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DEMENTIA

DEMENTIA. Leena Patel GPSTR. Overview. Causes of dementia Differential diagnosis Dementia and QOF. Degenerative diseases. Alzheimer’s Lewy body dementia Vascular Mixed (e.g. Alzheimer's & vascular) Parkinson’s disease Huntington’s chorea CJD Picks disease.

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DEMENTIA

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  1. DEMENTIA Leena Patel GPSTR

  2. Overview • Causes of dementia • Differential diagnosis • Dementia and QOF

  3. Degenerative diseases • Alzheimer’s • Lewy body dementia • Vascular • Mixed (e.g. Alzheimer's & vascular) • Parkinson’s disease • Huntington’s chorea • CJD • Picks disease

  4. Treatable causes of Dementia • Vitamin lack - B12, folic acid • Endocrine - hypothyroidism • Normal pressure hydrocephalus • Severe anaemia • Renal Failure

  5. Other causes of dementia • Traumatic - severe head injury • Infections - post encephalitis, HIV • Toxic - alcohol • Space occupying lesion - chronic subdural haematoma, intracranial tumour

  6. Alzheimer’s - insidious decline Progressive disorientation Restless activity insomnia Decline in social behaviour Dysphasia, dyspraxia Vascular step-wise decline Episode of confusion Seizures Neurological signs Alzheimer's Vs Vascular

  7. Lewy body Dementia • Progressive • Fluctuating course • Hallucinations (visual) • Delusions • Parkinsonism signs

  8. Differential diagnosis • Functional or organic? E.g.. Depressive pseudo dementia, dementia presenting as mood disorder • Delirium or dementia

  9. Delirium Acute Fluctuates Impaired consciousness Thinking disorganised Perceptual disturbances common Impaired alertness Dementia Insidious Stable/progressive Normal consciousness Impoverished thinking Perceptual disturbance uncommon Alert Delirium Vs Dementia

  10. 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.

  11. Dementia review template • Annual review • Discussion with carer (pt care needs, info) • Assessment of carer needs • Old age psychiatry referral

  12. References • Psychiatry; 2nd Edition; Gelder, Mayou, Geddes • Quality and Outcomes Framework guidance for GMS contract 2009/2010

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