1. The diagnosis of dementia - 2
Dr Johan Schoeman
Consultant in Old Age Psychiatry
SEPT in Luton and Bedfordshire
2nd November 2010

2. Overview
Diagnosis in Memory Assessment Service

3. Cognition Higher Brain Function – thinking for ourselves
performing complex tasks
reading
writing
calculation
learning new information
language use in communication
short term memory

4. Cognition Executive function – having insight control of emotion
control of inhibition
social awareness
awareness of physical surroundings
aspects of memory
aspects of language
use of initiative
level of motivation

5. What we measure Memory – verbal }immediate and delayed
visual }immediate and delayed
Language
Visuospatial skills
Executive function
Attention and orientation
WTAR

6. Cognition Use as screening tool Brief and simple
Be aware of – educational level
cultural background
language
sensory deficits
TYM test
MMSE
Clock Drawing Test
ACE-R

7. TYM (Test Your Memory) 1 Quick (5 minutes) Uses 10 cognitive tasks
Validated against MMSE and Addenbrooke's
Powerful in detecting mild Alzheimer's disease
1 Brown 2008

8. TYM - Example

9. Clock Drawing Test Takes 2 minutes
Encompasses frontal lobe functioning
Simplicity and non-threatening
Instructions:
Draw a large circle
Mark in the numbers
Draw the hands to indicate 11 minutes past two

10. Clock Drawing Test

11. Mini Mental State Examination1
10 minute test (scored out of 30 points)
Test of cognition not of dementia
No executive items
Poor detecting cognitive impairment –
well-educated
poorly educated
NICE use this as cognitive ‘gold standard’-
21/30 and above: minimal-no impairment
10-20 mild impairment
<10 severe impairment
1 Folstein MF, 1975

12. MMSE

13. ACE-R 1 Addenbrooke’s Cognitive Examination – Revised
20 minutes to perform
Contains in it the MMSE
Executive function tests –
Verbal and Category Fluency
Limitations: Educational and Cultural
At 88/100 sensitivity 72% (MMSE 27/30 36%)
At 82/100 sensitivity 56% (MMSE 24/30 11%) 2
1 John R Hodges, 2000
2 Gaber T, 2008

14. ACE-R

15. Advanced Cognitive Testing
WAIS-III

16. Phineas Gage
Boston Post 21/09/1848

17. Executive function (frontal lobe)
Phonemic (verbal) fluency – FAS test
Name as many words starting with letter F A S
Category fluency
name as many animals you can starting with any
letter
Discrepancy in between above scores are
sensitive indicator of organicity

18. Verbal and Category Fluency
Letter - P
>
<
Category - Animals
>
<

19. Similarities What is the similarity between the following:
monkey and dog
shirt and dress
table and chair
banana and apple
plant and animal

20. Trails A and B

21. Approximations How long would a window cleaner take to clean
the windows of an average bungalow?
- 1 and half days
- 20 minutes
- 45 minutes
- 4hours 15 minutes
What is the lifespan of a dog?
What does an elephant weigh?
How high is the Eiffel Tower?
How fast can an average man run?

22. Luria Hand Test Go/no-go Test Fist – Edge – Palm test
The patient is asked to make a response to one signal (the Go
signal) and not to respond to another signal (the no-go signal). The most basic is to ask the patient to tap their knee when the examiner says, “Go” and to make no response when the examiner says, “Stop”

23. Physical Examination Blunted affect Expressionless facies
Glabellar reflex
Rooting reflex
Pout reflex
Grasp reflex
Palmar-mental reflex

24. Questions and Discussion