Dementia One Day Essentials 2015

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Dementia One Day Essentials 2015"

Transcription

1 Dementia One Day Essentials

2 Dementia One Day Essentials

3 At Risk of Dementia: Mild Cognitive Impairment and Other Non-Dementia Diagnoses Dr Jill Rasmussen

4 Declaration of Interests NHS: GP East Surrey SCN SE Coast Clinical Lead Dementia Honorary Research Fellow Wolfson Institute King s College London Co-developer of MoodHive (Depression Anxiety Pathway) Royal College of General Practitioners Clinical Champion Dementia Chair Learning Disability Special Interest Group Member Dementia Roadmap Steering group Consultancy / Advisory Boards / Speakers Bureau: Alzheimer s Society, Cerestim Ltd, Chase Pharmaceuticals, Edmund de Rothschild, Eli Lilly, Ono, Otsuka, Pfizer, Roche, Servier, Wellcome Trust psi-napse Ref : 4

5 At Risk of Dementia: Questions? What percentage of people who are referred to a Memory assessment service are NOT given a dementia diagnosis? What diagnoses are they given? How should people who are identified as being at risk of dementia be Managed? Reviewed? Supported? How should Risk of Dementia be assessed? 5

6 Diagnosing Dementia Dementia is a clinical diagnosis that should consider all available information : Degree of functional impairment Neuropsychological profile Neuroimaging findings Other relevant data from person or informants 6

7 Cognitive Impairment: Contributions Not all Dementia Age Medications Depression Cognitive Impairment Physical Illness Cerebro Vascular disease Dementia 7

8 Risk Factors for Dementia Age: risk with advanced age. Alcohol use: drinking large amounts of alcohol risk Moderate alcohol may be protective Atherosclerosis: Lipids and cholesterol + inflammatory process low-density lipoprotein (LDL) risk for vascular dementia & Alz Dis Diabetes general risk for dementia Well-proven risk factor for stroke, CV events, risk vascular dementia Hypertension linked to cognitive decline, stroke, and types of dementia that affect the white matter regions of the brain. Mental illness. Depression has been associated with mild mental impairment and cognitive function decline. Smoking Ref: 8

9 Risk Factors for Dementia: - Genetic 1,2 9

10 Dementia: A Progressive Brain Disorder 10

11 Mild Cognitive Impairment Cognitive decline is a common and feared aspect of aging. Mild cognitive impairment (MCI) is defined as the symptomatic pre- dementia stage on the continuum of cognitive decline, characterized by objective impairment in cognition that is not severe enough to require help with usual activities of daily living Ref: Langa JAMA. 2014;312(23):

12 Mild Cognitive Impairment (MCI) Marks a transitional stage between healthy aging and dementia, BUT the understanding of MCI in the general population is limited Is not a unified disease but heterogeneous disorder with subtypes yet to be fully defined. Can no longer be assumed to always be a simple transitional state between normal aging and dementia. Some underlying causes such as psychiatric disorders remain poorly described but are likely to have a distinct phenomenology and course. Refs: 2. Mitchell Acta Psychiatr Scand

13 Mild Cognitive Impairment Subtypes 1 : Amnestic (amci), non-amnestic (nmmci), multi-domain (mmci) Simplified Consensus Criteria 2 Moderate cognitive deficits, short of dementia Self-reported and or informant reported cognitive complaints Impairment on objective clinical cognitive tests Preserved basic activities of daily living & minimal impairment in complex instrumental functions Refs: 1. Petersen, J Intern Med 2004; 2. Mitchell Acta Psychiatr Scand 2009 adapted from Winbald 2004 and Porter

14 Rotterdam Study Investigated determinants, MRI-correlates, and prognosis of MCI within the population-based Rotterdam Study Apo E4 status, waist circumference, hypertension, diabetes mellitus, total and HDL-cholesterol levels, smoking, stroke 4,198 participants were compared at baseline and 7 yrs prior to baseline Followed for 7 to 12 years Results (baseline) Of 4,198 participants, 417 had MCI 163 amnestic, 254 non-amnestic MCI Older age, ApoE4 status, lower total cholesterol levels, and stroke were associated with MCI HDL-cholesterol levels and smoking were related to MCI when assessed 7 years prior to baseline Ref : de Bruijn J Alz and Dem Jul 2014, v 10 14

15 Rotterdam Study Results baseline MCI subset MCI (especially non-amnestic MCI) compared with cognitively healthy had specific MRI correlates of cerebrovascular disease : Larger white matter lesion volumes Higher prevalence of lacunes, MCI was associated with: a four fold risk of dementia HR 3.98, 95%; CI 2.97;5.33, Alz dis (HR 4.03, 95% CI 2.92;5.56) mortality HR 1.54, 95% CI 1.28;1.85). Ref : de Bruijn J Alz and Dem Jul 2014, v 10 15

16 Implications of MCI: Rotterdam Study Ref : de Bruijn J Alz and Dem Jul 2014, v

17 Mild Cognitive Impairment: Findings The prevalence of MCI in adults aged 65 years: Is 10% to 20% Risk increases with age Men appear to be at higher risk than women. In older patients with MCI, clinicians should consider factors that risk for cognitive impairment and other negative outcomes: Depression Polypharmacy Uncontrolled cardiovascular risk factors Ref: Langa JAMA. 2014;312(23):

18 Mild Cognitive Impairment: Findings Currently, no medications have proved effective for MCI; Treatments and interventions should be aimed at: cardiovascular risk factors and prevention of stroke. Aerobic exercise, mental activity, and social engagement may help risk of further cognitive decline. Although patients with MCI are at risk for developing dementia there is currently substantial variation in risk estimates depending on the population studied. from <5% to 20% annual conversion rates Current research targets improving early detection and treatment of MCI, particularly in patients at high risk for progression to dementia. Ref: Langa JAMA. 2014;312(23):

