted in the public health staff of the district council (This will be for residents from 40 to 74 years.)
3. Nursing, etc staff at a hospital making a NHS assessment for those over 75 years staying in hospital at least 72 hours
4. Fire service staff following a call for assistance, eg at a fire incident or some other reason. They carry out an on-the-spot assessment of possible cognitve impairment in a person over 60 years - this would be carried out by fire and rescue service staff who are specially trained. 

27 Awareness, Assessment and Diagnosis for Memory Problems - Limbo Time [Update 2 - 13/11/13]

As the population gets older, the numbers with dementia are growing year by year. It is also likely that current life-style choices are  affecting younger citizens who may not otherwise develop to life with a dementia as they reach any decade over say 60. [Although seniors get dementia, younger persons, say 35 years onwards, may get young onset dementia.]    

England has over 300,000 individuals living with dementia which is not diagnosed. Also, many more persons have memory problems which may have dementia-like symptoms. Nationally as a policy it is recognised that early assessment and diagnosis are important. This post addresses issues surrounding this policy. 

 The West Kent CCG has recently issued a document which says that Sevenoaks has 1840 persons with dementia.
 http://www.e-watch.co/articles.php?viewarticle=4359&UID=4272&viaNL

Please note that the reference to Sevenoaks is likely to mean that part of the Sevenoaks District within the West Kent CCG area, ie roughly 100 square km. 

Awareness and Information
The country needs its people to be able to recognise dementia-like symptoms. The reason is that those with undiagnosed dementia will be encouraged to seek assessment and diagnosis. Where dementia is not the cause of the memory problems appropriate treatment for the condition follows, eg depression, drug abuse.

To this end a million volunteers who are being recruited to become Dementia Friends.  They have attended an awareness and information session about life with dementia and will spread this information to others. 

Preparedness of Health and Care Professionals
About 12 years' ago about 50% of doctors would probably be insufficiently trained to deal with assessment of dementia. Five or six years ago 30% of doctors in London would have said the same. By today many more local surgeries have doctors, practitioner nurses, reception staff  who are alerted respond to those with memory problems. More GPs are able to confidently carry out assessments and have the back up specialists in dementia who are based in local memory clinics. 

Specialist clinical training in assessment for dementia has been commissioned by the local Clinical Commissioning Group and given to doctors. Specialist nurses in dementia are being or will be attached to each of two surgeries.

In North West Kent the Alzheimer's and Dementia Support Services (ADSS), a charity, has devised a digital dementia appraisal package for dementia asssessment by doctors who want to use it.  

Limbo Time

As the local rate of assessments rises and and the diagnostic investigations are carried there may be an unfortunate delay - a person with memory problems may have to wait for the the result. 
In some areas the delay - limbo time - is sometimes as long as three months. Given that the national target is to increase diagnoses from about 45% to 66% Clinical Commissing Groups will need to consider any need to increase resources in memory clinics.

26 Dementia - Living at Home Alone [Update 1 - 07/12/13]

Living at home alone is often difficult and lonely for a person with dementia.  Life could be easier, safer and more enjoyable if he or she had visitors, help and advice. A better life is much less likely for the many who are not assessed or diagnosed. For the latter changes will often come about after a crisis - a serious illness, an accident, or when other type of emergency arises, eg the person is lost and found by the emergency services. 

From then any assessment will, on referral, be followed by diagnosis of a dementia (if that is the case). As a result in a care pathway is likely to be established. Hopefully, if this is the person's wish this will be at home but his or her destination may well be in a dementia care home.    

Where the diagnosis and appropriate treatment results in life at home changes which could result in adaptations and improvements to make life easier, safer and less stressful. So called assistive technology covers many devices and systems used by local organisations. For instance, the fire and rescue service may fit fire safety equipment. Many homes are fitted with water mist sprinklers - so reducing the impact of a fire caused by the person with dementia not remembering that a cooker is on and a pan catches fire.  

18B Memory Problems and Dementia - Symptoms Update 1 - 28/11/13]

One of the aims of Swanley as a Dementia Friendly Community [see Post 1] is to enhance awareness of dementia, and so support the national policy to increase the rates of diagnoses of dementias. 

The way in which this will be done is to let residents, visitors and those who work in the town know of the symptoms and so encourage those with memory problems or other symptoms to go to their general practitioner (GP), ie a doctor for an assessment.

However, it may be noted that there may be other conditions causing memory problems, eg depression. This Post is a general review of the symptoms that a person living with a dementia may show. [See Post 18 for types of dementia.]

Initial Assessment
Firstly though, you may like to note that a person may exhibit one of these symptoms, eg a problem of memory loss, but that this might be caused by a condition which is not in fact dementia. It is important therefore for the individual to be assessed by a clinical practitioner with relevant training and experience. In some instances the illness will not be dementia. As a result the person may be treated or referred for appropriate treatment after the assessment.

A second aspect of national policy on diagnosis or initial assessment for dementia is that a person over the age of 74 years who is admitted to hospital for 48 hours or more will be assessed routinely for dementia.

Symptoms of Dementia
In life with dementia the various symptoms manivest at different times and may be dormant for long periods. Although there are common symptoms some of those with a particular dementia may not show all of them.

The list which follows is derived from talking to friends at the time when they were early-diagnosed and from written accounts by those who have dementia or by their family members. It is not an attempt to provide clinical  list so what I have called a symptom may be one of the outcomes of an underlying or general symptom.

1. Loss of short term memory
2. Confusion
3. Inappropriate behaviour
4. Expressions of anger, frustration, etc, eg shouting
5. Difficulty with or inability to do simple tasks, eg preparing vegetables
6. Difficulty with reading, eg reading written signage 
7. Difficulty with numbers, eg dealing with money
8. Having a propensity to wander and /or becoming lost
9. Repeatedly asking the same question 
10. Mild to severe cognitive difficulties
11. Being unable to recognise faces, eg family members or friends 
12. Inability to speak or understand
13. Lack of concentration.

Notes
Note 1 Readers in @Europe, @USA and other places may like to note that in the England most residents and long stay visitors are registered with a general practice doctor (GP) in a local NHS primary care surgery. During opening hours, unless an illness or injury is life-threatening, we will be treated by the GP, dentist, pharmacist, etc. Sometimes we go to a minor injuries unit (MIU) or a walk-in centre.

Note 2 Most of us are encouraged to avoid our local (secondary care) NHS hospital unless:

• we are referred to a hospital consultant or the hospital's A&E by our GP or an out-of-hours duty doctor
• we suffer an acute illness or other life threatening injury and emergency paramedics take us to the hospital's Accident and Emergency Unit (A&E), eg by the regional ambulance service, etc
• we become ill out-of-hours, in which case be bettle off to the A&E.