Early Detection of Dementia by rt3463df

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									Early Detection of Dementia

          John Puxty
    (includes slides contributed by
       Drs W Dalziel, MF Rivard
“A Working Definition of Dementia”

Progressive and abnormal deterioration of
memory, and at least one other area of
cognitive function, which is affecting the
daily life of the patient, and not due to
affective disorders or delirium.
 Any Memory Concerns expressed by the
 Elderly or Caregivers must be evaluated

Canadian Consensus Conference on
 Dementia:
  – Memory Complaints should be evaluated
    and the individual followed to assess
    progression
  – Complaints should be considered very
    seriously if confirmed by caregivers /
    informants. Cognitive assessment and
    careful follow-up recommended

      (Patterson: Can J. Neuro Sci 2001; 28 (Suppl. 1) S 3-16).
     Is it worth screening for Cognitive
  Impairment is in High Risk Populations?

American Academy of Neurology
  – General cognitive screening instruments (e.g.
    MMSE) should be considered for the
    detection of dementia when used in patient
    populations with an elevated prevalence of
    cognitive impairment due to age or presence
    of memory dysfunction (Guideline).

                       (Peterson: Neurology 2001; 56:133-42)
 Informant Questionnaire To Screen for Dementia
     [If Total Over 3 Points  Full Cognitive Assessment]

Informant Questionnaire (4 Questions)
1.   Does the patient repeat or ask the same thing over and over?

      Not at all – 0 points   Mild – 1 point         Severe – 2 points
2.   Does the patient have problems remembering appointments, family
     occasions or holidays?
      Not at all – 0 points   Mild – 1 point         Severe – 2 points
3.   Does the patient have problems deciding which groceries or clothes to
     buy?
      Not at all – 0 points   Mild – 1 point         Severe – 2 points
4.   Does the patient have problems taking medications according to
     instructions?
      Not at all – 0 points   Mild – 1 point         Severe – 2 points
Behavioral Flags for Professionals

 1. Frequent phone calls.
 2.    Poor historian, vague, seems “off”.
 3.    Poor compliance: meds/instructions.
 4.    Appearance / mood / personality.
 5.    Word finding / decreased interaction.
 6.    Appointments - missing / wrong day.
 7.    Confusion: surgery, illness, meds.
 8.    Weight loss / dwindles.
 9.    Driving: accident / problems.
 10.   Head turning sign (Turning to caregiver for answer).
Early differentiation of dementia
 In Alzheimer Disease, memory and
  orientation are impaired early.
 In Lewy Body, Frontotemporal and Vascular
  dementias, executive functions are impaired
  early (with relatively preserved memory and
  orientation).
 Psychological and behavioral symptoms
  (apathy, depression, anxiety, irritability) may
  occur early in dementia.

								
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