diagnostic memory clinic & dementia services dr sandra evans lead clinician
TRANSCRIPT
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Diagnostic Memory Clinic & Dementia Services
Dr Sandra Evans Lead Clinician
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Outdated view of Dementia Diagnosis
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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
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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
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Memory Clinics
• Purpose built for “diagnostics”• Prescribing & CST• Aftercare & psycho-education• counselling / therapy for distress / carer• Impact – reduce distress• Reduce BPSD• Prevent institutionalisation
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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
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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.
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Diagnostic Memory Clinics
• Earlier diagnoses /MCI and its vicissitudes• BPSD• Anxiety disorders• Depression • Paranoid psychoses• Alcohol & substance-related issues• Multiple co-morbidities
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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
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Mental State Examination
• Appearance and Behaviour• Speech• Affect• Mood – subjective, objective• Thoughts• Perceptions• Cognition• Insight
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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
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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)
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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
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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
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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
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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
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YOUNG ONSET DEMENTIA
Case vignettes
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MR A- HISTORY
• Presented at 52• History of 2 year decline in function and
personality change • Performance deteriorated • Some depressive symptoms• Possible family history?
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Symptomatology
• Change in personality• Apathy• Extreme tiredness• Distractibility• Disinhibition• Suicidality
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DIAGNOSIS FTD
• Made at NHND on History, features and MRI• DAT scan negative• EEG- normal• Depression
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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
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Ongoing difficulties
• Boredom• Maintaining safety - telecare • Relationships• Engagement with services• Young and fit (fast)
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THANK YOU for LISTENING
Felstead St.0203 222 8500