19 Subjective Memory Complaints (SMCs) Are much more common in later life than the objective problems that suggest minor cognitive impairment or dementia Not a characteristic of the worried well, should be taken seriously Associated with depression, older age, female sex, low educational attainment Depression is itself a risk factor for dementia, making the diagnostic task even more difficult A poor predictor of dementia syndrome by themselves When deciding whether to refer to specialist services, practitioners need to rely on rules of thumb to evaluate the extent and possible significance of symptoms or subjective memory loss Ref: Iliffe BMJ

20 Diagnosing Dementia: MCI and / or SMC The key feature that differentiates people with SMC and MCI from those with dementia is the lack of association of the memory complaint with functional impairment Therefore, it seems appropriate that the review of people with SMC and MCI both at the first presentation at a MAS and subsequently either in primary care of in the MAS should include both a cognitive and a functional assessment 20

21 MIMIC: Mnemonic for Characterisation of Patients with Memory Problems Memory loss What Type? Informant history: Use GPCog OR global assessment of early dementia Mood: Depressed mood, now or in the past; PHQ-9 score Individual: Age, sex, education, other long term Psychological problems (anxiety, personality type) Cognitive function test results: 6CIT, GPCog Ref : Iliffe BMJ

22 Characterisation of Memory Impairments Episodic memory - memory of specific past events that involved the person; forgetting a wedding anniversary is qualitatively different from forgetting that you are married. Semantic memory - the store of facts and general knowledge: e.g., knowing the answer to the question who is the monarch? Implicit memory - the non-conscious part of memory that uses past experience to shape current behaviour. Inhibitions may be lost and much offence caused by someone whose manners and social behaviour had been impeccable Executive functioning - the forms of thinking necessary for goal directed behaviour. Anticipation of / adaptability to new situations are reduced Thinking becomes concrete rather than conceptual and abstract. E.g., driving on an unfamiliar route becomes problematic, proverbs lose their meaning Ref : Iliffe BMJ

23 Recommendations: Assessment of MCI: Clinical Dementia Rating Scale Ref: Morris Neurology

24 Early Dementia: Global assessment of Behaviour and Function The patient is impaired by their loss of memory for recent events They may forget that they have already collected their repeat prescription and argue with the receptionist about it) Some variable disorientation occurs in time and place, but not in relation to people Gets lost easily; turns up for an appointment days late or early Some difficulty with complex problems: Understanding what a letter / form is telling / requiring them to do Engagement in some social activities: The individual may appear normal because they retain the ability to conduct small talk ; cannot sustain a serious conversation More difficult tasks and hobbies are abandoned: Bills go unpaid, the garden is neglected Some prompting needed for personal care: Clothes are not washed, baths are missed Ref : Iliffe BMJ

25 Brief Dementia Screening Indicator for Primary Care Ref: Barnes Alzheimer s & Dementia 10 (2014)

26 Recommendations: Management of MCI Communication to Primary care about the outcome of referrals to a MAS should include: For people with dementia: Dementia subtype diagnostic code (READ / CTV) Advice about follow-up, treatment (including involvement in post-diagnosis group interventions) and whether referred to local dementia support/adviser service. For people with SMC or MCI Diagnostic code Risk categorization for conversion Guidance about longitudinal assessment of cognition and function Advice about non-pharmacological interventions and lifestyle For Atypical cases: Information about next steps 26

27 Recommendations: Management of MCI MAS should ensure: Concordance between staff for cognitive and functional assessments All relevant data are considered when making a diagnosis Either review non-dementia diagnoses regularly or hold a team meeting to agree classification of SMC / MCI and risk for conversion Provide data about the outcome of referrals that includes percentages of dementia, SMC and MCI diagnoses Publish / Document specific criteria used for MCI diagnosis used in their MAS 27

28 Recommendations: Management of SMC / MCI and Atypical Presentations Commissioners need to ensure that pathways and service specifications for the evaluation of people with cognitive impairment include provision for: Atypical cases that are likely to require: Sub-specialist or neurologist review Specialist investigations o Additional structural imaging (CT or MRI), HMPAO-SPECT, 18-FDG- PET, Dopamine Transporter (DAT) scan, amyloid PET for younger individuals according to agreed pathway o Cerebrospinal fluid evaluation Pathway for review of people with SMC / MCI Evidence-based non-pharmacological interventions for SMC and MCI 28

29 Recommendations: Review MCI Review of people with MCI both at the first presentation at a MAS and subsequently either in primary care OR in the MAS should include both a Cognitive and Functional assessment Review period determined by Risk for Conversion : 6 mth high risk 12 mths low risk Refer for a further dementia assessment if there is cognitive impairment AND a decline in function ONE point on the GP-Cog ONE point on the CDR-SB 29

30 Recommendations: Review MCI Classify patients according to their individual Risk for conversion to dementia. Age Metabolic and vascular risk factors Specific MRI correlates of cerebrovascular disease ApoE status (usually research at present) Future: Other biomarkers e.g inflammation Longitudinal follow-up on MRI, neuropsychology WHOSE Responsibility? 30

31 Recommendations: Dementia Coding Including MCI 31

32 Key Points Mild Cognitive Impairment Heterogeneous group of pts BUT important to recognise / document in a formal way as has implications for: QoL, mortality, risk for dementia Current evidence supports the following interventions: Aerobic Exercise, Mental activity, CV risk factor control What is good for the Heart if good for the Brain Need a process for categorisation of important subgroups of MCI: Depression, high risk of conversion to dementia Definition of review process Assessment of MCI cognition & function Responsibility for review Primary / Secondary care Mild Cognitive impairment from lack of structure to structured management 32

