Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly

Dementia

Dementia is a progressive and largely irreversible clinical syndrome that is characterised by a widespread impairment of mental function.

Although many people with dementia retain positive personality traits and personal attributes, as their condition progresses they can experience some or all of the following: memory loss, language impairment, disorientation, changes in personality, difficulties with activities of daily living, self-neglect, psychiatric symptoms (for example, apathy, depression or psychosis) and out-of-character behaviour (for example, aggression, sleep disturbance or disinhibited sexual behaviour, although the latter is not typically the presenting feature of dementia). (NICE CG42, 2006).

People with dementia usually present first to their family physician, although an estimated 39% present to specialist clinics (neurologists, psychiatrists and geriatricians), (NICE CG42, 2006).

 

The primary care physician (PCP) is often the first physician to observe patients with possible dementia and often the only physician involved in making the diagnosis (van Hout HP, 2007).

 

Difficulty making a diagnosis may necessitate referral to a specialist, such as a geriatrician, neurologist, or psychiatrist, or require the request for further investigations to be completed by a neuropsychologist.

 

For those with mild or questionable impairment, more comprehensive standardized cognitive assessments can be useful to assist with establishing a firm diagnosis; these are normally undertaken as part of a specialist assessment after referral, (NICE CG42, 2006).

 

CHALLENGES

 

Because of the key role that PCPs play in the long-term management of elderly individuals with chronic disease, the growing number of patients with dementia will have a significant impact on these health professionals (Langa KM, 2001).

 

The rising number of patients with dementia means that family physicians will have an increasingly important role in recognizing early signs and symptoms of disease, ordering appropriate tests, formally diagnosing, and, finally, treating these patients (Morris JC, 2001).

However, at present, diagnosing AD can be challenging. In the early stages, AD can be difficult to distinguish from the decline in cognitive abilities due to normal aging and the mild cognitive impairment (MCI) that often precedes AD (Salloway S, 2009) .

 

Furthermore, there are insufficient numbers of neurologists to care for all the patients with MCI and dementia, and there are a limited number of dementia specialists available for consultation. It is, therefore, imperative that PCPs learn how to assess their patients for dementia; specialty clinics cannot deal with the numbers of patients—a problem that will only worsen as the population continues to age.

Dementia is one of 4 sub-domains of the

Psychological Assessment

The Psychological Assessment is one of 8 domains of the

 Comprehensive Geriatric Assessment (CGA)

Psychological Assessment
Psychological Assessment
Psychological Assessment

Back To : Psychological Assessment

Back To : Comprehensive Geriatric Assessment

Comprehensive Geriatric Assessment
Comprehensive Geriatric Assessment
Comprehensive Geriatric Assessment

Types of dementia :

Progressive dementias

Types of dementias that progress and aren't reversible include:

  • Alzheimer's disease.

    • In people age 65 and older, Alzheimer's disease is the most common cause of dementia.

    • Although the cause of Alzheimer's disease isn't known, plaques and tangles are often found in the brains of people with Alzheimer's. Plaques are clumps of a protein called beta-amyloid, and tangles are fibrous tangles made up of tau protein.

    • Certain genetic factors might make it more likely that people will develop Alzheimer's.

 

  • Vascular dementia.

    • This second most common type of dementia occurs as a result of damage to the vessels that supply blood to the brain.

    • Blood vessel problems can be caused by stroke or other blood vessel conditions.Lewy body dementia.

 

  • Lewy bodies dementia.

    • Lewy bodies are abnormal clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer's disease and Parkinson's disease.

    • This is one of the more common types of progressive dementia.

 

  • Frontotemporal dementia.

    • This is a group of diseases characterized by the breakdown (degeneration) of nerve cells in the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior and language.

    • As with other dementias, the cause isn't known.

 

  • Mixed dementia.

    • Autopsy studies of the brains of people 80 and older who had dementia indicate that many had a combination of Alzheimer's disease, vascular dementia and Lewy body dementia.

    • Studies are ongoing to determine how having mixed dementia affects symptoms and treatments.

 

Other disorders linked to dementia :

 

  • Huntington's disease.

