HEALTH & SOCIETY ASSIGNMENT: YEAR 2 (MEDI12-203)

Dementia Assignment: Educational Podcast

Good evening and welcome back to the Gen Z Medical Podcast. My name is Indraneel Sikder
and today, we will be discussing dementia in Australia and what it means for our healthcare
system. Let us get straight into it!

Dementia is classified as a progressive, clinical syndrome that involves cognitive decline and
at least 1 of the following domains: abstract thinking, complex attention, executive
functioning, language, personality, praxis, social and visuospatial skills (Cloak & Khalili,
2022). Additionally, to this decline in cognitive ability, it must also interfere with the
individual’s daily life. Some of the common causes of dementia include Alzheimer’s disease,
Parkinson’s disease, Vascular dementia, Frontotemporal dementia and severe head injury
(AMBOSS, 2022).

Knowing which type of dementia an individual has can help with understanding the
symptoms of the disease and its progression. Except vascular dementia, it is believed that
dementia is caused by an accumulation of native proteins in the brain.

Proteins are three-dimension structures (determined by amino acid sequencing) that are
critical for biological function, thus must be properly folded to perform these functions.
When proteins are exposed to various internal and external factors such as proteins-protein
interactions, mutations etc, it can alternate protein conformation, thus decreasing its activity
(Soto & Pritzkow, 2018).

Newly synthesised proteins may not fold properly, or correctly folded proteins can no longer
spontaneously fond, causing aggregation. Protein aggregation has toxic impacts on the brain
over prolonged periods, leading to progressive damage of structure and function of neurons,
including neuron death (Soto & Pritzkow, 2018). In the brain, these proteins are called tau
and beta amyloid proteins. Currently, it is not fully understood as to how this leads to
dementia.

To diagnose an individual with dementia, a medical history, physical examination alongside

assessment of memory and thinking abilities must be performed. Dementia-like symptoms of
other conditions must be ruled out through lab tests such as urine and genetic tests and CT
scans. Testing neurological function is assessed through Mini-Mental State Examination
(MMSE), The Brief Cognitive Rating Scale and the Alzheimer’s Disease Assessment Scale –
Cognitive (ADAS-Cog) (Cloak & Khalili, 2022) . These can be followed up with
neuropsychological tests.

So, what does this mean for our healthcare system today?

Dementia is the second leading cause of death in Australia, accounting for 8.98% of deaths in
2020 (14,500 out of 161,300). For women, it was the leading cause of death and second for
men, preceded by coronary heart disease (Australian Institute of Health and Welfare, 2021).
As of 2022, it is predicted that approximately 487,500 Australians are living with dementia.

Burden of disease is the quantified impacts of living with and premature death resulting from
disease or injury, which is measured using disability-adjusted life years (DALY). One

SID: 13695787
DALY equals one year of healthy life lost in an individual disease (Australian Institute of
Health and Welfare, 2021). In 2018, Dementia was the third leading cause of burden of
disease in Australia, following back pain and coronary heart disease. However, for women
aged 75 and over it was the most prevalent. The total burden of dementia was around 198,000
DALY, with 56% of this burden due to premature death and 44% due to the impacts of living
with dementia.

Aged care services are a vital facility for those with dementia and their careers. This
encompasses home support, care for those residing at home and residential age care for those
that required permanent or short-term care. Among those living with dementia in Australia,
one third lived in a cared environment. Out of the 244,000 people living in aged care in 2019
– 2020, 54% (132,000) had dementia disease (Australian Institute of Health and Welfare,
2021).

The response to dementia in Australia has required various investment in the health, aged
care, and welfare sectors. It was predicted that approximately $3 billion AUD of the health
and aged care spending in 2018 – 2019 was assigned to the caring, diagnosing, and treating
those with dementia disease (Australian Institute of Health and Welfare, 2021). Of this $3
billion AUD, $1.7 billion (56%) was allocated on residential aged care services, following by
community-based aged care services ($596 million or 20%) and hospital services ($383
million or 13%) disease (Australian Institute of Health and Welfare, 2021).

You may be wondering, how do the symptoms of dementia present and how do we care for
those affected?

BPSD (behavioural and psychological symptoms of dementia) encompasses a range of

neuropsychiatric disruptions that are behavioural, emotional and perceptual in nature.
Clinically, these disruptions are divided into five domains cognitive (hallucinations,
delusions), motor (pacing, physical aggression, repeating movements, wandering), verbal
(yelling out, repetitive syntax, aggressive tone), emotional (depression, anxiety, irritated
easily, euphoria) and vegetative (disturbances that impact sleep and individuals’ appetite)
(Cerejeira et al., 2012).

