Dementia: diagnosis and management
Dr Grace Lee talks with Dr Diana North FRNZCGP about the key components of assessment that a practitioner may incorporate into their personalized framework for evaluating dementia.
Topics covered include:
- Brief overview of cognitive impairment and candidates for assessment.
- Key points of assessment: memory, level of functioning, informant history, blood tests and neurological examination.
- Consideration of differential diagnosis and red flags for referral.
- Tips for streamlining the process of assessment.
Dr Diana North is a current Fellow of the RNZCGP with a special interest in chronic disease and has previously trained as a Public Health Physician. She has been a Clinical Director of the NZ Health Foundation and held a number of roles within Waitemata DHB. Diana is currently working with Waitemata DHB on the KARE project which is aimed at developing a comprehensive package of interventions to keep older adults healthier at home.
In the next video, Diana discusses the management of dementia, including:
- Discussing the diagnosis of dementia.
- Optimizing physical health by treating conditions that improve or maintain health.
- Managing patient wellbeing with broader aspects of self-care, social, financial and future planning.
- Resources for education and support for carers and family.
Resources
- Dementia short course
- Dementia care for Māori short course
- Recognising and managing early dementia bpacnz (2020)
- Living well with dementia podcast with Ngaire Kerse (2020)
- MoCA Test
- Rudas Test
- GPCOG Informant Interview
- Assessing decision-making capacity: the clinical basics short course
- Mate wareware: Understanding 'dementia' from a Māori perspective N Z Med J. (2019)
Patient resources
- Alzheimers NZ
- Carers NZ
- Dementia NZ
- Dementia Health Navigator NZ
- Seniorline NZ
- Advance care planning HQSCNZ
- Supporting Families NZ
Peer group discussion points |
Diana discussed a number of cues that may indicate a need for further assessment such as DNAs, head turning, difficulty answering questions or increased involvement of friends and relatives in the consultation narrative.
There are some key points that we should cover during our assessment. During the first MedTalk, Diana discusses the domains of memory assessment, level of functioning, informant history, physical examination and investigations.
Some patient may require further investigations or services, particularly those that present with atypical dementia.
Limited consultation time is one of the constraints of diagnosing and managing cognitive impairment or dementia in general practice.
Breaking bad news is a challenging task which requires a considered and tactful approach.
We should be aiming to optimise health by treating conditions that improve or maintain health. Medications are one of the parameters we should review.
Optimisation of patient wellbeing extends into broader aspects of self-care, social, financial and future planning.
Managing dementia is a challenge for care givers and family and they often look to their primary care provider for advice and support.
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