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Diagnostic Memory Clinic & Dementia Services
Dr Sandra Evans Lead Clinician
Outdated view of Dementia Diagnosis
Dementia• Term for irreversible degenerative brain
disease• Alzheimer’s most common -60%• NOT inevitable outcome of aging• Memory is only one possible symptom• Personality, speech, skills & awareness all at
risk
Diagnosis of Dementia
• Alzheimer’s Disease• Insidious• Confusion• Disorientation• STM• Awareness lacking• MTL & Hippocampus
• Vascular Dementia• Step wise• Vascular risk factors• Patchy memory loss• Insight preserved• Peri-ventricular
lucencies
Memory Clinics
• Purpose built for “diagnostics”• Prescribing & CST• Aftercare & psycho-education• counselling / therapy for distress / carer• Impact – reduce distress• Reduce BPSD• Prevent institutionalisation
Pathway • Recognition often delayed• Most via patient’s GP• Neurologist, geriatrician, psychiatrist• Memory assessment & neuropsychology• Neuro-imaging• Arrive at a diagnosis• Give feedback to patient & family with AS• Follow-up
Hospital Admission
Incoming Referral
Interventions by Community TeamsCPA level Criteria
City & Hackney MHCOP PathwayAllocation for Assessment – Health & Social Care Needs
Social Care Review
Single Point of Entry
Initial Screening & Triage
Intermediate Care Team
Dementia Care Team
Diagnostic Memory Clinic
Community Mental Health Team
See separate pathway.
MHCOP Outpatient Clinics
Discharged back to GP and/or other agencies.
Diagnostic Memory Clinics
• Earlier diagnoses /MCI and its vicissitudes• BPSD• Anxiety disorders• Depression • Paranoid psychoses• Alcohol & substance-related issues• Multiple co-morbidities
Dementia needs to be diagnosed earlier…
• But…• May unearth more complexity• Diagnosis raises anxieties and exposes new
needs• Dementia may be an expression of other
conditions• Largely involves more than one person
Mental State Examination
• Appearance and Behaviour• Speech• Affect• Mood – subjective, objective• Thoughts• Perceptions• Cognition• Insight
BPSD-Psychiatric Manifestations of Dementia I
• Most commonly depression and anxiety• delusions: often paranoid, jealousy • auditory hallucinations• visual hallucinations• beliefs exacerbated by confusion and illogical
thinking• disinhibition, aggression, occasional violence
Psychiatric Manifestations II
• Symptoms and behaviours often explicable in terms of patient experience
• sensory deprivations +impaired reality testing=delusional thinking
• receptive dysphasia (difficulties understanding spoken words leads to misunderstanding and fear-eg personal care)
Lack of awareness- Agnosia
• Affects judgement of capability –risk
• Lack of insight disrupts bond of communication
• Reduces sense of shared purpose when Rx or supporting disability
post-diagnostic psychological work
• Family and carer support• Family interventions may improve
communication• Dementia sufferers support groups• Sufferers and carers dialogues- modelling
communication• BPSD- are communications and a way of
understanding distress
Living Well with Dementia
• Recognises that dementia is a chronic condition that can set the sufferer apart
• Aims to reduce fear, further loss & risk of isolation
• Physical & mental health at risk• Improve awareness….• Accept some dependence on
others
Vascular Depression
• More common in late life• Associated with vascular risk factors• Associated with subjective memory loss• May be objective memory loss• Depression may be resistant• Increased likelihood of later dementia
YOUNG ONSET DEMENTIA
Case vignettes
MR A- HISTORY
• Presented at 52• History of 2 year decline in function and
personality change • Performance deteriorated • Some depressive symptoms• Possible family history?
Symptomatology
• Change in personality• Apathy• Extreme tiredness• Distractibility• Disinhibition• Suicidality
DIAGNOSIS FTD
• Made at NHND on History, features and MRI• DAT scan negative• EEG- normal• Depression
Treatment & Management
• No specific treatment for FTD• Supportive measures • Rx Citalopram for depression• Oxytocin for behavioural problems (Jesso et al 2011 Brain,
• CST group & carer support
Ongoing difficulties
• Boredom• Maintaining safety - telecare • Relationships• Engagement with services• Young and fit (fast)
THANK YOU for LISTENING
Felstead St.0203 222 8500