Exploring and supporting everyday life with a rare dementia - understanding symptoms, developing strategies and sharing stories

Lead Research Organisation: UNIVERSITY COLLEGE LONDON
Department Name: Institute of Neurology

Abstract

What this fellowship will achieve:
This fellowship will reveal and communicate what people living with posterior cortical atrophy (PCA) experience living with this debilitating condition day-to-day. PCA is a rare dementia mostly affecting vision which usually has a young age of onset. It leads to significant problems with seeing what and where things are and causes profound difficulties with all sorts of daily activities including reading, driving and dressing.
My PhD research has shown that people living with PCA face a convoluted and stressful diagnostic journey, as the symptoms are unusual and many health professionals are unfamiliar with the condition. With this fellowship I will communicate these experiences to the relevant health professional audiences to ensure they are better equipped to notice and support those living with any kind of dementia-related visual impairment. My PhD also highlighted that post-diagnosis, there is a lack of guidance about how to manage PCA symptoms and as a result, individuals and families are really creative and responsive, embarking on a process of ongoing problem-solving, continually adapting to the progressive symptoms in order to help the person with PCA to stay as independent as possible and engaged in the activities that matter to them. This fellowship will allow me to consolidate and share this wealth of knowledge with other individuals and families navigating a diagnosis of PCA, as well as the health and social care professionals supporting them. This will not only help people with PCA to live more independently and improve wellbeing, but will also instil a sense of confidence and connection in reminding them they are among a community of peers, all keeping going through similar challenges.
My PhD research involved in-depth interviews and all-day observations in the homes of people living with PCA and more typical, memory-led Alzheimer's disease (AD), during which I collected video and audio recordings, measures of wellbeing and functioning, and physiological data including heartrate and activity levels. This combination and volume of data hasn't before been collected in the homes of people with different dementias and there are numerous possibilities for further data analysis in collaboration with researchers from a range disciplines (e.g. speech and language therapy, physiology), which this fellowship will give me the opportunity to pursue.

Why it is important:
Visiting people at home made this study very accessible and inclusive for people with dementia as they were observed in an environment in which they were most comfortable, familiar and able. Another important next step will be to share not only what I found in my PhD research but also what I learned while doing it, to encourage others to do research at home with people living with dementia, to make sure that future findings are representative of and relevant to the real lives of people living with different dementias and their families.
Looking at the bigger picture, the sharing of my findings and further data analysis this fellowship will allow me to do is important because Alzheimer's disease (AD) is often misperceived as a disease that solely affects memory. Dementia-related visual impairment is poorly understood and often neglected, perhaps because in more typical memory-led AD, visual symptoms often occur at the later stages of the condition, at a time when people are less able to clearly explain and recall their symptoms and any perceptual challenges. This has real implications for how care is delivered on the ground, e.g. a person with later stage AD may be thought to have "forgotten" their cup of tea when they may actually be unable to perceive it. Sharing more about the impacts of dementia-related visual impairment and how people adapt and adjust, has significant implications for service development, and in the longer term, potential to maximise the independence, coping and wellbeing of those affected.

Publications

10 25 50

 
Description The most significant achievements from my ESRC postdoctoral fellowship have been me writing up 4 first author and 4 senior author journal articles for publication (5 accepted, 1 in press, 2 in revision), to disseminate the findings from my PhD research to academic and health and social care practitioner audiences. I have also been invited to contribute to a methodological textbook and have been invited to share my research findings at national and international conferences and events (support group meetings, workshops, academic meetings) for professional practitioner, public, and experts-by-experience audiences, and to contribute to the development of educational resources for a range of professional and patient groups. The key findings I have disseminated in these formats and to these audiences have been related to the lived experience of rarer forms of dementia such as posterior cortical atrophy and the specific symptoms and associated needs of these underrepresented groups. These include: the anxieties and uncertainties experienced over the course of a convoluted diagnostic journey; the profound and atypical difficulties in engaging with the physical environment, e.g. in seeing what and where things are; a range of knock-on psychosocial implications including impacts on roles, responsibilities and sense of self and identity; the creativity and resilience families show in adapting to their new circumstances and associated challenges; and the value and benefit of peer support and psychological intervention in supporting those affected to live well with these conditions.
Exploitation Route The outcomes of this award could be taken forward by academic researchers who will be able to increase the accessibility and inclusivity of their research methods to incorporate the unique and complex needs and experiences of people with less common forms of dementia and their families. They will continue to support health and social care practitioners to respond in a timely and tailored way to these needs, improving outcomes for individuals and efficiencies for health and social care systems. Finally they will continue to support for people living with these conditions and their families to be empowered to utilise their own creativity and resourcefulness to develop supportive strategies to enable continued engagement in the things that matter to them, and also to feel a sense of community with others who have a similar shared experience.
Sectors Communities and Social Services/Policy

