{"id":116,"date":"2017-03-23T18:33:05","date_gmt":"2017-03-23T18:33:05","guid":{"rendered":"http:\/\/papergp.com\/index.php\/care-of-older-adults\/dementia\/"},"modified":"2023-01-24T11:25:26","modified_gmt":"2023-01-24T11:25:26","slug":"dementia","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/care-of-older-adults\/dementia\/","title":{"rendered":"Dementia"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4>Differential diagnosis<\/h4>\n<ul>\n<li>Normal-age related memory changes<\/li>\n<li>Mild cognitive impairment<\/li>\n<li>Depression<\/li>\n<li>Delirium<\/li>\n<li>Vitamin deficiency<\/li>\n<li>Hypothyroidism<\/li>\n<li>Adverse drug effects\n<ul>\n<li>benzodiazepines, analgesics, anticholinergics, anti-depressants (such as tricyclics), antipsychotics (such as haloperidol), anti-convulsants (especially older preparations, such as phenytoin and phenobarbital), and corticosteroids<\/li>\n<\/ul>\n<\/li>\n<li>Normal pressure hydrocephalus\n<ul>\n<li>cognitive impairment, urinary incontinence, gait disorder<\/li>\n<\/ul>\n<\/li>\n<li>Sensory deficits\n<ul>\n<li>Vision and hearing impairment can contribute significantly to apparent cognitive decline<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4>Data gathering<\/h4>\n<ul>\n<li>Red flags &#8211; sudden loss of memory, fall, head injury<\/li>\n<li>others &#8211; personality, mood, speech, tremor, activities of daily living<\/li>\n<li>Examination &#8211; Neurological, GPCOG\/6 CIT<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4>Clinical management<\/h4>\n<ul>\n<li>Investigations\n<ul>\n<li>Bloods &#8211; FBC, U+E, LFTs, TFTs, B12, folate, calcium, HbA1c, lipids, syphilis<\/li>\n<li>Urine &#8211; dip \/ MSU<\/li>\n<li>Others\n<ul>\n<li>CXR<\/li>\n<li>ECG<\/li>\n<li>Syphillis, HIV<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Explanation\n<ul>\n<li>small deposits form within the brain which can damage the nerves with accompanying changes in the chemical transmitters in brain &#8211; leads to problems with short term memory, tasks, personality<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Treatment\n<ul>\n<li>Refer &#8211; memory clinic &#8211; further assessment, MRI<\/li>\n<li>Lifestyle &#8211; Reduce smoking, alcohol, BP, cholesterol, keep whiteboards for reminders<\/li>\n<li>Individual care plan &#8211; keep familiar environment, consistent staffing, reduce relocations<\/li>\n<li>Community teams e.g. social services, occupational therapy<\/li>\n<li>Groups &#8211; physical activity, cognitive group stimulation &#8211; Alzheimer&#8217;s society<\/li>\n<li>Medications &#8211; for moderate Alzheimer&#8217;s, low mood, aggressive behaviour, dosette box<\/li>\n<li>Inform DVLA &#8211; can drive but yearly review<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Follow-up \/ Safety net\n<ul>\n<li>PIL<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>NB: Consider carers needs &#8211; Carers UK, capacity<\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4>Dementia and aggression<\/h4>\n<ul>\n<li>Look for reversible causes\n<ul>\n<li>Infections &#8211; urine, chest, meningitis, viral<\/li>\n<li>Medications &#8211; benzodiazepines, opioids, steroids, anticholinergics, anticonvulsants<\/li>\n<li>Drugs &#8211; alochol, illict drugs<\/li>\n<li>Metabolic causes &#8211; electrolytes, BM<\/li>\n<li>Vitamin deficiencies &#8211; thiamine, B12<\/li>\n<li>Endocrine &#8211; thyroid<\/li>\n<li>Trauma &#8211; head injury<\/li>\n<\/ul>\n<\/li>\n<li>Investigations\n<ul>\n<li>Bloods &#8211; U+Es, LFTs, TFTs, B12, Folate<\/li>\n<li>Urine dip<\/li>\n<\/ul>\n<\/li>\n<li>Management\n<ul>\n<li>Discuss with secondary care, possible options:\n<ul>\n<li>Mirtazapine 15mg ON &#8211; increase to 30mg ON after 4 weeks<\/li>\n<li>Trazodone 25mg ON &#8211; increase in steps of 25mg up to 100mg OD (divided doses)<\/li>\n<li>Carbamazepine 50mg &#8211; increase in steps of 50mg every 2-4 weeks up to 200mg BD<\/li>\n<li>Risperidone 0.5mg OD &#8211; increase up to 0.5mg BD if needed (increased risk of stroke)<\/li>\n<li>Memantine 5mg OD &#8211; increase in steps of 5mg at weekly intervals to 20mg OD<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Refer\n<ul>\n<li>Consider Older Person Assessment Unit<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Differential diagnosis Normal-age related memory changes Mild cognitive impairment Depression Delirium Vitamin deficiency Hypothyroidism Adverse drug effects benzodiazepines, analgesics, anticholinergics, anti-depressants (such as tricyclics), antipsychotics (such as haloperidol), anti-convulsants (especially older preparations, such as phenytoin and phenobarbital), and corticosteroids Normal pressure hydrocephalus cognitive impairment, urinary incontinence, gait disorder Sensory deficits Vision and hearing impairment can &hellip; 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