Recognising and Diagnosing Dementia in Primary Care · •Early diagnosis •Consider staging...
Transcript of Recognising and Diagnosing Dementia in Primary Care · •Early diagnosis •Consider staging...
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Recognising and Diagnosing Dementia in Primary Health Care
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• Why early diagnosis?• Patient and Informant history• Work up
• Cognitive screening/assessment• Physical• Differential diagnosis
• Identification of risks• Delivering the diagnosis
• Initial support
• Referral to secondary services• Self care
Topics Covered
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Subjective memory
impairment
Mild cognitive
impairment
Mild dementia
Moderate dementia
Sever dementia
Loss of physical
functions
Dying and death
Post bereavement
Assessment focused on diagnosis , exclusion of reversible causes/ serial
assessments
Patient / Whanau education Anticipatory planning i.e. EPOA,
ACP
Assessment focused on individual functioning
Dementia and care goals
Care in the community-----------------------------------------------------------Aged Residential Care--------------------------------------
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• What might make you suspect cognitive impairment?
• What are the barriers, why might we miss identifying cognitive impairment?
How do we capture cognitive impairment early ?
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How do we capture cognitive impairment early?
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How do we capture cognitive impairment early?
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• History• Individual
• Informant - IQCODE
• Physical examination
• Initial cognitive screening
• Investigations
Initial consultation
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• Differentiating delirium, Dementia and Depression
• Blood tests• FBC• TSH• Glucose• Electrolytes• Creatine• Calcium• B12• Folate• Liver function tests• HbA1c• CRP• Consider if appropriate HIV, syphilis
aetiology
• Urine• MSU
• Neurological exam
• CT head• Check local guidelines
• Consider CXR ECG
Investigations
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• Cognitive screen:• 6CIT
• GPcog
• Cognitive assessment:• MOCA
• RUDAS
• ACE R
Cognitive assessment
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Risk assessment
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• Consider an extended consult, bringing family/whanau
• More than normal ageing
• Discuss how diagnostic results have lead to diagnosis
• Naming the condition allows access to information services and any support that is available.
• Refer to local Alzheimer's society
• As required referrals to Needs Assessment team
• EPOA
• Advanced Care planning/advanced directives
Giving a diagnosis
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• BPSD – occurs in 50 to 80% of dementia
• Rapidly deteriorating individual
• Young age onset
• Atypical presentation
• Language or translation difficulties
• Past significant head injury
• Chronic neurological disorders
• Intellectual disability
• Specific defects, ie speech only
Referral to specialist service
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It takes a village
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Summary
• Early diagnosis
• Consider staging workup• History
• Timeframe• Individual and Informant• Change in functioning• Cognitive screen
• Diagnostic testing• Bloods• CT• MSU• Neuro exam• Cognitive assessment
• Differential diagnosis
• Giving a diagnosis
• Risk assessment
• Referral to secondary care
• It takes a village!
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• Goodfellow unit - Dementia https://www.goodfellowunit.org/courses/dementia?course=introduction
• Map of Medicine Whanganui • Cognitive impairment assessment dementia suspected
• New Zealand Framework for Dementia Care http://www.health.govt.nz/publication/new-zealand-framework-dementia-care
References