Education

Healthcare

 
Description This postdoctoral fellowship award afforded me unprecedented protected time to focus on writing up and disseminating the findings from my PhD research, which allowed me to develop my international profile as a social science researcher working at the underpopulated intersection of lived experience, qualitative methods and young onset, non-memory-led and inherited dementias. I have been able to engage a wide range of patient and professional audiences with my research findings, both within and beyond academia, to ensure that the lessons learned about how daily life is experienced and the support needed and valued by patients and carers are being communicated to the relevant audiences. These include professional practitioners such as Occupational Therapists, Social Workers, Speech and Language Therapists and Rehabilitation Officers for Visual Impairment who work on the ground with people facing difficulties associated with the younger age of onset and atypical symptoms that characterise rarer and non-memory-led forms of dementia like PCA. Alongside my fellowship I also trained clinically as an integrative counsellor and psychotherapist and now co-lead a psychological intervention service at University College London Hospitals NHS Foundation Trust. Within this role I have also managed placements of 8 trainee Clinical Psychologists within the service to improve knowledge and awareness of the specific psychological needs and experiences of those experiencing lesser known forms of dementia. This professional education and engagement was a primary aim of my dissemination plans as a result of my PhD findings which indicated that people with rarer types of dementia are often confronted with professionals who have limited awareness of their conditions which can exacerbate a sense of anxiety, uncertainty and isolation. I have also shared these stories and strategies with patient and carer groups via presentations and workshops and at national and international support group meetings. This iterative process of collecting, sharing and inviting feedback and further input on strategies for living well with atypical dementia has formed the basis for a web-based accessible and dynamic resource for people affected by these conditions in the community, currently in co-production. This resource will empower and enable continued engagement with meaningful activities for these underserved and underrepresented populations. Within academia, as well as establishing my profile as a researcher with expertise in the lived experience and support needs of those affected by non-memory-led, young onset and inherited forms of dementia, the award has also helped me to establish my profile as a researcher working within the growing field of innovative and creative methods in dementia research which answer priority calls to improve accessibility and inclusivity in dementia research participation. I have disseminated this work among academic research, clinical, professional and public audiences. Related to this, the award has given me the opportunity, time and autonomy to curate and manage of team of junior qualitative researchers from a range of backgrounds (the first in my department) which has established the utility of and improved recognition of the value of qualitative methods within a traditionally biomedical setting, fostering unique opportunities for collaboration and interdisciplinary working, several of which will form the basis for further funding applications currently in development. More broadly, having dedicated time to concentrate on building my profile and disseminating outputs from my PhD, has allowed me to dramatically increase my output in terms of publications, including my first senior ones, and has seen me invited to join international networks (e.g. INTERDEM) which will increase my scope for collaboration and further funding opportunities going forward. Finally, this award has offered me the autonomy and independence to dedicate time and resources to the consideration of my professional development and future directions. In focusing on the dissemination and implementation of my PhD research I have been able to identify specific needs of people affected by lesser known and inherited dementias and gaps in clinical skills in the care and support of people with these, and have recently completed complementary clinical training in psychotherapy and counselling to fulfil my own motivation to contribute in the area of developing and delivering psychological interventions for these underserved groups as a clinician-researcher. Further cementing my profile and professional identity in this area I am also a named researcher and work-package and trial lead on a £1,892,793.00 NIHR-funded Programme Grant for Applied Research (PGfAR): 'Psychosocial support for people affected by Genetic and Non-Memory Led Dementias: developing digital provision and understanding the role of existing TALKing therapy services (GNMLD-TALK)' (PI: Prof. Joshua Stott), to design and deliver tailored psychological intervention for people affected by genetic and non-memory-led dementias which runs until 2028.
First Year Of Impact 2021
Sector Communities and Social Services/Policy,Education,Healthcare
Impact Types Societal

Policy & public services

 
Description Invited speaker at Royal College of Occupational Therapists Pan London Memory Service OT Network meeting about challenges and strategies for people affected by dementia-related visual impairment.
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact Training delivered to pan-London memory network of Occupational Therapists about the specific challenges associated with dementia-related visual impairment they may come across in their caseloads as well as potential strategies to ameliorate difficulties in independent function in this population.
 