33 Thank You 33

Dementia Recognition: Case-finding:Community & Care Homes

Dementia Recognition: Case-finding:Community & Care Homes Dementia Recognition: Case-finding:Community & Care Homes Jill Rasmussen, Dementia Clinical Lead jillrasmussen@nhs.net South East Mental Health Commissioning Network 17/5/16 Declarations of Interest NHS:

More information

Primary Care Dementia Case Finding. Dr Jill Rasmussen RCGP Clinical Lead Dementia

Primary Care Dementia Case Finding. Dr Jill Rasmussen RCGP Clinical Lead Dementia Primary Care Dementia Case Finding Dr Jill Rasmussen RCGP Clinical Lead Dementia Declarations of Interest NHS: GP East Surrey SCN SE Clinical Lead Dementia Co-developer of MoodHive (Depression Anxiety

More information

Rates and Predictors of Progression from Mild Cognitive Impairment to Dementia: The Mayo Clinic Study of Aging

Rates and Predictors of Progression from Mild Cognitive Impairment to Dementia: The Mayo Clinic Study of Aging Rates and Predictors of Progression from Mild Cognitive Impairment to Dementia: The Mayo Clinic Study of Aging 11 th Annual Mild Cognitive Impairment Symposium January 19th, 2013 Rosebud Roberts, M.B.

More information

London Memory Service Audit

London Memory Service Audit London Dementia Strategic Clinical Network Date London Memory Service Audit Dr Jeremy Isaacs Consultant Neurologist St George s University Hospitals NHS Foundation Trust Clinical Lead Effective diagnosis

More information

Dementia and Mild Cognitive Impairment

Dementia and Mild Cognitive Impairment Standard 5.1 Dementia and Mild Cognitive Impairment Aims To reduce the gap between expected and actual dementia prevalence and the variance between practices. To improve the assessment of all patients

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.

More information

Primary Care Update January 28 & 29, 2016 Alzheimer s Disease and Mild Cognitive Impairment

Primary Care Update January 28 & 29, 2016 Alzheimer s Disease and Mild Cognitive Impairment Primary Care Update January 28 & 29, 2016 Alzheimer s Disease and Mild Cognitive Impairment Kinga Szigeti, MD Associate Professor UBMD Neurology UB Department of Neurology Questions How do we differentiate

More information

Age Related Changes In Memory, Dementia and Alzheimer s Disease

Age Related Changes In Memory, Dementia and Alzheimer s Disease Age Related Changes In Memory, Dementia and Alzheimer s Disease William W. Pendlebury, M.D. Professor of Pathology and Neurology Director, Center on Aging University of Vermont Director, Memory Center

More information

CRITERIA FOR AD DEMENTIA June 11, 2010

CRITERIA FOR AD DEMENTIA June 11, 2010 CRITERIA F AD DEMENTIA June 11, 2010 Alzheimer s Disease Dementia Workgroup Guy McKhann, Johns Hopkins University (Chair) Bradley Hyman, Massachusetts General Hospital Clifford Jack, Mayo Clinic Rochester

More information

Presented by: Rick Dobyns, MD

Presented by: Rick Dobyns, MD Presented by: Rick Dobyns, MD Learning Objec-ves Demen-a What is Dementia? Causes Symptoms Treatment Signs and Tests Prevention Alzheimer s Disease What is Alzheimer s? Types of AD Causes Risk Factors

More information

The diagnosis of dementia for people living in care homes. Frequently Asked Questions by GPs

The diagnosis of dementia for people living in care homes. Frequently Asked Questions by GPs The diagnosis of dementia for people living in care homes Frequently Asked Questions by GPs A discussion document jointly prepared by Maggie Keeble, GP with special interest in palliative care and older

More information

What is Alzheimer s disease?

What is Alzheimer s disease? What is Alzheimer s disease? Contents Introduction 03 What is Alzheimer s? 04 Symptoms 06 Diagnosis 08 Support 14 Causes 15 Risk factors 16 Research 19 Treatments 10 02 visit: www.alzheimersresearchuk.org

More information

Montreal Cognitive Assessment (MoCA) Debbie Froese, B.M.R.-O.T., B.A. Christine Knight, Ph.D.,R.Psych.

Montreal Cognitive Assessment (MoCA) Debbie Froese, B.M.R.-O.T., B.A. Christine Knight, Ph.D.,R.Psych. Montreal Cognitive Assessment (MoCA) Debbie Froese, B.M.R.-O.T., B.A. Christine Knight, Ph.D.,R.Psych. Community Geriatric Mental Health Model of Continuum of Cognition with Aging Normal Mild cognitive

More information

Update on Alzheimer s Disease. Samir F. Atweh Professor and Chairman Department of Neurology American University of Beirut

Update on Alzheimer s Disease. Samir F. Atweh Professor and Chairman Department of Neurology American University of Beirut Update on Alzheimer s Disease Samir F. Atweh Professor and Chairman Department of Neurology American University of Beirut Alzheimer s Disease The most common form of dementia in the elderly Age related

More information

Mental Health in the Quality Outcomes Framework

Mental Health in the Quality Outcomes Framework Mental Health in the Quality Outcomes Framework Tony Kendrick Professor of Primary Care, University of Southampton Rationale for QOF SMI indicators Mortality rates for people with SMI (schizophrenia,

More information

Primary Endpoints in Alzheimer s Dementia

Primary Endpoints in Alzheimer s Dementia Primary Endpoints in Alzheimer s Dementia Dr. Karl Broich Federal Institute for Drugs and Medical Devices (BfArM) Kurt-Georg-Kiesinger-Allee 38, D-53175 Bonn Germany Critique on Regulatory Decisions in

More information

Memory: What is normal, and what is Alzheimer s?

