Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
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