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MENTAL CAPABILITY in the ELDERLY

MENTAL CAPABILITY in the ELDERLY. CASE PRESENTATION. Mr Max Rich. WHAT IS FRAILTY?. Irremediable dependence CAUSES cognitive impairment mobility failure both. Dementia. Memory and other Cognitive Impairment That Affects Daily Function. Causes of Dementia. Common

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MENTAL CAPABILITY in the ELDERLY

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  1. MENTAL CAPABILITYin theELDERLY

  2. CASE PRESENTATION Mr Max Rich

  3. WHAT IS FRAILTY? Irremediable dependence CAUSES cognitive impairment mobility failure both

  4. Dementia Memory and other Cognitive Impairment That Affects Daily Function

  5. Causes of Dementia Common Alzheimer’s disease Vascular dementia Mixed AD and VaD Less Common Frontal temporal dementia Dementia with Lewy Bodies Parkinson’s disease with dementia Normopressure Hydrocephalus 7

  6. Progression

  7. MILD • forgets recent events • trouble with complex tasks • SLOW to understand and accomplish things

  8. MODERATE • Doesn’t know year or address • Word-finding trouble • Very poor short-term memory

  9. SEVERE • Doesn’t recognize relatives • Wanders • Needs constant supervision

  10. Who needs evaluation? A person may • Want to do an important task • Want to make a will • Apparently need help or protection • Have to make an important health care decision

  11. General Principles • Capability is Particular • Capability is Presumed • Is incapability permanent?

  12. Mental Incapability CAUSES Easy and Hard

  13. Easy Dementia Mood Disorders Psychosis

  14. Hard Disorders of judgement Mental retardation Intermittent incapacity Delirium Medication Alcohol

  15. Hardest • Communication problems • “out of practice” at task

  16. TESTAMENTARY CAPACITY The bar is low… • Nature and effect • Assets • Heirs • Delusional? • (Undue influence)

  17. Who MIGHT be Incapable? • Elderly • Strange • Emotional • Drunk etc

  18. Screening For Dementia 1. MMSE (Folstein) 2. Montréal Cognitive Assessment (MoCA) 3. Sloan’s shortcut

  19. Who ya gonna call?? • Client’s GP • Psychiatrist • Geriatrician • Neurologist • GP with special interest

  20. John P Sloan MD tosloan@shaw.ca 604 788 4037 24 hours

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