Dementia

• Dementia:

  • Irreversible, progressive decline and impairment of more than one aspect of higher brain function - concentration, memory, language, personality, emotion
  • Occurs without impairment of consciousness
  • Increasing age is the biggest risk factor
  • Can only be proven post-mortem
• If you suspect a person to have dementia, use a screening validated cognitive assessment tool, if dementia is suspected then refer to specialist memory services:

  • 10-point cognitive screener (10-CS)
  • 6-item cognitive impairment test (6CIT)
  • Mini-Cog
  • Test your memory (TYM)
• Arrange appropriate blood tests to exclude reversible causes:

  • FBC
  • ESR and CRP
  • U+Es
  • Calcium
  • HbA1c
  • LFTs
  • TFTs
  • B12 and folate
  • Other tests if clinically appropriate - urine MCS, chest XR, ECG, syphilis and HIV serology
• Addenbrooke's Cognitive Examination-III (ACE-III):

  • Detailed assessment tool for memory impairment typically used by specialist memory services
  • Can take up to 90 minutes to complete and 5 domains are tested:
  • Attention
  • Memory
  • Language
  • Visuospatial function
  • Verbal fluency
  • Scored out of 100 - score of 88 or less indicates possible dementia
• Behavioural and psychological symptoms of dementia (BPSD):

  • Depression
  • Anxiety
  • Agitation
  • Aggression
  • Disinhibition (e.g. sexually inappropriate behaviour)
  • Hallucinations
  • Delusions
  • Sleep disturbance
• Medication options for managing BPSD are only used where necessary and cause significant side effects. Options include:

  • SSRI antidepressants for depressive symptoms
  • Antipsychotic drugs (typically risperidone first-line)
  • Benzodiazepines (only for crisis management)