Memory: What is normal, and what is Alzheimer s? Memory: What is normal, and what is Alzheimer s? Andrew Frank M.D. B.Sc.H. F.R.C.P.(C) Cognitive Neurologist, and Medical Director, Bruyère Memory Program Élisabeth Bruyère Hospital Ottawa, Ontario Memory:

More information

Diagnosis and Initial Management of Cognitive Disorders

Diagnosis and Initial Management of Cognitive Disorders Diagnosis and Initial Management of Cognitive Disorders January 29, 2016 Kelly Garrett, PhD Cathleen Obray, MD, MHS Neurosciences Clinical Program Cognitive Care Team None Disclosures Neurosciences Clinical

More information

What is. Alzheimer s disease?

What is. Alzheimer s disease? What is Alzheimer s disease? Contents 03 What is Alzheimer s? What is dementia? 04 Symptoms 06 Diagnosis 08 Treatments This introductory booklet aims to provide an overview of Alzheimer s disease. It is

More information

Underwriting long term care insurance: a primer

Underwriting long term care insurance: a primer By Lori Boyce, AVP Risk Management and R&D Underwriting long term care insurance: a primer Every day Canadians die, are diagnosed with cancer, have heart attacks and become disabled and our insurance solutions

More information

Changes in the Brain

Changes in the Brain Alzheimer s Disease Alzheimer s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. In most

More information

11 DIAGNOSTIC CRITERIA FOR DEMENTIA

11 DIAGNOSTIC CRITERIA FOR DEMENTIA DEMENTIA Q&A 11 DIAGNOSTIC CRITERIA FOR DEMENTIA This sheet provides information about recent changes to the diagnostic criteria for dementia and related conditions, and the use of biomarkers for earlier

More information

Diagnosis of Alzheimer s Disease

Diagnosis of Alzheimer s Disease Diagnosis of Alzheimer s Disease At the age of 58, Matthew Blair began to have difficulty reading, speaking, and performing daily tasks at work. His wife, Isabel, was convinced that he had Alzheimer s.

More information

LIVING WITH HIV-ASSOCIATED NEUROCOGNITIVE DISORDERS (HAND)

LIVING WITH HIV-ASSOCIATED NEUROCOGNITIVE DISORDERS (HAND) LIVING WITH HIV-ASSOCIATED NEUROCOGNITIVE DISORDERS (HAND) Information for people living with HIV and HAND, their partners, families and friends This booklet has been produced by Alzheimer s Australia

More information

Steps to getting a diagnosis: Finding out if it s Alzheimer s Disease.

Steps to getting a diagnosis: Finding out if it s Alzheimer s Disease. Steps to getting a diagnosis: Finding out if it s Alzheimer s Disease. Memory loss and changes in mood and behavior are some signs that you or a family member may have Alzheimer s disease. If you have

More information

Cognitive Impairment. Patient Information Sheet

Cognitive Impairment. Patient Information Sheet Cognitive Impairment Patient Information Sheet What is dementia? Dementia is a term used to describe the loss of mental function. Memory loss is its most common symptom. Patients can have problems with

More information

Understanding. Alzheimer s Disease. Lora, diagnosed in 2004, with her daughter, Jill.

Understanding. Alzheimer s Disease. Lora, diagnosed in 2004, with her daughter, Jill. Understanding Alzheimer s Disease Lora, diagnosed in 2004, with her daughter, Jill. What Is Alzheimer s Disease? Alzheimer s disease is a neurologic disorder that affects the brain. It causes dementia.

More information

Cognitive Impairment. LPT Gondar Mental Health Group.

Cognitive Impairment. LPT Gondar Mental Health Group. Cognitive Impairment LPT Gondar Mental Health Group www.le.ac.uk Areas to be covered Causes of cognitive impairment Delirium Definition and causes Clinical features Management principles Dementia Common

More information

What is Alzheimer s disease?

What is Alzheimer s disease? alzheimers.org.uk What is Alzheimer s disease? Alzheimer s disease is the most common cause of dementia, affecting around 496,000 people in the UK. The term dementia describes a set of symptoms which can

More information

What is Alzheimer s disease?

What is Alzheimer s disease? What is Alzheimer s disease? Introduction This introductory booklet aims to provide an overview of Alzheimer s disease. It is for anyone who wants to know more about the disease, including people living

More information

Vascular Cognitive Impairment: There is Something that YOU can do

Vascular Cognitive Impairment: There is Something that YOU can do Vascular Cognitive Impairment: There is Something that YOU can do David F. Tang-Wai MDCM FRCPC Assistant Professor (Neurology & Geriatric Medicine) University of Toronto Co-director University Health Memory

More information

What is dementia? Types of dementia. Alzheimer s disease. Vascular dementia

What is dementia? Types of dementia. Alzheimer s disease. Vascular dementia What is dementia? Dementia is the name for several conditions that lead to the progressive loss of the powers of the brain and changes in a person s behaviour. The most common change is in a person s memory,

More information

THE FEASIBILITY OF A COGNITIVE BEHAVIOURAL THERAPY GROUP FOR MEN WITH MILD MODERATE COGNITIVE IMPAIRMENT

THE FEASIBILITY OF A COGNITIVE BEHAVIOURAL THERAPY GROUP FOR MEN WITH MILD MODERATE COGNITIVE IMPAIRMENT Behavioural and Cognitive Psychotherapy, 1999, 27, 189 193 Cambridge University Press. Printed in the United Kingdom THE FEASIBILITY OF A COGNITIVE BEHAVIOURAL THERAPY GROUP FOR MEN WITH MILD MODERATE

More information

Dementia - Alzheimer's disease

Dementia - Alzheimer's disease Dementia - Alzheimer's disease Summary Alzheimer s disease is a physical disease of the brain with progressive damage to brain cells, which causes dementia. Alzheimer s disease is the most common form

