1. The Memory Assessment and Treatment Service (MATS)
Dr. Liam Higgins
Consultant Psychiatrist

2. What is Dementia?
Dementia is a syndrome due to disease of the brain, usually of a chronic progressive nature, in which there is a disturbance of multiple higher cortical functions.
Consciousness is not clouded
Often accompanied and sometimes preceded by deterioration in emotional control, social behaviour or motivation

3. ICD-10 definition Evidence of each of the following:
A decline in memory, Mostly in new learning (verbal and non-verbal)
Mild, Moderate, Severe
A decline in other cognitive abilities: judgement & thinking
Absence of clouding of consciousness
A decline in emotional control/motivation/social behaviour
Duration at least six months; if shorter the diagnosis is tentative

4. Early Symptoms Struggling to remember recent events Forgetting names
Repeated questioning
Misplaced objects
Others commenting on forgetfulness
Anxiety/depression

5. Epidemiology UK 700,000 (2008); 1.4 million (2038)
Cost £17 billion (2008); £50 billion (2038)
60yrs-65yrs – 1.6% doubling every 5 years
Under 65: male > female; over 65: female > male
Lobo A et al (2000)
C) 2.2% of those affected with dementia are under 65

6. Causes of dementia Alzheimer’s Disease Mixed Vascular Dementia
Dementia with Lewy Bodies
Fronto temporal Dementia
Others

7. Treatable/Reversible causes
Deficiency (B12, Folic acid, Thiamine)
Electrolyte imbalances (chronic)
Metabolic (uraemia, hepatic problems)
Endocrine (hypothyroidism)
Normal Pressure Hydrocephalus
Tumour/trauma (SOL & SDH)
Infection/Inflammation (HIV, SLE etc)
Alcohol, toxins and drugs

8. Alzheimer’s Disease General criteria for dementia
Insidious onset with slow deterioration
No evidence of other possible causes of dementia
CT scan: generalised cerebral atrophy, more in the medial temporal lobe

9. Vascular Dementia Uneven impairment of cognitive functions
There is clinical evidence of focal brain damage
Abrupt onset and stepwise deterioration
Evidence of stroke, hypertension, other risk factors for vascular disease
Personality relatively preserved, emotional lability
Large vessel infarct: Small ischaemic changes

10. Lewy Body Dementia Core features: Fluctuating cognition
Recurrent well formed and detailed visual hallucinations
Features of parkinsonism
Suggestive features:
Repeated falls
Sensitivity to antipsychotics

11. Fronto temporal Dementia
Early decline in social interpersonal conduct
Impairment in regulation of personal conduct
Emotional blunting
Loss of insight
Neuropsychology: impaired frontal lobe tests
Imaging: Frontal and/or anterior temporal abnormality

12. The National Dementia Strategy
Ensure better knowledge
Help everyone to understand dementia better.
Get rid of the stigma attached to dementia
2) Ensure early diagnosis
Only about a third of people with dementia ever have a proper diagnosis
3) Develop services

13. Early
diagnosis
Liaison
services
Education
National
Dementia
Strategy
Carers
assessments
Dementia
Advisors
Support at
home

14. NICE Guidelines (PACE Guidelines)
Early identification in Primary Care
Consider referring people with signs of mild cognitive impairment (MCI) for assessment at memory assessment services
Be aware of the increased risk of dementia in people with learning disabilities
The possibility of dementia in other high risk groups (for example people who have had a stroke or have a neurological condition such as Parkinson’s disease)

15. Diagnosis and assessment
History taking
Physical examination
Review of medication to identify any drugs
That may impair cognitive functioning
Conduct formal cognitive testing using standardised instrument, such as
Mini Mental State Examination (MMSE)
General Practitioner Assessment of Cognition (GPCOG)
6 Item Cognitive Impairment Test (6-CIT)

16. Investigation of Suspected dementia
Conduct a basic dementia screen at the time of presentation, usually in primary care.
Include:
-routine haematology
-biochemistry tests (electrolytes, calcium, glucose, and renal and liver function)
-thyroid function tests
-serum vitamin B12 and folate levels

17. Structures of the Clinics
History, Mental State Examinations
Addenbrooke’s Cognitive assessment –
Revised (ACE-R)
Carer assessment
Input from Alzheimer’s society
Medication commenced and titrated
(according to NICE guidelines)

18. Access to services
Financial
help
Medication
The benefits
of receiving
a diagnosis
Carer support
Information and
support