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

  

Patient resources

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.

  • How do you identify patients of potential concern? What is your approach when family and patients cite specific concerns about memory and behavior?

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.

  • What key questions and screening tools (e.g. MOCA and RUDAs) do you use to identify activities of daily living or instrumental activities of daily living level?
  • Informant history is an important part of the assessment. Do you use formal assessment tools such as the GPCOG informant interview or an informal discussion?  

Some patient may require further investigations or services, particularly those that present with atypical dementia. 

  • How confident are you in recognising atypical features of dementia? If not, are there local educational resources that you can tap into? What service pathways are in your area for referral?

Limited consultation time is one of the constraints of diagnosing and managing cognitive impairment or dementia in general practice.

  • Are there any other strategies that you use to stream line assessment such as using quick keys or organising other staff members for components of assessment?

Breaking bad news is a challenging task which requires a considered and tactful approach.

  • Reflect on your own experiences giving and receiving bad news. Share your experiences and ideas with your peer group about the challenges of breaking bad news and what works well when discussing a new diagnosis.

We should be aiming to optimise health by treating conditions that improve or maintain health. Medications are one of the parameters we should review.

  • Anticholinergic medication may worsen dementia symptoms, do you routinely review these medications in your elderly patients? Have you considered an audit for this at-risk group?

Optimisation of patient wellbeing extends into broader aspects of self-care, social, financial and future planning.

  • What are the local services in your area for support and further education?
  • How do you link in discussion around wills, EPOAs, ACP? Do you routinely discuss this prior to your patients becoming unwell? If so, what strategies do you use to tie it into a consultation?  

Managing dementia is a challenge for care givers and family and they often look to their primary care provider for advice and support.

  • Are you aware of your local support services? What educational resources do you direct your patient to?

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Date Published: 
Monday, February 24, 2020

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This presentation is intended for qualified health practitioners professional development and should not be relied upon for any other purpose. Any opinions offered are those of the presenter or other speaker and do not necessarily represent the views of Goodfellow Unit.