Harjinder Kaur Community psychiatric nurse manager – Asian link Diagnosing Vascular Dementia in South Asian Communities: The importance of a culturally appropriate assessment tool Harjinder Kaur Community psychiatric nurse manager – Asian link

Background In 1999, health and social care agencies in Wolverhampton (West Midlands, UK) became aware of the large numbers of people from Black, Asian and Minority Ethnic (BAME) communities and their under- representation in mental health services. Consequently, Fordementia (now Dementia UK) commissioned a research project which reviewed the relevant literature, engaged with local community leaders and organisations, and identified and interviewed people with suspected dementia and their carers from South Asian and African Caribbean communities (Twice a Child, 2001). The findings led to wide ranging recommendations in several areas and a policy decision was made to appoint a CPN – Asian Link Team Leader, to help implement these recommendations.

My role Promote knowledge, understanding and sensitivity of cultures within services Provide outreach within communities Improve and increase access to services Involve communities in the planning process Initial assessments Supporting consultants with diagnosis

Wolverhampton City (2011 census) Ethnicity - Based on Census 2011 data, the majority of residents in the city belong to the White ethnic group (64.5%), whilst the percentage of Black, Asian and Minority Ethnic (BAME) residents has risen since 2001 by 11% to 35.5%. The percentage of Asian residents has risen from 14% to 18%. Mixed ethnic group residents has increased from 3% to 5% and the percentage of Black residents has risen from 5% to 7%. Country of Birth - According to the Census 2011, of the 16% of residents in the city who were born outside of the UK, 6% were born in India, 3% European Union, 2% Africa, 1% Poland, 1% Pakistan, 1% Zimbabwe, 1% Irish Republic, 1% Poland. Religion - Wolverhampton now has the 2nd highest percentage of Sikh residents in England. Sikh residents account for 9% of the city’s population (England = 0.8%). Christian residents continue to account for the majority of the population at 56%, however, this group has seen an 11% decrease since 2001. Those residents who stated that they had no religious affiliation increased by almost 9% to 20%. This trend mirrors the national picture.

Dementia in ethnic minorities Low dementia diagnosis Need for early intervention Avoid crisis Vascular dementia is most common in South Asian and African Caribbean communities High incidences of hypertension and diabetes Diet Misdiagnosis

Challenges for diagnosis Differences in…. Language Migration Culture Value and Beliefs

Standardised Mini Mental State Examination (SMMSE) SMMSE was developed in 1975 in New York and is a brief measure of cognitive functioning and its change taking about 10 minutes by a trained interviewer to complete. It has high test-retest reliability, internal consistency and high inter-observer reliability

Addenbrooke’s Cognitive Examination ACE-III The Addenbrooke’s Cognitive Examination-III (ACE-III) is a screening test used to assess cognitive performance. It is often used in conjunction with the Standardised Mini Mental State Examination (SMMSE) to provide more detailed screening of cognitive abilities on later life and is helpful in the diagnosis of dementia. The assessment focusses on the five cognitive domains in more detail: attention memory verbal fluency language visuospatial abilities

Rowland Universal Dementia Scale (RUDAS) RUDAS is a relatively new tool in comparison to the MMSE. RUDAS was developed in a multicultural setting in Australia. It is a brief six item screening test which is short and easy to administer and so far, is the most effective tool for diagnosing dementia in ethnic minorities.

What does the RUDAS involve? Functional, practical tests Relies on verbal communication Memory recall; a story Movement and co-ordination Memory recall; the story Visual Planning and judgement 1 minute test

Why I like this tool… It’s friendly and fun Takes away the fear of having an assessment done They do not have to admit that they cannot read or write You can use information from the initial assessment to assist with the tool You still have to be able speak their language and dialogues They have to hear you (and understand) and see you

Dementia in South Asian communities now… Improved dementia diagnosis rates Started in 2001… By 2006, 88 clients By 2011, 135 clients By 2012 an additional CPN was employed FT, Asian Link PT Now, a total of 368 clients, with approximately 60 from memory clinic referrals.

Thank you & any questions? Contact details Harjinder Kaur: hkaur2429@gmail.com