More information

The impact of Alzheimer s disease

The impact of Alzheimer s disease The impact of Alzheimer s disease Ron Petersen, MD, PhD, is Director of the Mayo Alzheimer's Disease Research Center. 2 Typical changes Typical age-related changes involve: Making a bad decision once in

More information

The impact of Alzheimer s disease. Typical changes. Problematic changes. Problematic changes. What is dementia? Typical age-related changes involve:

The impact of Alzheimer s disease. Typical changes. Problematic changes. Problematic changes. What is dementia? Typical age-related changes involve: The impact of Alzheimer s disease Ron Petersen, MD, PhD, is Director of the Mayo Alzheimer's Disease Research Center. 2 Typical changes Problematic changes Typical age-related changes involve: Making a

More information

The impact of Alzheimer s disease

The impact of Alzheimer s disease The impact of Alzheimer s disease Ron Petersen, MD, PhD, is Director of the Mayo Alzheimer's Disease Research Center. 2 The impact of Alzheimer s disease Ron Petersen, MD, PhD, is Director of the Mayo

More information

Assessment of depression in adults in primary care

Assessment of depression in adults in primary care Assessment of depression in adults in primary care Adapted from: Identification of Common Mental Disorders and Management of Depression in Primary care. New Zealand Guidelines Group 1 The questions and

More information

Depression in Older Persons

Depression in Older Persons Depression in Older Persons How common is depression in later life? Depression affects more than 6.5 million of the 35 million Americans aged 65 or older. Most people in this stage of life with depression

More information

Brent JSNA 2014/15 Refresh. Learning Disabilities information sheet NHS Brent CCG and LB Brent

Brent JSNA 2014/15 Refresh. Learning Disabilities information sheet NHS Brent CCG and LB Brent JSNA Refresh 2014/15 March 2015 Learning Disabilities Summary Nationally, 2.2% of the population currently have a learning disability. In Brent, this equates to 6,980 people when applied to the current

More information

Objectives. Evaluation of Memory Loss. Cognitive Impairment. Clinical Questions. Medicare Wellness Visit

Objectives. Evaluation of Memory Loss. Cognitive Impairment. Clinical Questions. Medicare Wellness Visit Evaluation of Memory Loss and Mild Cognitive Impairment Skotti Church, MD Geriatrics Grand Rounds 4/3/2014 Objectives 1. Describe recommendations and tools for evaluation of cognitive impairment 2. Define

More information

Terms You Need to Know

Terms You Need to Know Understanding and Recognizing Alzheimer s Disease This article is about Alzheimer's disease and other types of dementia. It presents information for patients, family members, and other caregivers. It talks

More information

Dementia research: progress and challenges

Dementia research: progress and challenges Dementia research: progress and challenges University of Birmingham College of Medicine: Challenging Dementia September 6 th 2013 Dr Simon Ridley, Head of Research, Alzheimer s Research UK Alzheimer s

More information

The dementia care pathway. Kritika Samsi Research Fellow, King s College London

The dementia care pathway. Kritika Samsi Research Fellow, King s College London The dementia care pathway Kritika Samsi Research Fellow, King s College London Outline of presentation Introduction: what is dementia; numbers Living with dementia and need for a dementia care pathway

More information

Early Diagnosis of Dementia Alzheimer s Australia Paper 10. March 2007

Early Diagnosis of Dementia Alzheimer s Australia Paper 10. March 2007 Early Diagnosis of Dementia Alzheimer s Australia Paper 10 March 2007 Alzheimer s Australia/ 1 Promoting early diagnosis of dementia Introduction The purpose of this paper is to outline the steps involved

More information

Mild Cognitive Impairment

Mild Cognitive Impairment Mild Cognitive Impairment Claudia Cooper UCL Clinical Reader Honorary consultant old age psychiatrist, Camden and Islington NHS FT Talk plan Diagnosis Treating MCI: Evidence from RCTs Evidence from prospective

More information

Dr Trevor Chan Locum Consultant Psychiatrist in Learning Disabilities Dr Vicky Turk Consultant Clinical Psychologist, Learning Disabilities

Dr Trevor Chan Locum Consultant Psychiatrist in Learning Disabilities Dr Vicky Turk Consultant Clinical Psychologist, Learning Disabilities Dementia in People with Learning Disabilities Dr Trevor Chan Locum Consultant Psychiatrist in Learning Disabilities Dr Vicky Turk Consultant Clinical Psychologist, Learning Disabilities Overview Context

More information

ANXIETY & COGNITIVE IMPAIRMENT

ANXIETY & COGNITIVE IMPAIRMENT ANXIETY & COGNITIVE IMPAIRMENT Dr. Sherri Hayden, Ph.D., R. Psych. Neuropsychologist, UBC Hospital Clinic for Alzheimer Disease & Related Disorders Clinical Assistant Professor, UBC Department of Medicine,

More information

Ronald C. Petersen, PhD, MD Mayo Alzheimer s Disease Research Center Mayo Clinic College of Medicine Rochester, MN

Ronald C. Petersen, PhD, MD Mayo Alzheimer s Disease Research Center Mayo Clinic College of Medicine Rochester, MN DSM-5 Renaming Dementia (?) Ronald C. Petersen, PhD, MD Mayo Alzheimer s Disease Research Center Mayo Clinic College of Medicine Rochester, MN 3023518-1 Disclosures Pfizer, Inc.: Chair DMC Janssen Alzheimer

More information

Recognition of dementia in people with learning disabilities

Recognition of dementia in people with learning disabilities Recognition of dementia in people with learning disabilities Dr Karen Dodd Co-Director, Services for People with Learning Disabilities Associate Director, Therapies Learning Disabilities / Consultant Clinical

More information

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population

More information

When is Memory Loss Significant? David Williamson, PhD (ABPP-Cn), MBA

When is Memory Loss Significant? David Williamson, PhD (ABPP-Cn), MBA When is Memory Loss Significant? David Williamson, PhD (ABPP-Cn), MBA Third Annual Neuroscience Symposium Orange Beach, AL April 2016 Disclosures Dr. Williamson is an employee of Janssen Scientific Affairs,

