Diagnostic Memory Clinic & Dementia Services

Dr Sandra Evans Lead Clinician

Outdated view of Dementia Diagnosis

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

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

Memory Clinics

• Purpose built for “diagnostics”• Prescribing & CST• Aftercare & psycho-education• counselling / therapy for distress / carer• Impact – reduce distress• Reduce BPSD• Prevent institutionalisation

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

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.

Diagnostic Memory Clinics

• Earlier diagnoses /MCI and its vicissitudes• BPSD• Anxiety disorders• Depression • Paranoid psychoses• Alcohol & substance-related issues• Multiple co-morbidities

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

Mental State Examination

• Appearance and Behaviour• Speech• Affect• Mood – subjective, objective• Thoughts• Perceptions• Cognition• Insight

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

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)

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

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

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

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

YOUNG ONSET DEMENTIA

Case vignettes

MR A- HISTORY

• Presented at 52• History of 2 year decline in function and

personality change • Performance deteriorated • Some depressive symptoms• Possible family history?

Symptomatology

• Change in personality• Apathy• Extreme tiredness• Distractibility• Disinhibition• Suicidality

DIAGNOSIS FTD

• Made at NHND on History, features and MRI• DAT scan negative• EEG- normal• Depression

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

Ongoing difficulties

• Boredom• Maintaining safety - telecare • Relationships• Engagement with services• Young and fit (fast)

THANK YOU for LISTENING

Felstead St.0203 222 8500