DEMENTIA Leena Patel GPSTR

Overview  Causes of dementia  Differential diagnosis  Dementia and QOF

Degenerative diseases  Alzheimer’s  Lewy body dementia  Vascular  Mixed (e.g. Alzheimer's & vascular)  Parkinson’s disease  Huntington’s chorea  CJD  Picks disease

Treatable causes of Dementia  Vitamin lack - B12, folic acid - B12, folic acid  Endocrine - hypothyroidism - hypothyroidism  Normal pressure hydrocephalus  Severe anaemia  Renal Failure

Other causes of dementia  Traumatic - severe head injury - severe head injury  Infections - post encephalitis, HIV - post encephalitis, HIV  Toxic - alcohol  Space occupying lesion - chronic subdural haematoma, intracranial tumour - chronic subdural haematoma, intracranial tumour

Alzheimer's Vs Vascular  Alzheimer’s - insidious decline -Progressive disorientation -Restless activity -insomnia -Decline in social behaviour -Dysphasia, dyspraxia  Vascular -step-wise decline -Episode of confusion -Seizures -Neurological signs

Lewy body Dementia  Progressive  Fluctuating course  Hallucinations (visual)  Delusions  Parkinsonism signs

Differential diagnosis  Functional or organic? E.g.. Depressive pseudo dementia, dementia presenting as mood disorder  Delirium or dementia

Delirium Vs Dementia  Delirium -Acute -Fluctuates -Impaired consciousness -Thinking disorganised -Perceptual disturbances common -Impaired alertness  Dementia -Insidious -Stable/progressive -Normal consciousness -Impoverished thinking -Perceptual disturbance uncommon -Alert

QOF indicators for dementia  Practice can produce a register of pts diagnosed with dementia  Percentage of pts diagnosed with dementia whose care has been reviewed in the previous 15 months.

Dementia review template  Annual review  Discussion with carer (pt care needs, info)  Assessment of carer needs  Old age psychiatry referral

References  Psychiatry; 2 nd Edition; Gelder, Mayou, Geddes  Quality and Outcomes Framework guidance for GMS contract 2009/2010