More information

Cognitive Disorders. What Is Cognition? OCW: Geriatric Dentistry ()

Cognitive Disorders. What Is Cognition? OCW: Geriatric Dentistry () 1. 2. What Is Cognition? Page - 1 3. Terms 4. Examples of Cognitive Syndromes and Disorders Page - 2 5. Delirium 6. Delirium: Core Deficits Page - 3 7. Prevalence of Delirium 8. Associated Signs and Symptoms

More information

Bury Dementia Guide. A brief guide for people with dementia and memory problems, and their carers

Bury Dementia Guide. A brief guide for people with dementia and memory problems, and their carers Bury Dementia Guide A brief guide for people with dementia and memory problems, and their carers Contents Introduction - about this booklet 2 Memory problems 3 What is dementia? 4 Diagnosis and support

More information

Alzheimer s and dementia: your questions answered

Alzheimer s and dementia: your questions answered Alzheimer s and dementia: your questions answered This booklet gives answers to some commonly-asked questions about Alzheimer s disease and dementia. Information in this booklet is for anyone who wants

More information

Appropriate Use of CPT Coding in Treatment of Persons with Memory Impairment

Appropriate Use of CPT Coding in Treatment of Persons with Memory Impairment Appropriate Use of CPT Coding in Treatment of Persons with Memory Impairment Cameron J. Camp, Ph.D. Director of Research and Development Center for Applied Research in Dementia Cameron@CEN4ard.com www.cen4ard.com

More information

The Hellenic Longitudinal Investigation of Aging and Diet (HELIAD): study description and preliminary data

The Hellenic Longitudinal Investigation of Aging and Diet (HELIAD): study description and preliminary data The Hellenic Longitudinal Investigation of Aging and Diet (HELIAD): study description and preliminary data Margioti E 1,5, Sakka P 1, Dardiotis E 2, Kosmidis MH 5, Yannakoulia M 4, Hadjigeorgiou GM 2,

More information

What is vascular dementia?

What is vascular dementia? What is vascular dementia? Contents Introduction 03 What is vascular dementia? 04 Symptoms 06 Diagnosis 08 Support 12 Causes 13 Risk factors 14 Research 15 Treatments 10 02 visit: www.alzheimersresearchuk.org

More information

Alzheimer Disease: State of the Science and Research Update

Alzheimer Disease: State of the Science and Research Update Alzheimer Disease: State of the Science and Research Update Thomas J. Grabowski MD Departments of Radiology and Neurology Director, Memory and Brain Wellness Center Director, Alzheimer Disease Research

More information

Mental health issues in the elderly. January 28th 2008 Presented by Éric R. Thériault etheriau@lakeheadu.ca

Mental health issues in the elderly. January 28th 2008 Presented by Éric R. Thériault etheriau@lakeheadu.ca Mental health issues in the elderly January 28th 2008 Presented by Éric R. Thériault etheriau@lakeheadu.ca Cognitive Disorders Outline Dementia (294.xx) Dementia of the Alzheimer's Type (early and late

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE 1 Guideline title Autistic spectrum conditions: diagnosis and management of autistic spectrum conditions in adults 1.1 Short title Autistic spectrum

More information

Supplemental Table 1 Studies Considered in Our Review Study Sample Follow up assessments Domains and tests Main results

Supplemental Table 1 Studies Considered in Our Review Study Sample Follow up assessments Domains and tests Main results Supplemental Table 1 Studies Considered in Our Review Study Sample Follow up assessments Domains and tests Main results Moorhead 20 BD I Performance IQ: Wechsler et al. (2007) 7 & follow up after 4 Abbreviated

More information

Alzheimer s and Depression: What is the Connection?

Alzheimer s and Depression: What is the Connection? Alzheimer s and Depression: What is the Connection? Ladson Hinton MD Professor and Director of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Director, Education Core, Alzheimer

More information

Mary Sano, PhD Director, Alzheimer Disease Research Center Mount Sinai School of Medicine James J Peters Veterans Affairs Hospital June 14, 2014

Mary Sano, PhD Director, Alzheimer Disease Research Center Mount Sinai School of Medicine James J Peters Veterans Affairs Hospital June 14, 2014 Expanding Research: Preventing and Treating Alzheimer s Disease Mary Sano, PhD Director, Alzheimer Disease Research Center Mount Sinai School of Medicine James J Peters Veterans Affairs Hospital June 14,

More information

Copywrite - Eric Freitag, Psy.D., 2012

Copywrite - Eric Freitag, Psy.D., 2012 Diagnosis, Intervention and Care for Patients With Cognitive Impairment Eric J. Freitag, Psy.D, FACPN Diplomate, American College of Professional Neuropsychology Mt. Diablo Memory Center Founder/Executive

More information

What is vascular dementia?

