How do we diagnose

dementia?

Why do we even

bother?

Dr Nyein Nyein Nyi Nyi

Geriatrician

Southcare, Sutherland Hospital

What is dementia? Disease

Not a normal part of ageing

More common with age

Neurodegenerative disorder

Exact cause unknown in many cases

Progressive

Gradual decline

Variable rate

What is dementia?

‘Progressive decline in brain function’

Memory impairment

Speech impairment

Judgement and planning skills

Ability to carry out daily functions

Bowel and bladder control

Walking and swallowing

Affects daily life

What is the difference

between dementia and

Alzheimer’s disease? Dementia

Describes someone with a progressive cognitive decline

Many illnesses cause dementia

Alzheimer’s disease is the most common cause of dementia

Other causes of dementia

Vascular dementia (‘Multi-infarct dementia’)

Lewy Body disease

Mixed ( Alzheimer’s disease and vascular disease)

Fronto-temporal dementia, alcohol related, sport/trauma

related.....

How do we diagnose

dementia? History

Cognitive tests

Physical examination

Blood tests, rarely lumbar puncture

Brain scans

CT scan

MRI scan

Nuclear medicine scans

History Story of the patient’s symptoms and signs

Specific problems and concerns

Short term memory impairment, word finding difficulties,

disorientation, difficulty driving, hallucinations,....

Story from the patient and the family

Patients often are not aware of their problems

MOST IMPORTANT AND HELPFUL PART OF THE

REVIEW

How do we diagnose

dementia? Memory tests

Mini-mental state examination

Montreal cognitive assessment, ADAS-Cog

Neuropsychological assessments

Physical examination

Strokes, Parkinson’s disease

Blood tests

Vitamin B12, Folate, thyroid function

Brain scans

How do we diagnose

dementia? No definitive blood tests or scans to diagnose the

different dementias (yet )

Help to confirm or exclude our clinical assessment

“brain biopsy”

Clinical diagnosis

Assess each patient individually

“pattern recognition”

Is it dementia?

What type of dementia?

Alzheimer’s disease

Short-term memory impairment

Repeat same statements and questions

Disoriented to time, place

Other symptoms manifest later

Slow, gradual, steadily progressive

decline

Physical exam normal

Brain scan shows “atrophy”- shrinkage

Vascular dementia

History of strokes, high blood pressure

Stepwise deterioration

Poor judgement with relatively preserved

memory

Physical and brain scan evidence of

previous strokes

Lewy body disease

Cognitive impairment

Parkinsonian features

Tremor, impaired walking

Hallucinations, paranoia, delusions

Significant fluctuations

Frontal lobe dementia

Short term memory well preserved

Change in personality

Poor insight, poor planning

Disinhibited

Brain scan may support diagnosis

Why do we bother diagnosing

dementia?

You may NOT have dementia

Anxiety due to family history of dementia

Other conditions can mimic dementia

Depression

Sleep apnoea

Poorly controlled diabetes

Electrolyte and hormonal disturbances,...

These need appropriate treatments

Why do we bother diagnosing

dementia?

Explanation for the symptoms and

changes

Knowledge and education

You are not “stupid”, you are forgetful

Know that you are not alone facing these

challenges

Other patients and carers

Community support

Alzheimer’s Australia

Why do we bother diagnosing

dementia?

Plan for the future

Will

Enduring power of attorney

Enduring guardianship

Living accommodations

Travel and lifestyle decisions

Treatments for dementia

There is no cure YET

Medications to slow down the progression of

dementia

Acetyl-choline cholinesterase inhibitors

Galantamine/Reminyl

Donepezil/Aricept

Rivasigmine patch/Exelon

Memantine/Ebixa

Helpful for variable amount of time

Medications for dementia

Not miracle cures

Slow down the progression of symptoms

Maintain independence longer

Short-term memory same

Concentration better

Improve word finding difficulties

Side-effects

Treatments for dementia

Symptomatic treatments

Depression and anxiety

Hallucinations, paranoia and delusions

“Sundowning” with agitation,

aggression

Insomnia, altered day-night cycle

Treatments for specific types

of dementia

Alzheimer’s disease

Acetylcholine esterase inhibitors

Memantine

Lewy body disease

Rivastigmine patch

Vascular dementia

Prevent further strokes

Frontal lobe dementia

Forward planning

Treatments for dementia

To slow down progression of

disease:

Physical exercise

Socialising

Keeping active and busy

Maintain good physical health

Southcare

“One stop shop in Aged Care”

Medical/ Geriatricians

7 Geriatricians

Out-patient clinics at Southcare

Acute in-hospital care

Acute assessment in Sutherland Hospital

Emergency Department

In-patient care

Behavioural unit

Rehabilitation

Orthogeriatric service

Medical consultations

Southcare

Mobility clinic

Individual physiotherapy assessments

Occupational therapy

Podiatry

Dietician

Continence nurses

Southcare

Aged Care Assessment Team (ACAT)

My Aged Care

Aged care facility liason

Community nurses

Dementia Home Monitoring

Community options

Southcare

The Cottage (Dementia Day Care)

The Retreat (Frail Aged Day Care)

Pulmonary Rehabilitation gym

Sutherland Heart-lung team (SHALT)

Sutherland transitional care (STACS)

Equipment lending pool

Southcare

Geriatric Flying Squad

Treat acute medical problems in the nursing homes)

Southcare Outreach Service (SOS)

Acute issues at home

Southcare : 9540 7175

Geriatrician’s office: 9540 7109