    • Caused by a genetic mutation, this disease causes certain nerve cells in your brain and spinal cord to waste away.

    • Signs and symptoms, including a severe decline in thinking (cognitive) skills usually appear around age 30 or 40.

 

  • Traumatic brain injury.

    • This condition is caused by repetitive head trauma, such as experienced by boxers, football players or soldiers.

    • Depending on the part of the brain that's injured, this condition can cause dementia signs and symptoms, such as depression, explosiveness, memory loss, uncoordinated movement and impaired speech, as well as slow movement, tremors and rigidity (parkinsonism).

    • Symptoms might not appear until years after the trauma.

 

 

  • Creutzfeldt-Jakob disease.

    • This rare brain disorder usually occurs in people without known risk factors.

    • This condition might be due to an abnormal form of a protein.

    • Creutzfeldt-Jakob disease can be inherited or caused by exposure to diseased brain or nervous system tissue.

    • Signs and symptoms of this fatal condition usually appear around age 60.

​​

  • Parkinson's disease.

    • Many people with Parkinson's disease eventually develop dementia symptoms (Parkinson's disease dementia).

 

Dementia-like conditions that can be reversed :

Some causes of dementia or dementia-like symptoms can be reversed with treatment. They include:

 

  • Infections and immune disorders.

    • Dementia-like symptoms can result from fever or other side effects of your body's attempt to fight off an infection.

    • Conditions such as multiple sclerosis that result from the body's immune system attacking nerve cells also can cause dementia.

  • Metabolic problems and endocrine abnormalities.

    • People with thyroid problems, low blood sugar (hypoglycemia), too little or too much sodium or calcium, or an impaired ability to absorb vitamin B-12 can develop dementia-like symptoms or other personality changes.

  • Nutritional deficiencies.

    • Not drinking enough liquids (dehydration); not getting enough thiamin (vitamin B-1), which is common in people with chronic alcoholism; and not getting enough vitamins B-6 and B-12 in your diet can cause dementia-like symptoms.

  • Reactions to medications.

    • A reaction to a medication or an interaction of several medications can cause dementia-like symptoms.

  • Subdural hematomas.

    • Bleeding between the surface of the brain and the covering over the brain, which is common in the elderly after a fall, can cause symptoms similar to dementia.

 

  • Poisoning.

    • Exposure to heavy metals, such as lead, and other poisons, such as pesticides, as well as alcohol abuse or recreational drug use can lead to symptoms of dementia.

    • Symptoms might resolve with treatment.

  • Brain tumors.

    • Rarely, dementia can result from damage caused by a brain tumor.

 

  • Anoxia.

    • This condition, also called hypoxia, occurs when organ tissues aren't getting enough oxygen.

    • Anoxia can occur due to severe asthma, heart attack, carbon monoxide poisoning or other causes.

​​

  • Normal-pressure hydrocephalus.

    • This condition, which is caused by enlarged ventricles in the brain, can cause walking problems, urinary difficulty and memory loss

NICE guidelines : CG42

Dementia : Supporting people with dementia and their carers in health and social care. (Nice CG42, 2006)

view/access

Practical Guidelines for the Recognition and Diagnosis of Dementia 

(Galvin JE, 2012)

view/access

An Approach to Diagnosing and Assessing Dementia in Primary Care

view/access

Behavioural and Psychological Symptoms of Dementia (BPSD)

 

Behavioural and psychological symptoms of dementia (BPSD) refer to the often distressing non-cognitive symptoms of dementia and include agitation and aggressive behaviour. BPSD have been defined as symptoms of disturbed perception, thought content, mood or behaviour, frequently occurring in patients with dementia.

Assessment and Management of People With Behavioural and Psychological Symptoms of Dementia (BPSD).

(RANZCP, 2013).

view/access   (pdf 1,340 KB)

The Use of Antipsychotics in Residential Aged Care.

(RANZCP, 2011)

view/access

Assessment of Patients with BPSD

view/access

Back To : Dementia

Dementia
Dementia
Dementia

This Read More page is an extension of Dementia