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Yeah, so hi everyone. Thank you for joining us on a Thursday afternoon. We have doctor with us today to give us a talk on dementia and delirium. So I'll pass on over to him and if you have any questions, please pop into the chat. Uh Thank you very much. Indeed. Ada um Thank you very much everyone for being here. Um I think I said it's entirely your choice if you want to stop me and ask questions or you want me to finish and then you can ask questions about dementia. So we're gonna start first with dementia. Um II do have one hour. So I'm afraid I might need just to go uh through some of the slides quickly. Um Just to make sure that you get the chance of understanding both dementia and delia. So we all know that dementia is a syndrome because we do have many diseases that could possibly lead to the same cluster of symptoms. Um And we know that it's not only when we say dementia, it doesn't mean it's only memory. Remember we are talking about excutive function as well as um you know, the other parts of the cognitive function. So it, it includes a number of things including uh the uh functional abilities um in the day to day activities. So these are the things that it could all all involve in terms of the clustering of the symptoms. So, thinking, orientation, comprehension, language, judgment, cognitive estimates. Um and we all know that the difference between dementia and delirium is the consciousness. So here it's clear consciousness. So um if, if we um ask ourselves who is likely to develop dementia. Um And of course, we do have some facts, we still don't know the exact cause of dementia. Um um including whether it's Alzheimer's Lewy bodies, uh frontotemporal and the rest of it. But we do have a number of risk factors that could play part in terms of developing dementia and these are uh some of those um factors or these factors. Um Genetics will, which will we will go through them. Uh We do have also head injuries, that's why possibly as you know, those who have history of chronic um alcohol intake with multiple falls and head injuries are likely to develop dementia than those who never had or they don't um never had any head injuries. Boxers are likely to be at high risk of dementia. So we're talking about professional boxers. So, uh we do have a number of things. We also know that aging. So um we, we know that 20% of those above the age of 80 are likely to have dementia at some stage. Um And uh compared to 15% those in their seventies, 10% in between uh uh 6070 the rest of it. So it sounds like it's with aging, uh the brain becomes frailer and likely to um develop some um of those things that could happen in dementia, which we will go through them, neurotransmitter abnormalities. We know that acetylcholine is the most likely um uh neurotransmitter involved in in dementia uh because it helps in terms of processing information and the messages between different parts of the brain with the inflammation. But we do have other um including gapa uh dopamine, um uh uh no adrenaline and the rest of the other neuro transmitters. But the main one is a low educational attainment. Uh These are just some observational studies. Um So they found that most of those who develop dementia are likely those who are not using the their brain fully ie they are not having regular cognitive stimulations. So we're talking about those possibly working as in, in catering. Uh just simple manual uh work, um just organizing shelves, uh those kind of work that uh don't require any sort of um thinking, let's say it's kind of a simple thing needed. Read uh vascular risk factors. We know that those who developed um um dementias are also um uh likely to have some sort of vascular changes, not all of them, but these are some of the things that were observed, um what we know that from these vascular changes are likely to damage the blood brain barrier. And once there is a damage, so you have got some sort of holes in them and certain types of proteins when they are blocked, we're talking about uh toxic proteins, uh unlikely to penetrate intact blood brain barriers. But when there is a gap in them due to lack or infarcts, and similar kind of vascular events are likely to penetrate and then go inside the brain precipitate in a certain area and start or um enhance the process or speed up the process of of damage that could happen in in certain type of dementia history of depression. This is likely to be a prodromal stage of dementia. So we know from studies that between um 48, sometimes even 10 years before the onset of the dementia, some patients will start develop certain types of um functional problems, whether it's depression and anxiety. Um uh mania psychosis, um very late onset when there is no any reason for it. So there is no precipitating factor. So it is likely that the changes in the brain started, but it hasn't reached the point to cause the uh very clear cognitive impairment. So it's likely to be in the protrama stage, uh diabetes and obesity. These are vascular risk factors. Um also linked to uh certain types of dementia uh infection. We can um I can either give you now some sort of information because that will help you to understand. So we have, for example, when you work in A&E and when you start your uh work as, as a doctor, you will see that some patients um admitted because of uti and confusion. So they develop delirium easily just with a uti or with constipation. Um while others uh could definitely have uti but they don't end up having confusion. So it's likely that there are changes in the brain, render these patients at high risk of developing delirium. So it's likely that they already um have dementia possibly in the background or there are some changes in the brain. It's studies show that there is a type of protein, it's called interleukin. Be for example, one of these interleukins can uh definitely uh penetrate the blood brain barrier and precipitate in the area of media temporal lobe and can cause uh signs and symptoms similar to dementia. So it sounds that with time, the more you have these infections, you are likely to speed up the development of Alzheimer's in some of these patients. Now, you might ask us. So why constipation cause confusion in elderly patients or some patients? The in theory is that what you are, uh what what is happening is that when you have constipation, there is an overstretching of the bowels. So the the lining, the mucous membrane of mucosa or the lining of the uh large intestine or small intestine are likely to become over um stretched and you will end up having some sort of what we call it, micro wounds, micro wounds in contact with the um with the content of the bowels ie with the feces, uh likely to cause micro infection. And micro infection could possibly a again, in theory, produce the same type of some of these toxic proteins including interleukins. Uh and they can also penetrate blood brain barrier and cause confusion. So these are the likely to be the causes in, in, in some of these uh patients. How come um it, the slide should be changed. Now, it's reached nearly 1 million people or more in the UK that have dementia and this is likely to increase with time. And as I explained the, and you've got 50% of those uh more than 65 and you've got 20% of more than those who are the age of 80 more. So it's likely that by 2050 we might end up having 1.2 sometimes saying that could be up to 2 million uh patients with dementia. So you can see it's, it's, it's, it's becoming more and more the reason for that because yourselves as medical students, junior um uh doctors or we call them residents now and seniors and senior trainees and SAS and even GPS, they start to be more aware of dementia in the past, they used to be called aging thing, but it's now it's different types of dementias. So the uh the and the development and, and, and the advances in uh neuroimaging uh functional imaging and the rest of the other uh tests that we have kind of made us more aware of this pro problem. And um hence, we do have uh now more cases because everyone is trying to screen for dementia. So as you know, um growing old is not easy when you look at it. Um from this slide, you can see it's all about losses. So you have got loss of family members, losses of the structure, losses of the uh sensory um function, losses of body function, losses of financial things. So it's all about loss. Um when we grow older. Um you, it, I know it could be a, just a depressive or a depressing slide, but this is the reality. Um it's all about losses. So that's why when we deal with these patients, especially when those getting uh old, whether in, in the care of the elderly medicine or care, care of the elderly mental health or psychiatry. Um It, it's, it's the most um you know, kind of difficult group of patients because you are not dealing just with the patient and with the uh uh entity or the disease entity. You're talking about all uh of the patient environment, including uh home, family members and others. Uh and, and financial problems, especially