Dr James Warner: IDENTIFYING AND MANAGING DEMENTIA

Dementia affects more than 850,000 people in the UK alone. This number is projected to go over 1.6 million by 2040. Roughly 50% of all our clients at Guardian Carers are affected by dementia.

Guardian Carers spoke to Dr James Warner, Consultant Psychiatrist and Medical Director at Halcyon Doctors. Having a particular interest in the study of dementia, Dr Warner discussed the telling signs people should look out for early on and how to manage dementia.

Dementia is an umbrella term used to describe an array of progressive neurological disorders, the most common form being Alzheimer’s disease. Dr Warner says that “approximately 90% of all dementia is Alzheimer’s disease.”

IDENTIFYING THE EARLY SIGNS

Identifying the early signs of dementia can be quite difficult. Dr Warner explains that “actual changes in the brain begin 20 years or so, before the individual becomes symptomatic.'' When conducting his diagnosis, and attempting to track back and identify what the symptoms were, he believes “it is difficult because they are very subtle.”

Dr Warner suggests that the early signs people should look out for should be “increasing memory lapses”, and checking whether the individual is “repeating questions”. Specifically with Alzheimer’s, he recommends keeping an eye out for “subtle, mild memory loss” and seeing whether the individual is experiencing difficulty in “abstract thinking and weighing things in the balance.”

From a psychological perspective, it’s important to be aware if the individual has other problems, such as “depression or psychosis”. These could also be early signs of dementia, says Dr Warner.

GENETIC INHERITANCE

In rare cases, dementia may be genetically inherited. This means it is passed on from parent to child through the transmission of genes. This typically affects people under the age of 65. Dr Warner suggests this is more likely to occur as a “rare form of Alzheimer’s or a condition called Huntington’s disease.” However, he points out that only “1% of the 850,000 have this type of genetically inherited dementia.”

“But dementia does cluster in families,'' says Dr Warner. So if you have parents who are living with dementia, even if they haven’t genetically inherited it, “you are still a little more at risk of having dementia yourself.” With the inherited disorder, the risk of the child developing dementia around the age of 80, is 1 in 5. If the child has a strong family history of the non-inherited form, the risk may increase to around 1 in 4.

LACK OF RECOGNITION

As dementia progresses, some people may stop recognising their friends or family members. Dr Warner mentions that it’s important to manage this situation carefully as “it can be very distressing” for the individual with dementia. Unfortunately, their carer or family member become strangers to them, which can cause “all sorts of anxiety, and often irritability and aggression.”

Caring for someone who suffers with dementia can be a very difficult task, “often with no gratitude or thanks”, says Dr Warner. “You can’t get [them] to easily start to recognise someone if they have forgotten who they are.” To keep these connections, he strongly recommends taking a “here and now” approach. For example, he suggests that saying ‘I am just here to help get you washed and dressed today’ could be better “because the person can hold that for a few minutes, while the intimate tasks are being done.”

PROMPTING MEMORY

Maintaining familiarity and helping the person to relive any memories could help them develop occasional moments of recognition. Prompting a person’s memory could be a challenging task, but Dr Warner believes there are methods worth trying. “Create a life story” he says. A life story is an album or a book with photographs and pieces of information, tracing a person’s life. “I think that everyone should make a life story before they get dementia”, says Dr Warner. If the memory is linked with a strong emotion, the person could recall that memory more easily.

Using “inventive ways of communicating” could also be a method of prompting someone’s memory. Music is a fantastic way to do that. It “ registers to a different part of the brain that seems to be less affected. People with dementia respond very well to music.” It can enhance communication and help them express feelings and connect with past memories.

As the ageing population is rising, the number of people at risk of getting dementia is rising with it. But Dr Warner mentions that “it is now [becoming] more recognised that the risk factors of dementia are pretty much the same as risk factors for heart disease”, which means the different ways of improving heart health are also the same for improving brain health.

But, if an individual is diagnosed with dementia, it is still possible to slow down its progression. In order to do this, Dr Warner suggests:

  • Keeping healthy
  • Eating well
  • Exercising regularly
  • Making sure your blood pressure is controlled
  • If you suffer from diabetes, you should make sure that it is under control
  • If you have an irregular heart rate, make sure it is treated

MAKE THE HOME DEMENTIA FRIENDLY

People with dementia are more likely to stay at home surrounded by familiar faces and cherished possessions. But, it is important to take the time to make the home dementia-friendly, as Dr Warner states that the home can be full of hazards. “When I am diagnosing someone I will always try and see them in their home ''. He says that one of the reasons he does that is to “spot any obvious environmental hazards, but also so I can look in their fridge and make sure they are eating properly.”

Dr Warner further explains that “if you put a symbol of a toilet on the toilet door, that would help to guide them to the toilet”. Or “modify your oven so someone with dementia can’t turn it on and then leave it on accidentally.” He also mentions devices that can “prompt people to take their medication.”

ENCOURAGING EATING AND DRINKING

An individual with dementia may have problems with eating and drinking, and it may also be difficult for their carer to encourage them to maintain a healthy diet. There are two main complications when it comes to eating and drinking for someone with dementia. “Number one: people lose weight with dementia. Number two: they don’t keep to the usual meal times” says Dr Warner. “It’s really important that someone with dementia isn’t kept to rigid breakfast, lunch and dinner.” He says that having food that is really easy to digest and easy to eat is vital.

He also mentions that “finger food can be helpful if a full meal is difficult'', as the individual with dementia may not be able to use a knife and fork. They also tend to develop a change in appetite or taste. In fact Dr Warner says “it’s extremely common for someone with dementia to develop a sweet tooth”, so the carer would need to ensure they maintain a healthy balance with their food, focusing on their “nutritional intake and [making sure they are] getting enough vitamins.”

The individual may also have difficulty swallowing, and if they start choking this may deter them from eating. Dr Warner suggests that they will “need to get a speech and language swallowing assessment.” Being flexible around meal times is also recommended, and it is best to avoid times when the person is feeling tired or distressed. Dr Warner advises to make the food “available at the time the person wants to eat. People will forget that they have had a meal, but they will also forget they have not had a meal, so they need to be encouraged to eat.”

Dementia may be a complicated condition, but this doesn’t mean it cannot be managed. Ensuring the carer remains calm, compassionate and patient is the best way to approach someone living with dementia. While their personality and behaviours change over time, there are always methods which can maintain their quality of life.

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