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Course Summary (30 minutes)

Mental Health

Last revision: 09/11/2021

First uploaded: 01/09/2018

Next planned review: 01/09/2023

Overview

Introduction
- What is dementia and what are the differences between the subtypes of dementia
Background
- Prevalence, risk factors, outcomes and complications of dementia
Diagnosis
- When to suspect dementia, symptoms specific to different subtypes, making a clinical assessment and differential diagnosis
Management
- When to admit or refer, driving and cognitive impairment, follow up management after diagnosis
End of life care
- Advance planning for palliative care and specific end of life issues related to dementia
Optional quiz to assess learning goals from the course

Goals

Ensure a timely diagnosis of dementia
Ensure that primary healthcare is coordinated with secondary healthcare and social care in the management of people with dementia
Ensure symptoms, behavioural problems, and physical disabilities are addressed in partnership with the person and their family/carers
Ensure the appropriate use and monitoring of drug treatments
Avoid the use of antipsychotic drugs for the control of behaviour, if possible
Provide effective psychosocial support for the person's family or carers from the time dementia is first suspected
Ensure effective end-of-life care is provided

References

Dowrick A, Southern, A (2014) Dementia 2014: Opportunity for change. Alzheimer's Society. [Abstract]

DVLA (2016) Assessing fitness to drive – a guide for medical professionals. Driver and Vehicle Licensing Agency. [Free Full-text]

Hort J, O'Brien JT, Gainotti G, Pirttila T, Popescu BO, Rektorova I, Sorbi S, Scheltens P; EFNS Scientist Panel on Dementia.(2010) EFNS guidelines for the diagnosis and management of Alzheimer's disease. European Journal of Neurology. 17(10), 1236-1248.

Iliffe S, Robinson L, Brayne C, Goodman C, Rait G, Manthorpe J, Ashley P; DeNDRoN Primary Care Clinical Studies Group(2009) Primary care and dementia: 1. diagnosis, screening and disclosure. International Journal of Geriatric Psychiatry. 24(9), 895-901.

Kales HC, Gitlin LN, Lyketsos CG (2015) Assessment and management of behavioural and psychological symptoms of dementia.BMJ. 350, .

Maust DT, Kim HM, Seyfried LS, Chiang C, Kavanagh J, Schneider LS, Kales HC (2015) Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA Psychiatry. 72(5), 438-445.

Mayo MC, Bordelon Y (2014) Dementia with Lewy Bodies. Seminars in Neurology. 34(2), 182-188.

McKeith,I.G., Dickson,D.W., Lowe,J., et al. (2005) Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology. 65(12), 1863-1872. [Abstract]

Medicines and Healthcare products Regulatory Agency (2012) Antipsychotics: initiative to reduce prescribing to older people with dementia. Drug Safety Update. 5(10), H1.

National Institute for Health and Care Excellence (2010) NICE quality standard [QS1] Dementia: support in health and social care. NICE. www.nice.org.uk/guidance/qs1

National Institute for Health and Care Excellence (2015) NICE Advice [KTT7] Low-dose antipsychotics in people with dementia. NICE. www.nice.org.uk/advice/ktt7?unlid=3488384812015112912294

National Institute for Health and Care Excellence (2016) Dementia. pathways.nice.org.uk/pathways/dementia

National Institute for Health and Care Excellence (2016) Mental health problems in people with learning disabilities: prevention, assessment and management. NICE. www.nice.org.uk/guidance/ng54

National Institute of Health and Care Excellence (2015) Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset. NICE. www.nice.org.uk/guidance/ng16

National Institute of Health and Care Excellence (2015) Low-dose antipsychotics in people with dementia. NICE. www.nice.org.uk/advice/ktt7

NICE (2006) Dementia: supporting people with dementia and their carers in health and social care (NICE guideline). National Institute for Health and Clinical Excellence. [Free Full-text]

NICE (2011) Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease (NICE technology appraisal 217). National Institute for Health and Clinical Excellence. [Free Full-text]

van der Steen JT, Radbruch L, Hertogh CMPM, de Boer ME, Hughes JC, Larkin P, Francke AL, Jünger S, Gove D, Firth P, Koopmans RTCM, and Volicer L, on behalf of the European Association for Palliative Care (EAPC) (2014) White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care. Palliative Medicine. 28(3), 197-209.

Villars H, Oustric S, Andrieu S, Baeyens JP, Bernabei R, Brodaty H, Brummel-Smith K, Celafu C, Chappell N et al (2010) The primary care physician and Alzheimer’s disease: An international position paper. The journal of nutrition, health & aging. 14(2), 110-120.

WHO and Alzheimer’s Disease International (2012) Dementia: a public health priority. WHO. www.who.int/mental_health/publications/dementia_report_2012/en/

Audit Suggestions

Run a report to identify patients with a current diagnosis of dementia
Run a further report to identify patients who may not be coded for dementia but where other indicators recorded for the patient suggest that they should be included, such as people with falls, frailty, mild cognitive impairment, confusion, delirium.
Ensure that all people with dementia and those suspected with dementia in the practice receive the flu vaccine.
Ensure that those people coded with dementia are not prescribed antipsychotic medication, except where agreed by a consultant psychiatrist for the elderly.
Ensure that those people coded with dementia are not prescribed benzodiazepine medication, except where agreed by a consultant psychiatrist for the elderly.
Percentage of people with a possible diagnosis of dementia referred to memory assessment services.

Dementia – Diagnosis and Management

Please note
You may take this course and download a certificate when you finish. All unfinished progress will be lost.

Course Summary (30 minutes)

Overview

Goals

References

Audit Suggestions

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