What is vascular dementia? alzheimers.org.uk What is vascular dementia? Vascular dementia is the second most common form of dementia after Alzheimer s disease. It is caused by problems in the supply of blood to the brain. This factsheet

More information

Biomarkers for Alzheimer's Disease in Down Syndrome

Biomarkers for Alzheimer's Disease in Down Syndrome Biomarkers for Alzheimer's Disease in Down Syndrome Brad Christian, Ph.D. Waisman Laboratory for Brain Imaging Outline Rationale for Studying AD in Down Syndrome Background of Alzheimer s Disease Biomarkers

More information

Survey instrument proposal to measure some dimensions of mental health (depression) in the next wave of the European Health Interview Survey

Survey instrument proposal to measure some dimensions of mental health (depression) in the next wave of the European Health Interview Survey Cornelia Lange Survey instrument proposal to measure some dimensions of mental health (depression) in the next wave of the European Health Interview Survey Eurostat Grant 10501.2009.007-2009.890 Robert

More information

South African Cholesterol Guidelines Compared

South African Cholesterol Guidelines Compared South African Cholesterol Guidelines Compared Jacqueline van Schoor, Amayeza Info Centre While infectious diseases are currently the leading cause of death in South Africa, cardiovascular disease (CVD)

More information

GOING BEYOND RISK REDUCTION: PHYSICAL EXERCISE MAY BE AN EFFECTIVE TREATMENT FOR ALZHEIMER S DISEASE AND VASCULAR DEMENTIA

GOING BEYOND RISK REDUCTION: PHYSICAL EXERCISE MAY BE AN EFFECTIVE TREATMENT FOR ALZHEIMER S DISEASE AND VASCULAR DEMENTIA CONTACT: Alzheimer s Association AAIC newsroom, 202-249-4002, media@alz.org Niles Frantz, Alzheimer s Association, 312-335-5777, niles.frantz@alz.org GOING BEYOND RISK REDUCTION: PHYSICAL EXERCISE MAY

More information

Alzheimer s disease. What is Alzheimer s disease?

Alzheimer s disease. What is Alzheimer s disease? Alzheimer s disease What is Alzheimer s disease? What we know about dementia and Alzheimer s disease Alzheimer s disease is the most common of a large group of disorders known as dementias. It is an irreversible

More information

An understanding of person s expectation of how the problem can be resolved A discussion of, and agreement on a plan for an intervention

An understanding of person s expectation of how the problem can be resolved A discussion of, and agreement on a plan for an intervention Understanding and Describing Mental Health Problems the use of Problem Statement Summaries and Diagnostic/ Problem Categories in the IAPT Programme and the Implications for PWP Training and Practice 1

More information

Risk factors in dementia

Risk factors in dementia IS 40 April 2011 Information sheet Risk factors in dementia Introduction... 1 Ageing... 1 Genetics... 1 Medical history, particularly cardiovascular problems... 2 Lifestyle and environment... 3 Diet...

More information

PARTNERING WITH YOUR DOCTOR:

PARTNERING WITH YOUR DOCTOR: PARTNERING WITH YOUR DOCTOR: A Guide for Persons with Memory Problems and Their Care Partners Alzheimer s Association Table of Contents PARTNERING WITH YOUR DOCTOR: When is Memory Loss a Problem? 2 What

More information

Exploring Mild Cognitive Impairment

Exploring Mild Cognitive Impairment Exploring Mild Cognitive Impairment Kelly Murphy, PhD Angela Troyer, PhD Neuropsychology & Cognitive Health, Baycrest Health Sciences Alzheimer Society of Canada September 25, 2013 CDRAKE webinar Objectives

More information

2 Treatments. In this section. Key points: Treatments 15 Drugs to treat dementia 16 Non-drug treatments 18 Treating depression and anxiety 21

2 Treatments. In this section. Key points: Treatments 15 Drugs to treat dementia 16 Non-drug treatments 18 Treating depression and anxiety 21 14 The dementia guide In this section Key points: 15 Drugs to treat dementia 16 Non-drug treatments 18 Treating depression and anxiety 1 Call the National Dementia Helpline on 0300 11 15 Key points: There

More information

NEUROPSYCHOLOGY QUESTIONNAIRE. (Please fill this out prior to your appointment and bring it with you.) Name: Date of appointment: Home address:

NEUROPSYCHOLOGY QUESTIONNAIRE. (Please fill this out prior to your appointment and bring it with you.) Name: Date of appointment: Home address: NEUROPSYCHOLOGY QUESTIONNAIRE (Please fill this out prior to your appointment and bring it with you.) Name: Date of appointment: Date of birth: Age: _ Home address: _ Home phone: Cell phone: Work phone:

More information

Health Professionals who Support People Living with Dementia

Health Professionals who Support People Living with Dementia Clinical Access and Redesign Unit Health Professionals who Support People Living with Dementia (in alphabetical order) Health Professional Description Role in care of people with dementia Dieticians and

More information

Chemobrain. Halle C.F. Moore, MD The Cleveland Clinic October 3, 2015

Chemobrain. Halle C.F. Moore, MD The Cleveland Clinic October 3, 2015 Chemobrain Halle C.F. Moore, MD The Cleveland Clinic October 3, 2015 Terminology Chemotherapy-associated cognitive dysfunction Post-chemotherapy cognitive impairment Cancer treatment-associated cognitive

More information

Barriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness

Barriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness Barriers to Healthcare Services for People with Mental Disorders Cardiovascular disorders and diabetes in people with severe mental illness Dr. med. J. Cordes LVR- Klinikum Düsseldorf Kliniken der Heinrich-Heine-Universität

More information

An approach to cognitive symptoms in younger people

An approach to cognitive symptoms in younger people An approach to cognitive symptoms in younger people Dr Jeremy Isaacs Consultant Neurologist and Dementia Clinical Lead St George s Hospital Excellence in specialist and community healthcare I m worried

More information

The changing diagnostic criteria for AD, including early and asymptomatic disease stages and their impact on clinical trial design

The changing diagnostic criteria for AD, including early and asymptomatic disease stages and their impact on clinical trial design The changing diagnostic criteria for AD, including early and asymptomatic disease stages and their impact on clinical trial design Eric Siemers On behalf of the EFPIA Working Group 24-25 November 2014

More information

Mild depression: Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.

