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DEMENTIA Leena Patel GPSTR
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Overview Causes of dementia Differential diagnosis Dementia and QOF
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Degenerative diseases Alzheimer’s Lewy body dementia Vascular Mixed (e.g. Alzheimer's & vascular) Parkinson’s disease Huntington’s chorea CJD Picks disease
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Treatable causes of Dementia Vitamin lack - B12, folic acid - B12, folic acid Endocrine - hypothyroidism - hypothyroidism Normal pressure hydrocephalus Severe anaemia Renal Failure
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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
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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
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Lewy body Dementia Progressive Fluctuating course Hallucinations (visual) Delusions Parkinsonism signs
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Differential diagnosis Functional or organic? E.g.. Depressive pseudo dementia, dementia presenting as mood disorder Delirium or dementia
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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
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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.
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Dementia review template Annual review Discussion with carer (pt care needs, info) Assessment of carer needs Old age psychiatry referral
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References Psychiatry; 2 nd Edition; Gelder, Mayou, Geddes Quality and Outcomes Framework guidance for GMS contract 2009/2010
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