1. Diagnostic Memory Clinic & Dementia Services
Dr Sandra Evans Lead Clinician

2. Outdated view of Dementia Diagnosis

3. Dementia Term for irreversible degenerative brain disease
Alzheimer’s most common -60%
NOT inevitable outcome of aging
Memory is only one possible symptom
Personality, speech, skills & awareness all at risk

4. Diagnosis of Dementia Alzheimer’s Disease Insidious Confusion
Disorientation
STM
Awareness lacking
MTL & Hippocampus
Vascular Dementia
Step wise
Vascular risk factors
Patchy memory loss
Insight preserved
Peri-ventricular lucencies

5. Memory Clinics Purpose built for “diagnostics” Prescribing & CST
Aftercare & psycho-education
counselling / therapy for distress / carer
Impact – reduce distress
Reduce BPSD
Prevent institutionalisation

6. Pathway Recognition often delayed Most via patient’s GP
Neurologist, geriatrician, psychiatrist
Memory assessment & neuropsychology
Neuro-imaging
Arrive at a diagnosis
Give feedback to patient & family with AS
Follow-up

7. City & Hackney MHCOP Pathway
Hospital Admission
Incoming Referral
Interventions by Community Teams
CPA level Criteria
City & Hackney MHCOP Pathway
Allocation for Assessment – Health & Social Care Needs
Social Care Review
Single Point of Entry
Initial Screening & Triage
Intermediate Care Team
Dementia Care Team
Diagnostic Memory Clinic
Community Mental Health Team
See separate pathway.
MHCOP Outpatient Clinics
Discharged back to GP and/or other agencies.

8. Diagnostic Memory Clinics
Earlier diagnoses /MCI and its vicissitudes
BPSD
Anxiety disorders
Depression
Paranoid psychoses
Alcohol & substance-related issues
Multiple co-morbidities

9. Dementia needs to be diagnosed earlier…
But…
May unearth more complexity
Diagnosis raises anxieties and exposes new needs
Dementia may be an expression of other conditions
Largely involves more than one person

10. Mental State Examination
Appearance and Behaviour
Speech
Affect
Mood – subjective, objective
Thoughts
Perceptions
Cognition
Insight

11. BPSD-Psychiatric Manifestations of Dementia I
Most commonly depression and anxiety
delusions: often paranoid, jealousy
auditory hallucinations
visual hallucinations
beliefs exacerbated by confusion and illogical thinking
disinhibition, aggression, occasional violence

12. Psychiatric Manifestations II
Symptoms and behaviours often explicable in terms of patient experience
sensory deprivations +impaired reality testing=delusional thinking
receptive dysphasia (difficulties understanding spoken words leads to misunderstanding and fear-eg personal care)

13. Lack of awareness- Agnosia
Affects judgement of capability –risk
Lack of insight disrupts bond of communication
Reduces sense of shared purpose when Rx or supporting disability

14. post-diagnostic psychological work
Family and carer support
Family interventions may improve communication
Dementia sufferers support groups
Sufferers and carers dialogues- modelling communication
BPSD- are communications and a way of understanding distress

15. Living Well with Dementia
Recognises that dementia is a chronic condition that can set the sufferer apart
Aims to reduce fear, further loss & risk of isolation
Physical & mental health at risk
Improve awareness….
Accept some dependence on others

16. Vascular Depression More common in late life
Associated with vascular risk factors
Associated with subjective memory loss
May be objective memory loss
Depression may be resistant
Increased likelihood of later dementia

17. YOUNG ONSET DEMENTIA
Case vignettes

18. MR A- HISTORY Presented at 52
History of 2 year decline in function and personality change
Performance deteriorated
Some depressive symptoms
Possible family history?

19. Symptomatology Change in personality Apathy Extreme tiredness
Distractibility
Disinhibition
Suicidality

20. DIAGNOSIS FTD Made at NHND on History, features and MRI
DAT scan negative
EEG- normal
Depression

22. Treatment & Management
No specific treatment for FTD
Supportive measures
Rx Citalopram for depression
Oxytocin for behavioural problems (Jesso et al 2011 Brain,
CST group & carer support

23. Ongoing difficulties Boredom Maintaining safety - telecare
Relationships
Engagement with services
Young and fit (fast)

24. THANK YOU for LISTENING Felstead St. 0203 222 8500