Download DEMENTIA - Derby GP Specialty Training Programme

DEMENTIA
Leena Patel
GPSTR
Overview
 Causes of dementia
 Differential diagnosis
 Dementia and QOF
Degenerative diseases
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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
 Endocrine
- hypothyroidism
 Normal pressure hydrocephalus
 Severe anaemia
 Renal Failure
Other causes of dementia
 Traumatic
- severe head injury
 Infections
- post encephalitis, HIV
 Toxic
- alcohol
 Space occupying lesion
- chronic subdural haematoma, intracranial
tumour
Alzheimer's Vs Vascular
 Alzheimer’s
- insidious decline
- Progressive
disorientation
- Restless activity
- insomnia
- Decline in social
behaviour
- Dysphasia, dyspraxia
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Vascular
step-wise decline
Episode of confusion
Seizures
Neurological signs
Lewy body Dementia
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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
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Delirium
Acute
Fluctuates
Impaired consciousness
Thinking disorganised
Perceptual disturbances
common
- Impaired alertness
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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; 2nd Edition; Gelder, Mayou,
Geddes
 Quality and Outcomes Framework
guidance for GMS contract 2009/2010