Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,

Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health

Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,

Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health

Diagnosis and Early Management of Dementia

Madeleine Adams

Occupational Therapist

Team Leader SACS Cognitive Services

madeleine.adams@easternhealth.org.au

Ph: 9955 1230

Overview

• Eastern Health SACS Cognitive Service

• How to refer - Inclusion/Exclusion Criteria

• Cognitive enhancing medication

• Future Planning

Eastern Health Cognitive Service

• Cognitive, Dementia and Memory Service (CDAMS)

• Geriatric Evaluation and Management (GEM)

• Knox, Maroondah, Monash, Manningham, Whitehorse, Yarra Ranges

CDAMS

• CDAMS targets people with early changes that may include:– Increased forgetfulness of recent events– Changes in language skills– Difficulty with complex tasks– Decreased interest in hobbies and activities– Slowed thinking– Altered behaviour 

CDAMS Service & Location

• CDAMS operates at two sites:

– Wantirna Health• Services clients from mainly from council areas of Monash,

Whitehorse, Knox, Manningham

– Yarra Ranges Health (Lilydale)• Services clients mainly from council areas of Yarra Ranges

and Maroondah

CDAMS - Referral Criteria

• For cognitive assessment where:– No previous diagnosis of dementia– Diagnosis is the primary reason for referral– Specialist diagnosis is required for medication– Person is medically stable– Person agrees to attend

CDAMS - Exclusion Criteria

• Recent onset of cognitive decline

• Urgent assessment

• People with longstanding impairment (e.g. ABI)

• People aged < 50 complaining of memory problems in the context of

stress, anxiety, depression

• People whose diagnosis is known

• People requiring neuropsychological assessment only

CDAMS - Exclusion Criteria

• People with moderate to severe dementia symptoms

• People with complex psychiatric conditions who may also have cognitive changes

• People who are physically unable to attend the clinic

GEM• People with more severe impairment may be more appropriate

for GEM:– Difficulties managing own personal care

– Becoming lost in own home

– Difficulties recognizing family and friends

– Have a diagnosis but need Geriatrician advice for a medication trial

GEM – Service & Location

– GEM operates at two sites:– Peter James Centre (East Burwood) – Wantirna Health

• Clients attend closest clinic or fastest appointment

GEM Referral Criteria

• Referral is for cognitive assessment and diagnosis is the primary reason for referral

• Specialist opinion is required for consideration or review of medication

• The person is medically stable• The person is physically able to attend centre based appointments• The person agrees to attend or can be persuaded by family/carer

GEM Exclusion Criteria• Recent onset of cognitive decline• People with complex psychiatric conditions• People with early changes to memory and thinking or who require

multidimensional evaluation• People from a CALD background are strongly preferred to be

referred to CDAMS for cognitive assessment• Where carer stress or need for counselling/education/community

supports is the primary reason for referral

GEM Exclusion Criteria

• People whose diagnosis is known and behavioural or psychological

disturbance is the primary issue

• People requiring allied health/nursing assessment and treatment

• People who are physically unable to attend the clinic

• Referrals for testamentary capacity or neuropsychological

assessment only

Referral to CDAMS/GEM

• Referrals are received via the Access Unit at Peter

James Centre on the EH SACS referral form

• Anyone can refer to CDAMS and GEM, however it is our

strong preference that the GP is involved

• Wait times vary contact EH Access Unit Ph: 9881 1100

Cognitive Enhancing Medication

• Both GEM and CDAMS provide this service • For people given a diagnosis of Alzheimer’s Disease or

Dementia with Lewy Bodies• Involves screening for risk factors and consideration of

side effects• Standardised cognitive testing before and after a 6

month trial

Cognitive Enhancing Medication

• Two main types of medication– Acetylcholinesterase inhibitors

• Mild-moderate dementia

– Mematine• Moderate –severe dementia

• Both work by moderating the effects of neurotransmitters in the brain

Treatment Options

• The current medication is only available for a diagnosis of Alzheimer’s Disease (or mixed dementia)

• Medication is initiated as a trial - client can receive 6 months supply through PBS, but needs to demonstrate a beneficial effect of the medication to qualify for ongoing PBS subsidy.

CRITERIA FOR CONTINUED PBS SUBSIDY

• Improvement of 2 points or more in MMSE

• Improvement (decrease) of 4 points or more in ADAS-Cog score

Medication Issues

• The medication can have side effects so there needs to be consideration of the benefit versus the risk

• Trial needs to be well managed - start at a low dose and increase to full dose after 1 month if well tolerated

• Client needs to reliably take medications/assistance needs to be organised

• If no improvement is seen, ongoing prescriptions must be privately purchased.

Future Planning

• CDAMS provides advice about future planning in the context of a dementia diagnosis

• This involves looking at:– Driving ability– Legal Issues – eg. Enduring Powers of Attorney– Advanced Care Planning– Services, supports and residential care

Future Planning

• Linkage with services from community service providers:– Alzheimer's Australia Victoria (AAV)

• Living With Memory Loss programs• Counselling/Education• Memory Lane Café

– Planned Activity Groups/Day Centres