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Dr. Aisling Denihan, Consultant Psychiatrist for Older People,
Co. Meath
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My time in M.I.R.A. From M.I.R.A. To Navan Green-field site Lots of “no’s” Oh, and no office 2003-2010 MMSE, CDT, abbrev. CAPE Tertiary referral
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Ceiling effect – MMSE Resources even scarcer Unmet need, late presentations Early 2009 – something new needed Enthusiastic SR, keen team Support of Robert Coen/M.I.R.A.
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Where? Who to contact? Cognitive Assessment team Clerical support? Pharma money? Referral form Exclusion criteria
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Patient plus Doctor and S/W Informant plus Doctor and S/W Collateral Hx., NPI, PSMS, IADL S/W – supports, legal, financial Patient plus Nurses – neuropsych. testing MDT consensus meeting Feedback session
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Addenbrooke’s Cognitive Examination Montreal Cognitive Assessment (MoCA) Delayed Word Recall Test (DWR) MMSE +/- Frontal Assessment Battery (FAB) Interesting observations
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OPD unsuitable Too many chiefs... 2 locations do not work Quality-control issues Inappropriate referrals Incomplete referrals
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48 referrals, 38(80%) met criteria Of 38, 28 via GP, 5 via Cons. Psychs., 5 via
our community case load 38 assessments scheduled, 2 DNA’s, 4
pending 32 full assessments, most within 4/52 19 (59%) female, 13 male Mean age (range 51-85y)
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10 (20%) in total Reasons – Incomplete referrals - 5 Patient deceased - 1 Established dx., on Rx - 2 MMSE < 19 - 2
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DIAGNOSIS NUMBER
Alzheimer’s Disease
10 (early onset = 2) 31%
Mixed AD/VaD 6 19%
Pure VaD 3 (MID = 1) 9%
Frontal Dementia
1 3%
Alcohol- Related 1 3%
MCI 8 25%
Other Dx 3 9%
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28/32 (88%) came for feedback 3 DNA, 1 did not want feedback 15/32 – drug Rx. Suggested Information folder provided Follow-up - GP 13 Us 11 Other 8
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To scan or not? Blood dementia screen? No physical exam Copyright issues – MMSE Managing expectations - preseniles ADL in males?
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Truth-telling or fudge? Driving advice – rural pop. Schiz/BAD neuropsych. No-shows for feedback? MCI is not a dx. Ref. Rate waxes and wanes No monitoring clinic
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MCI Link up with GM regionally? Monitoring Clinic at 6/12? No S/W for 9/12 – buy sessions? Carer support – Zarit B.I., group Not in Vision for Change
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