1. The Stockport Memory Assessment Service
Dr Carol-Ann McArdle (Associate Specialist)
Carol Rushton
(Clinical Lead)
Alison Hargreaves (CPN)

2. Aims of session
The dementias and their diagnosis
What makes a ‘good’ referral
MAS - pathway
Medications
Post diagnostic groups
Shared care re referrals
Q and A

3. “I forget things, doctor…”
What to do next?

4. “Just old age” or The beginnings of a dementia?

5. There are different types of dementia:
Dementia is an umbrella term
There are different types of dementia:

6. Alzheimer’s Disease: memory loss, lack of vascular risk factors (patient generally well) Dementia with Lewy Bodies: parkinsonism, fluctuations, visual hallucinations, REM sleep disorder (physically acting out dreams) Dementia in Parkinson’s Disease: Parkinson’s disease diagnosed first, dementia develops later Frontotemporal Dementia: behavioural difficulties, disinhibition, personality change, (memory not bad) Alcohol related dementia: Global impairment in setting of high alcohol intake

7. Vascular dementia?

8. Please - if you are happy to diagnose vascular dementia, you do not need to refer in for a diagnosis
Look for:
Vascular risk factors
A more physically ill patient – obese, poor mobility, breathless
Subcortical picture: slowness, lack of initiative and motivation, apathy (may present as depression “They don’t want to do anything doctor, just sit in that chair all day”)

9. Vascular Dementia Conference
If you make a diagnosis of a vascular dementia, your patient can still access post diagnostic support from the Memory Assessment Service
Vascular Dementia Conference
Edgeley Park
31/1/19

10. Possible presentations of a dementia.
Memory problems (? Alzheimer’s)
Behavioural difficulties (? Frontotemporal dementia)
Apathy / lack of motivation (? Vascular dementia)
Hallucinations (? Dementia with Lewy bodies)
Delirium (? Not dementia)

11. Is it just “old age”…
The assessing clinician needs a good history to understand when and what changes have been seen in the patient. An observer history is extremely valuable so…
…a good referral will include carer contact details.
A mental state examination picks up level of insight, any language problems, repetitiveness, mood disturbance or psychosis
A cognitive assessment gives the extent and pattern of difficulties

12. …or the start of a dementia?
A dementia screen of bloods and ECG will pick up (non cerebral) potentially reversible causes of memory loss and confusion so… …a good referral will include a dementia screen A brain scan will pick up (cerebral) potentially reversible causes of memory loss and confusion, and may give more information about the cause of the memory problems.

13. An ideal referral Clinical info: Carer contact details
Good history (symptoms, time scale, functioning, associated physical illness?)
Past medical history
Drug history
Dementia screen
Demographic info:
Ethnicity, marital status and religion

14. Can’t remember all that
Can’t remember all that? Referral form available (on EMIS) ‘Old Age Psychiatry Referral Form’

15. GP Referral Form for Old Age Psychiatry
DATE
NHS NO
NAME
DOB
ADDRESS
ETHNICITY
RELIGION
REFERRER Name, Address, Phone and Fax
NEXT OF KIN Name, Address and Contact Details
CONSENT GIVEN
Yes No
PRIORITY
URGENT
ROUTINE
REASON FOR REFERRAL
PLEASE INCLUDE THE NATURE OF THE PROBLEMS, CURRENT CIRCUMSTANCES AND IDENTIFIED RISKS

16. MEDICAL HISTORY AND LIST OF PRESCRIBED MEDICATION
PLEASE INCLUDE SCREENING BLOODS AND A COPY OF A 12 LEAD ECG IF APPROPRIATE
PAST PSYCHIATRIC HISTORY
Please include dates of last contact with services
PLEASE SUBMIT THIS FORM AND ANY ADDITIONAL INFORMATION TO SPOE OVER 65
TEL: OPTION 3
FAX:

17. Referral arrives in SPOE
Referral triaged by SPOE.
Once complete, KPI start date recorded.
Referral passed on to MAS for allocation
Referral allocated to doctor
(1/3)
Referral allocated to nurse
(2/3)
If concern, patient allocated to a doctor for a follow up visit
Assessment and diagnosis at one appointment
If no concern, patient discussed in MAS MDM with doctor and discharged back to GP
Doctor does further assessment and makes a diagnosis if appropriate

18. Medication follow up clinic
For patients with Alzheimer’s disease, dementia with Lewy bodies, and dementia in Parkinson’s disease.
Follow up will increasingly be by our support workers.
We are aiming to discharge patients within 3 months

19. NICE Guidelines 2018 The NICE guidelines allow for:
Anticholinesterases to be prescribed in combination with memantine.
GPs prescribing and titrating memantine without specialist involvement
Anticholinesterases and memantine’s use in BPSD

20. Post diagnostic groups
Alzheimer’s information session
Vascular information session
Dementia with Lewy Bodies information session
Frontotemporal dementia support group
In Two Minds (for patients)

21. Post diagnostic groups (cont.)
Living Well With Dementia Session(for carers)
Followed by:
Living Well With Dementia Drop In (carers)
*New for 2019*
MAS Monthly Drop In Clinic (carers known to MAS)
As Dementia Progresses (course)
End of Life information session

22. New driving assessment centre
RDAC Manchester AJ Bell Stadium 1 Stadium Way Barton-upon-Irwell Salford M30 7EY Phone: Fax: Can make referrals on website: (Health professional referral costs £40, self referral, £80)

23. MAS re-referrals We get approximately 25 re-referrals a month
MAS staff can:
Review of anti-Alzheimer medication including considering whether memantine would be appropriate
Manage BPSD
Give carer support
(MAS does not have a S/W so referrals to do with the package of care at home will be redirected by SPOE to social services.)
We are changing our approach to this part of the service by starting a monthly drop in clinic for re referred patients.

25. Key Messages
We are hoping that today will encourage (more) good referrals and in particular referrals that include carer contact details and a dementia screen Empower GPs to make their own vascular dementia diagnoses And raise awareness of our post diagnostic groups

26. Any Questions?