Description Lecture to North East London NHS Foundation Trust (NELFT) Research and Development Department on supporting people affected by non-memory-led dementias and the development of accessible resources for patients and families.
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact Highlighting the specific accessibility challenges of people with rarer forms of dementia including dementia-related visual impairment and reporting on their preferences and priorities for intervention to inform research agendas and local practice by attending practitioners and research and development teams.
 
Description Centre for Equality in Brain Sciences Small Grants - Project title: An exploration of the barriers and facilitators to accessing care and support for people from diverse backgrounds living with rare forms of dementia.
Amount £1,981 (GBP)
Organisation University College London 
Sector Academic/University
Country United Kingdom
Start 01/2024 
End 07/2024
 
Description Postgraduate scholarship
Amount £4,400 (GBP)
Organisation University of East London 
Sector Academic/University
Country United Kingdom
Start 08/2021 
End 06/2023
 
Description Psychosocial support for people affected by Genetic and Non-Memory Led Dementias: developing digital provision and understanding the role of existing TALKing therapy services (GNMLD-TALK).
Amount £1,911,592 (GBP)
Funding ID NIHR203680 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 03/2023 
End 03/2028
 
Description Co-facilitation of Walking in your Footsteps creative workshops funded as part of the Trellis: Arbor knowledge exchange programme to explore experiences of living in a family affected by familial Alzheimer's disease. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact 15-20 people affected by a rarer form of inherited dementia attended a creative collaging workshop to share their stories of living with a genetic dementia to inform the development and co-creation of a series of artistic outputs to be shared with the public.
Year(s) Of Engagement Activity 2023
URL https://www.ucl.ac.uk/ion-dri-programme/public-art/trellis-arbor/walking-your-footsteps
 
Description Filming for In2Research national website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact Filming for In2Research scheme which supports disadvantage young people to access careers in science and research - invited to share my experience as a host of a successful placement in 2022 and to disseminate the In2Research mission and encourage wider participation (https://in2scienceuk.org/).
Year(s) Of Engagement Activity 2023
URL https://in2scienceuk.org/
 
Description Invited presentation at DemiQual Spring meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact I presented my PhD research findings at the DemiQual Spring meeting which is a collective of academic and clinical researchers working in dementia using qualitative methods and this was a themed session on sensory loss and dementia. ~20 other researchers and practitioners attended and engaged in a critical discussion about the challenges associated with rarer forms of dementia and the particular challenges and benefits of qualitative methods with underrepresented groups.
Year(s) Of Engagement Activity 2022
 
Description Invited speaker at Rare Dementia Support Canada peer support group for people living with posterior cortical atrophy 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact I was invited to attend an international peer support group for people affected by posterior cortical atrophy and their family members to present my PhD research findings about activity engagement and to workshop strategies with them to support continued engagement in meaningful activities within their own everyday environments.
Year(s) Of Engagement Activity 2022
URL https://raredementiasupport.ca/community/group-support-and-education/support-groups/
 
Description Invited speaker at Rare Dementia Support Familial Alzheimer's disease annual seminar 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact ~60 patients and families affected by Familial Alzheimer's disease attended for an all-day support group meeting, talks, presentations and interactive activities. I provided a talk and engagement activity about psychological support needs and demonstrated strategies.
Year(s) Of Engagement Activity 2022
URL https://www.youtube.com/watch?v=NgydryDKqcs
 
Description Invited speaker at Rare Dementia Support Posterior Cortical Atrophy webinar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact An interactive presentation with Clinical Psychologist Dr Joshua Stott to communicate the Acceptance and Commitment Therapy model to support group members and to demonstrate how the techniques can be applied for people affected by posterior cortical atrophy and their family members to help manage the psychological and emotional impact. Attendees were invited to express interest in future focus groups about their specific psychological support needs and experiences engaging with talking therapies.
Year(s) Of Engagement Activity 2021
URL https://www.youtube.com/watch?v=Tf1SZvlYVH4&t=4398s
 
Description Invited speaker at Rare Dementia Support Young Onset Alzheimer's disease support group webinar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact ~60 people affected by Young Onset ALzheimer's disease, their family and health and social care professionals working with this population attended for my presentation on the family impacts of a diagnosis of YOAD to learn about coping strategies and signposting for further support.
Year(s) Of Engagement Activity 2021
URL https://www.youtube.com/watch?v=wCX3eizzKlw&t=2743s
 
