1. Dementia Masterclass December 2013 Types of Dementia, key features, prognostic issues and when to re-refer. Dr A R McMahon ST4 Old Age Psychiatry

2. Objectives of this session Outline the key presenting features of types of dementia Outline the difficulties in terms of the prognosis of dementia When to re-refer to Old Age Services.

3. Alzheimer’s Dementia Presenting Features: Insidious nature, subtle presentation. Prognostic Features: Later onset of psychotic features. Family support, maintaining a good level of function. Impact of carer stress on situation. Considering the introduction of social care Potential use of anti-psychotics (short vs. long term) Impact of infection on the patient with Alzheimer’s: Delirium on Dementia. When to Re-refer? Red Flags in Alzheimer’s Dementia Concerns with change in mental state: the emergence of a severe depressive or psychotic episode Considering medications: use of psychotropic medications, compliance and safety issues Capacity and Best Interests considerations

4. Vascular Dementia Presenting Features: Stepwise deterioration in vascular dementia Emotional lability Prognostic Features: Deteriorating course with vascular events, cerebro-vascular changes Depression vs. Emotional lability Emergence of pschotic features (and the use of Psychotropic medications in vascular dementia) Red Flags for re-referral in Vascular Dementia: Emotional lability/unstable mental state and associated features, e.g. aggression and carer stress, especially with a VULNERABLE carer Involving local services to support changing need: Occupational therapy, Physiotherapy, Social Services, Old Age Psychiatry team. Safeguarding issues

5. Lewy Body Dementia (DLB) Presenting Features: Difficulty in (early) diagnosis of DLB Parkinsonian features, fluctuating cognitions and vivid hallucinatory experiences. Neuroleptic sensitivity. Prognostic Features: Unpredictable course, difficult to outline prognostic features Physical implications Increased requirements for care Advanced planning and social care Delirium in DLB Red Flags for re-referral in Lewy Body Dementia: Medication support, difficult prescribing Distress, sleep problems, ‘night terrors’. Hallucinations

6. Fronto-Temporal Dementia (FTD) Presenting Features: Younger onset Personality change, or language problems as an early feature of FTD. Prognostic Features: Prognosis is difficult to predict: rapid and progressive vs. slow and stable. Significant carer stress Capacity/consent and safeguarding issues (e.g. children in the home) Changing mental state/Changing level of need Red Flags for re-referral in Fronto-Temporal Dementia: Changing mental state: consideration of psychotropic medications to treat emerging symptoms Utilising Community teams: YODS/Social Services

7. Re-referral to services Medication Deteriorating mental state - from difficult to treat depression, to acute Mental Health Act referrals Challenging behaviour Specialist community support Safeguarding concerns Capacity assessment/consent issues Carer support and signposting

8. Thank you Any questions?