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Dementia Masterclass December 2013

Dementia Masterclass December 2013 Types of Dementia, key features, prognostic issues and when to re-refer. Dr A R McMahon ST4 Old Age Psychiatry. Objectives of this session. Outline the key presenting features of types of dementia

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Dementia Masterclass December 2013

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  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?

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