Such symptoms of BPSD do not occur in isolation, present in clusters that can vary with
severity, time and diagnosis. It is predicted that most individuals that have dementia will
develop BPSD at some point of the progression of their illness. The behavioural disturbances
of BPSD have greater contributions to carer burden and admission into residential care
comparative to cognitive problems (Cerejeira et al., 2012). BPSD can progress to more
extreme symptoms and individuals often display this through physical aggression. This can
be distressing for these individuals and their family. It is often difficult to manage, even in
aged care environments focused on dementia care, whilst also presenting a risk for other
patients, carers and staff (Cerejeira et al., 2012).

The Brodaty Triangle is a model which classifies BPSD into seven tiers. From tier three,
individuals are classified with dementia with mild BPSD, showing symptoms such as
wandering and mild depression (NSW Health, 2021). Tier five represents severe BPSD, with
individuals showing severe depression, psychosis and severe agitation. This can progress to
tier seven, dementia with extreme BPSD, with those affected showing physical violence.

SID: 13695787
Classifying BPSD with tiers does not measure the extent or magnitude of the symptoms
shown of an individual affected with dementia, rather the impact their behaviours may have
upon themselves, those around them or the level of management or care they may require.
The classifications are determined by the impact of the person’s changed behaviours on
themselves the people around them, and the intensity of the interventions the person requires
(NSW Health, 2021).

Those with extreme BPSD require highly specialised, intensive care with a larger ratio of
male staff, something that is not required in lower tiers of BPSD symptoms. They may need
to be temporarily restrained by staff and in some instances seclusion to ensure safety of all
staff, carers and patients (NSW Health, 2021).

We will further discuss how agitation, one of the symptoms of BPSD, is cared for and
managed currently. Those affected with BPSD that display signs of agitation are marked at
Tier 5 on the Brodaty Triangle (NSW Health, 2021). Individuals will show exaggerated
motor function, verbal or physical aggression that can impact their daily life and social
relationships. This affects the frontal lobe of the brain, in particular the orbitofrontal cortex
and anterior cingulate cortex, with post-mortem studies of those affected show significant tau
protein accumulation in these areas of the brain (Azermai, 2015).

When I went on a school trip into an aged care facility, we met Charles, an elderly man with
dementia who displayed obvious agitation when asked to do certain things by the carers, such
as being asked to sit down to eat lunch. He was evidently aggressive, pushing away his food
and lashing out at the aged care nurses. However, Charles would love to talk about
motorcycles and would boast about owning a Harley Davidson motorcycle in the past.
Discussing his love of motorcycles would uplift his mood, as that was what he wanted rather
than being told to eat lunch. As such, Charles became much more co-operative and was
willing to listen to the aged care staff.

The first line treatment options for those with dementia is through non-pharmacological
methods. This includes animal therapy, aromatherapy, music, massages and multi-sensory
stimulation (Cerejeira et al., 2012). Another form of treatment is using antipsychotics such as
chlorpromazine, which have seen an increase in use globally. However, it was reported that
antipsychotics may have adverse effects such as stroke, deep vein thrombosis or cognitive
decline (Cerejeira et al., 2012). As such, there are questions to the use of these medications,
as the long-term effects of antipsychotics do not have sufficient evidence.

Unfortunately, that concludes this week’s episode on dementia in Australia. I hope that gave
you a further insight on the effects of dementia on our population. On next week’s episode,
we will be discussing Chronic Obstructive Pulmonary Disease, its management and
prevalence in Australia. Thank you so much for tuning into the Gen Z Medical Podcast.

Word Count: 1333

SID: 13695787
 REFERENCE LIST:

1. Amboss.com. (2022). Major neurocognitive disorder. AMBOSS.

https://www.amboss.com/us/knowledge/Major_neurocognitive_disorder/

2. Australian Institute of Health and Welfare. (2021). Dementia in Australia. Australian

Government. https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/
summary

3. Azermai, M. (2015). Dealing with behavioral and psychological symptoms of

dementia: a general overview. Psychol Res Behav Manag. 8, 181-185.
https://doi.org/10.2147/PRBM.S44775

4. Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska E. B. (2012). Behavioral and

psychological symptoms of dementia: Frontiers in neurology, 3, 73.
https://doi.org/10.3389/fneur.2012.00073

5. Cloak, N., & Khalili, Y. (2022). Behavioral And Psychological Symptoms In

Dementia. https://www.ncbi.nlm.nih.gov/books/NBK551552/#article-81923.s14

6. NSW Health. (2021). Extreme Behavioural and Psychological Symptoms of Dementia

(BPSD). NSW Health.
https://www.health.nsw.gov.au/mentalhealth/resources/Publications/behavioural-
psychological-symptoms-dementia.pdf

7. Soto, C., & Pritzkow, S. (2018). Protein misfolding, aggregation, and

conformational strains in neurodegenerative diseases. Nature neuroscience,
21(10), 1332–1340. https://doi.org/10.1038/s41593-018-0235-9

SID: 13695787