People with learning disabilities

Ageing and Dementia

We are all living longer which has attendant implications for our long term health. Dementia, which affects mental ability, becomes an increasing risk as we age. For the general population who are aged over 65 years, around five people in every 100 develop dementia. At the age of 80 years plus, it is reported as 20 in 100.

Learning disability and dementia

The prevalence of dementia for individuals with a learning disability can vary according to whether you include the statistics for people who also have Down's Syndrome.

For those who are learning disabled and who do not have Down's Syndrome, the prevalence rate is still increased over the general population. It is said to be around 13 in 100 people when aged over 50 years to 22 in 100 people when aged over 65. This is approaching a level that is four times as great as the general population.

People who have Down's Syndrome are at an even greater risk of developing a particular form of dementia known as Alzheimer's Disease (some times referred to as Dementia Alzheimer's Type or DAT). Due to congenital chromosome abnormality, the differences in brain tissue are already similar to changes that occur with the onset of Alzheimer's Disease. Prevalence rates have been put at ten (some studies report as high as 25) in 100 people at 40 years of age, 36 in 100 people at 50 years and 50-65 people in 100 when aged over 60.

What can cause Dementia?

Some of the common causes of dementia amongst the general population are:

Trauma, e.g. head injury
Infections, e.g. Meningitis, Encephalitis
Vitamin deficiency, e.g. Hypothyroidism
Neurological disease, e.g. Parkinson Disease, C.J.D
Brain conditions, e.g. Hydrocephalus, cerebral tumour
Cerebral anoxia (lack of blood), e.g. cerebral vascular disorder like arteriosclerosis.
Cerebral strokes and clots
Alcoholism e.g. Korsakoff Syndrome

General Signs and Symptoms of Dementia:

Failing memory particularly for names, places and important things like where you live and finding your way home
Reduced ability to concentrate and comprehend what others are saying
Reduced verbal interactions
Disorientation or poor sense of time and place
Changed mood, for example depression, anxiety or emotional detachment
Behaviour changes like agitation, apathy or aggression
Reduced self and domestic care.
Difficulty in solving simple problems
There may be a late onset of epilepsy

Signs and symptoms of dementia when found in people who have a learning disability

There is no evidence that dementia affects individuals with a learning disability differently from the general population. However, the condition may be more difficult to initially diagnose. It may be more difficult to recognise changes taking place on account of a person's already limited language skills and reasoning ability and their behaviour traits.

Carers can play a very important role in helping to interpret potential symptoms. They know the person well and can best judge if there are changes to the personality and untoward behaviour emerging.

From the outset, it is important to exclude other medical causes for a person showing deterioration and a full health assessment should be undertaken. An organisation called Down's Syndrome Scotland has produced a very useful fact sheet as a guide for General Practitioners. It indicates the presence of early stages of dementia and alerts as to what other health problems can also mimic symptoms. Listed below are conditions they feel can potentially be confused with the onset of dementia (particularly in Down's Syndrome):

Failing eye sight and vision, possibly due to inflammation or coning of the cornea. Cataract formation
Increasing hearing loss
Poor diet, leading to nutritional problems like anaemia
Constipation
Bereavement or other significant change
Depression
Sleep problems
Skeletal changes in places like spine, knees or hips. Osteoporosis
Cardiac abnormalities, especially if undetected in earlier life
Urinary tract infection
Diabetes
Hypothyroidism
Medication side affects

A diagnosis of the onset of dementia in an individual who also has a learning disability can take many months whilst health screening is undertaken, and further psychological observations and evaluations are made. A clearer picture will emerge over time when all other potential causes have been excluded, but an enduring deterioration still appears evident in the individual.

Supporting a person with learning disability and dementia

The Alzheimer's Society suggests a number of practical steps which can support a person developing dementia:

Still enable individuals to have as much control over their lives as possible
Use prompts and regular reassurance when you see them finding a task more difficult
Use visual planners and cues to structure the day
Try to structure each day and keep to the same routine
Use visual labels to identify things and places
Use photos and mementos known to the person to stimulate interaction and reminiscences
Simplify instructions and give plenty of time for them to respond
If someone is agitated, consider that their environment may be too noisy or busy
Consider using relaxation techniques such as massage, aromatherapy and music if someone is anxious or agitated
If a person is being aggressive, it is usually as a result of some frustration. Try and find out what that may be
A cautious use of medication might be considered to help if a person is depressed or psychotic

By understanding a person's past and knowing their likes and dislikes, we can endeavour to support them in how they may feel at times. This background knowledge can also assist with reassurance should they become distressed. The main focus is to preserve as much quality of their previous lifestyle as is possible. This not only retains the person's dignity, but also helps to maintain their orientation and sense of reality.