Dementia diagnosis doorway Dr Ethie Kong GP and Chair of NHS Brent #BigBrentDebate Improving services & Supporting communities DiagnosisRisk factors

Before diagnosis… Memory getting worse Hard to think clearly Hard to communicate clearly Daily tasks become more difficult Can feel demoralised, worried and sad Uncertain about the future Unsure what to do, or who can help Not sure if other family members are at risk too #BigBrentDebate

Risk factors for dementia… #BigBrentDebate Aged over 65 Physical illness Culture Family history

Process of diagnosis… #1 Temporary condition Treat the underlying illness Delirium Life-long illness Treat to slow or reduce some symptoms Rule out temporary delirium, look at the medical history, use quick cognitive tests. GP can diagnose undifferentiated dementia. #BigBrentDebate BothDementia

Benefits of diagnosis of ‘undifferentiated dementia’… Diagnosis of ‘undifferentiated dementia’ can be a doorway to practical advice How to: Cope now Plan for the future Find support for carers Slow the symptoms and get check-ups Reduce the risks for other family members Work with care-homes and local communities on adaptations #BigBrentDebate

Estimated 2,500 people with dementia Brent dementia data… #BigBrentDebate Data from 2014/15 GP register – currently c.350, people in care homes GP list size No. diagnosed

National drive to increase diagnosis rates. Brent one of the top boroughs (77.1%) #BigBrentDebate Brent September 2014March 2015 <50%50-55%55-60% %>66.6%

Ethical and clinical judgement about doing further diagnostic tests… When is the right time to do more investigations? Tests take time and resources Knowing the type of dementia will not change the treatment of symptoms for mild or moderate dementia (88%) Some drugs may slow severe Alzheimer’s disease; some drugs can reduce severe feelings of distress Severity of dementia in Brent in 2015 #BigBrentDebate Mild Moderate Severe

Process of diagnosis… #2 Undifferentiated Dementia Dementia with Lewy bodies Alzheimer's disease Vascular dementia Frontotemporal dementia Specialist diagnosis requires travel and time, CAT scan, blood tests and psychiatric assessment. Can benefit people with severe dementia or distressing symptoms #BigBrentDebate

Commissioning intentions… More GPs giving ‘undifferentiated dementia’ diagnosis –Opens the dementia diagnosis doorway earlier –Less reliance on psychiatrists to give a diagnosis –Refer people for specialist diagnosis at a time when they might benefit Support from specialist nurses in primary care –For carers and patients –For care-home staff and acute hospital staff –Ensuring regular follow-up happens –Crisis plans, so less need to use A&E Support from peer support workers –Links to community resources (not just NHS) –Part of a Dementia Friendly Brent –Regular check-ins with carers and patients #BigBrentDebate

What are your ideas…? Pubic meetings, online survey, twitter, In November, the CCG Governing Body will consider public and patient feedback to set the strategic direction for our contract negotiations (Jan-Mar’16). A public meeting will be held in January to tell you how your ideas influenced our plans. #BigBrentDebate