DEMENTIA Leena Patel GPSTR
Overview Causes of dementia Differential diagnosis Dementia and QOF
Degenerative diseases Alzheimer’s Lewy body dementia Vascular Mixed (e.g. Alzheimer's & vascular) Parkinson’s disease Huntington’s chorea CJD Picks disease
Treatable causes of Dementia Vitamin lack - B12, folic acid - B12, folic acid Endocrine - hypothyroidism - hypothyroidism Normal pressure hydrocephalus Severe anaemia Renal Failure
Other causes of dementia Traumatic - severe head injury - severe head injury Infections - post encephalitis, HIV - post encephalitis, HIV Toxic - alcohol Space occupying lesion - chronic subdural haematoma, intracranial tumour - chronic subdural haematoma, intracranial tumour
Alzheimer's Vs Vascular Alzheimer’s - insidious decline -Progressive disorientation -Restless activity -insomnia -Decline in social behaviour -Dysphasia, dyspraxia Vascular -step-wise decline -Episode of confusion -Seizures -Neurological signs
Lewy body Dementia Progressive Fluctuating course Hallucinations (visual) Delusions Parkinsonism signs
Differential diagnosis Functional or organic? E.g.. Depressive pseudo dementia, dementia presenting as mood disorder Delirium or dementia
Delirium Vs Dementia Delirium -Acute -Fluctuates -Impaired consciousness -Thinking disorganised -Perceptual disturbances common -Impaired alertness Dementia -Insidious -Stable/progressive -Normal consciousness -Impoverished thinking -Perceptual disturbance uncommon -Alert
QOF indicators for dementia Practice can produce a register of pts diagnosed with dementia Percentage of pts diagnosed with dementia whose care has been reviewed in the previous 15 months.
Dementia review template Annual review Discussion with carer (pt care needs, info) Assessment of carer needs Old age psychiatry referral
References Psychiatry; 2 nd Edition; Gelder, Mayou, Geddes Quality and Outcomes Framework guidance for GMS contract 2009/2010