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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