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Core business for general practice: recognition of and response to dementia

Core business for general practice: recognition of and response to dementia. Ngaire Kerse Professor, General Practice and Primary Health Care, University of Auckland Steve Iliffe Professor of Primary Care for Older People University College London Practice Based Commissioner, Brent PCT

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Core business for general practice: recognition of and response to dementia

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  1. Core business for general practice: recognition of and response to dementia Ngaire Kerse Professor, General Practice and Primary Health Care, University of Auckland Steve Iliffe Professor of Primary Care for Older People University College London Practice Based Commissioner, Brent PCT www.evidem.org.uk

  2. What is dementia? • A complex multi-factorial syndrome. Querfurth H , Laferla M Alzheimer’s Disease N. Engl J Med 2010;362:329-44 • Memory loss plus one other impaired cognitive domain • Not rocket science

  3. How do you know you are normal? Based on the Clinical Dementia Rating scale (CDR) Hughes CP et al A New Clinical Scale for the staging of Dementia Br J Psychiatry 1982;140:566-572

  4. Global assessment ~ early dementia

  5. Cognitive impairment & dementia Global cognitive functioning Normal ageing A D1 B Linguistic skill and general intelligence decline over decades D2 C D Symptomatic but pre-diagnostic phase with brain compensation occurring, over several years E Symptomatic & post-diagnosis phase, with progressive decline over years Dementia trajectory Time

  6. Cognitive assessment Diagnosis Informant history Cognitive function tests Blood screen (FBC, thyroid function) Scanning NICE 2006 • Mini-Mental State Examination (MMSE) • 6CIT • GPCog • MOCA • Verbal fluency • Clock drawing

  7. Psychosocial support • Regular doctor-initiated contact • Catastrophic thinking, beliefs attitudes fears • Review global assessment • Focus on ‘still do’, reframe as a disability • Manage co-morbidities • Review support needed • Carer’s health Robinson L et al for the DENDRON Primary Care Clinical Studies Group Primary care & dementia: 2 Case management, carer support & the management of behavioural and psychological symptoms IJGP 2009; Nov 27 [Epub ahead of print]

  8. Core business in general practice • Continuity of contact • Population reach • Pattern recognition • Problem solving not protocol driven • Systematised care Mary • 75 yrs, widowed 2 yrs, Hx breast cancer age 50 • Complains of losing her keys, forgetting appointments, even left her best dress at the drycleaners for 2 months

  9. Now 2 years time Brought by daughter Noticed definite change (you have too) Disheveled MMSE 22 diagnosis ?Alzheimers type Bloods, request imaging • MMSE 26 • Depressive symptoms • Offer treatment • Talking, exercise and drugs • Improves

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