Description Liverpool Dementia and Ageing Forum 4th Annual Conference Oral presentation: 'The Oxygen of Shared Experience' - Understanding the value of peer support for people affected by rare and young onset dementias 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Oral presentation titled ''The Oxygen of Shared Experience' - Understanding the value of peer support for people affected by rare and young onset dementias', presented at Liverpool Dementia and Ageing Forum 4th Annual Conference to ~200 delegates from a range of academic and professional practice disciplines. The talk prompted debate and discussion about the specific and unmet needs of people affected by lesser known dementias, the value and potential of peer support and the challenges with ensuring the sustainability of support. At this conference I was invited to join the INTERDEM Taskforce on inequalities in dementia care to collaborate on raising awareness of the inequalities faced by people affected by less common forms of dementia.
Year(s) Of Engagement Activity 2022
URL https://liverpooldementiaageingresearchforum.co.uk/4th-annual-conference/
 
Description Panellist and co-facilitator of public engagement workshop Talking Lines: Stories of diagnosis and support as told by those with lived experience of rarer forms of dementia at Drawing Room, London 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact 30 members of the public, practitioners, students and people living with dementia attended a workshop at the public gallery and exhibition space Drawing Room in London where they learned about a new creative methodology via an experiential workshop, attended a film screening sharing stories of those affected by rare forms of dementia and participated in a Q&A panel with members of the research team. The event sparked lots of questions and discussion and requests for further information and involvement as well as interest in setting up spin off projects.
Year(s) Of Engagement Activity 2023
URL https://drawingroom.org.uk/event/talking-lines-workshop-screening-and-panel-discussion/
 
Description Presentation at FTD UK annual meeting May 2023 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Presentation at FTD UK annual meeting about developing digital psychosocial interventions to support wellbeing for people affected by FTD and their families. Following the presentation audience members expressed interest in hearing more and networking to support collaboration and signposting from their patient groups to our research studies looking at developing tailored support for people affected by rarer dementias.
Year(s) Of Engagement Activity 2023
 
Description Presentation at Rare Dementia Support national PCA conference (London) April 2023. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact Presentation about adapting psychological support for people affected by Posterior Cortical Atrophy in terms of specific psychological impacts of the diagnosis as well as accessibility needs arising from lesser known symptoms of dementia-relates visual impairment. The talk prompted enquiries into the possible options for psychological therapy and means of accessing as well as requests for further information.
Year(s) Of Engagement Activity 2023
 
Description Presentation at Rare Dementia Support online FTD support group webinar (November 2023). 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact Presentation at Rare Dementia Support online FTD support group webinar about developing tailored, blended psychosocial support interventions for people living at risk of familial frontotemporal dementia (online). Following the event we received a range of questions and PPI input towards the development of the resource as well as requests for further involvement and participation.
Year(s) Of Engagement Activity 2023
URL https://www.youtube.com/watch?v=RhteoY4mCz0
 
Description Presentation at Rare Dementia Support online Posterior Cortical Atrophy support group webinar (December 2023) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact Dec 2023 - Presentation at Rare Dementia Support online Posterior Cortical Atrophy support group webinar about the development of a co-produced, sustainable resource to disseminate strategies for living well with PCA among those affected and their family members (online). The presentation prompted requests for further information as well as opportunities for people with lived experience to input and co-develop aspects of the resource.
Year(s) Of Engagement Activity 2023
URL https://www.youtube.com/watch?v=qQqsjvDubSo
 
Description Presentation at national Rare Dementia Support FTD Annual Seminar (London) March 2023. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact Presentation about psychological support for people with or supporting someone with Frontotemporal Dementia at Rare Dementia Support national FTD Annual Seminar (London) - the presentation prompted questions and discussion about options for psychological support and pathways to access.
Year(s) Of Engagement Activity 2023
 
Description UK Dementia Research Institute's Dementia Demystified - breaking barriers to public understanding of dementia 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Patients, carers and/or patient groups
Results and Impact Hosted roundtable discussions including a brief presentation and Q&A with 50 members of the local community with a personal or professional connection to dementia to communicate my research rationale, methods and findings and to hear attendee suggestions for future work and their experiences of research and support.
Year(s) Of Engagement Activity 2022
URL https://ukdri.ac.uk/news-and-events/dementia-demystified-breaking-barriers-to-public-understanding-o...