Mild depression: Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment. 6.1 Anxiety Depression - Adults Anxiety is a condition characterized by persistent worry or unease and is usually accompanied by fear, panic, irritability, poor sleep, poor concentration and avoidance,

More information

Taking Care of Dementia Caregiver

Taking Care of Dementia Caregiver Date 15pts Author Name 15pts Author Title 15pts Title of Presentation Arial Regular 22pt Single line spacing Up to 3 lines long Taking Care of Dementia Caregiver Date 15pts Author Name 15pts Author Title

More information

Learning Disabilities

Learning Disabilities Learning Disabilities Positive Practice Guide January 2009 Relieving distress, transforming lives Learning Disabilities Positive Practice Guide January 2009 Contents 1. Background and policy framework

More information

WHEN YOU SUSPECT ALZHEIMER S DISEASE

WHEN YOU SUSPECT ALZHEIMER S DISEASE WHEN YOU SUSPECT ALZHEIMER S DISEASE For more information, please contact Alzheimer s & Dementia Services of Northern Indiana: 922 E. Colfax South Bend, IN 46617 (888) 303-0180, toll-free, or (574) 232-4121

More information

What is dementia? Symptoms. alzheimers.org.uk

What is dementia? Symptoms. alzheimers.org.uk alzheimers.org.uk What is dementia? This factsheet explains what dementia is, including the causes and symptoms, and how it is diagnosed and treated. It also looks at some of the different types of dementia.

More information

Yorkshire and the Humber SCN Guidance on Neuro-imaging in Dementia

Yorkshire and the Humber SCN Guidance on Neuro-imaging in Dementia Yorkshire and the Humber SCN Guidance on Neuro-imaging in Dementia January 2015 (Review date January 2017) Introduction This guidance has been written by the Yorkshire and Humber Strategic Clinical Network

More information

Context t for us today People with LD are living i longer There s an increased rate of dementia in LD generally Special case of Down s syndrome & Alzh

Context t for us today People with LD are living i longer There s an increased rate of dementia in LD generally Special case of Down s syndrome & Alzh NICE Dementia Guideline and implications for learning disability Stephen Brown Context t for us today People with LD are living i longer There s an increased rate of dementia in LD generally Special case

More information

Patricia Beldotti, Psy.D. Email: drbeldotti@aol.com Tel: 520-404-7553 Web: www.drbeldotti.com

Patricia Beldotti, Psy.D. Email: drbeldotti@aol.com Tel: 520-404-7553 Web: www.drbeldotti.com Patricia Beldotti, Psy.D. Email: drbeldotti@aol.com Tel: 520-404-7553 Web: www.drbeldotti.com Assessment Costs I understand that assessment needs differ and that these assessments can be costly, especially

More information

The impact of Alzheimer s disease

The impact of Alzheimer s disease The impact of Alzheimer s disease Ron Petersen, MD, PhD, is Director of the Mayo Alzheimer's Disease Research Center. 2 Typical changes Typical age-related changes involve: Making a bad decision once in

More information

Living Well with Dementia Conference Person Centred Approaches

Living Well with Dementia Conference Person Centred Approaches Dr. Suzanne Timmons Consultant Geriatrician Living Well with Dementia Conference Person Centred Approaches Alzheimer s Disease: Memory affected primarily Later will involve all domains of brain function:

More information

Breaking Down the Barriers - Masterclass training package and modules

Breaking Down the Barriers - Masterclass training package and modules Breaking Down the Barriers - Masterclass training package and modules Assessment of a patient with urgent mental health needs in an emergency department Module 1 Module 2 Mental health awareness training

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE SCOPE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE 1 Guideline title SCOPE Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour

More information

Highlights of Changes from DSM-IV-TR to DSM-5

Highlights of Changes from DSM-IV-TR to DSM-5 Highlights of Changes from DSM-IV-TR to DSM-5 Changes made to the DSM-5 diagnostic criteria and texts are outlined in this chapter in the same order in which they appear in the DSM-5 classification. This

More information

2012 Medical School for Actuaries Nov. 6-7, 2012 Session #1: Alzheimer s Disease

2012 Medical School for Actuaries Nov. 6-7, 2012 Session #1: Alzheimer s Disease 2012 Medical School for Actuaries Nov. 6-7, 2012 Session #1: Alzheimer s Disease Dylan Wint, M.D. ALZHEIMER DISEASE Dylan Wint, M.D. Lou Ruvo Center for Brain Health DEFINITIONS Cognitive related to thinking,

More information

Prevention of cognitive decline

Prevention of cognitive decline Summary - 166 - Prevention of cognitive decline We live in a doubly ageing society: not only is the percentage of older adults within the total population growing, the life expectancy of these individuals

More information

Critical Illness Claim - Doctor s Statement Stroke / Brain Aneurysm Surgery or Cerebral Shunt Insertion / Carotid Artery Surgery

Critical Illness Claim - Doctor s Statement Stroke / Brain Aneurysm Surgery or Cerebral Shunt Insertion / Carotid Artery Surgery *SUPDOC* Critical Illness Claim - Doctor s Statement Stroke / Brain Aneurysm Surgery or Cerebral Shunt Insertion / Carotid Artery Surgery SECTION 2 DOCTOR S STATEMENT (to be completed by the attending

More information

Psychology and Aging. Psychologists Make a Significant Contribution. Contents. Addressing Mental Health Needs of Older Adults... What Is Psychology?

Psychology and Aging. Psychologists Make a Significant Contribution. Contents. Addressing Mental Health Needs of Older Adults... What Is Psychology? AMERICAN PSYCHOLOGICAL ASSOCIATION Psychologists Make a Significant Contribution Psychology and Aging Addressing Mental Health Needs of Older Adults... People 65 years of age and older are the fastest

More information

Overlap between VaD and AD: an epidemiological perspective

Overlap between VaD and AD: an epidemiological perspective EMEA 2nd workshop on neurodegenerative diseases:* Focus on Dementia Overlap between VaD and AD: an epidemiological perspective Miia Kivipelto,, MD, PhD Associate professor Aging Research Centre, Karolinska

More information