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Dementia - an LMC Update for your CPD folder

Date sent: Friday 3 October 2014

 

Email sent by Wessex LMCs, on Friday, 3 Oct 2014

Background

There are nearly 850,000 people with dementia in the UK, and about 26,500 people in Hampshire. This figure is increasing significantly year on year as our population gets older and the number of elderly patients rises.

The Government launched a national Dementia Strategy in 2012 to try to help meet these challenges.

Recently the LMC organised a conference to explore health and social care aspects from a general practice point of view.

The presentations can be found on the LMC website, via the following link:

Wessex LMCs Dementia Conference

Below is a summary of the various presentations that you might wish to use as part of your CPD for your next appraisal.

Information based on presentation by Older Peoples Mental Health Consultants.

Diagnosis

This is a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of higher cortical functions, including memory, thinking, orientation, comprehension, language, calculation, learning capability and judgment.

Consciousness is not impaired. Cognitive function is impaired and is commonly accompanied and occasionally preceded by deterioration in emotional control, social behaviour or motivation.

Must interfere with daily functioning.

At least 6 months duration.

The duration does pose problems to GPs who refer patients who they believe have dementia and once assessed in the memory clinic have a delay of a few months before the diagnosis is confirmed. The reason for the duration being so important is because some patients’ cognitive function will change and patients have in the past been assessed, diagnosed with dementia only to find their cognitive function improves and the diagnosis is delayed as a result.

Alzheimer’s Disease

This is the most common form of dementia and is caused by cortical degeneration and will frequently have the following deficits:

Fronto-Temporal Dementia

At first personality and behavioural changes may be the most obvious symptoms.

In this type of dementia deficits include:

Vascular Dementia

This accounts for about 20% of all cases of dementia although there are many patients who have a mixed picture with Alzheimer’s disease and vascular dementia.

Deficits include:

 

Mild Cognitive Impairment (MCI)

About 50% will go on to develop dementia.  About 10% per year of patients with MCI will develop dementia each year.

Patients with MCI are 3-5 time greater risk of developing dementia compared to the normal population.

Currently is not possible to predict which patients with MCI will go on to develop dementia.

No evidence that intervention changes the risk of developing dementia.

 

Anti-Psychotic Medication

Anti-psychotics were introduced in the 1950s, the most common being Haloperidol, Promazine and Thioridazine.

In the last 20 years newer classes of drugs have been introduced including Risperidone and Olanzapine.

In 2004 concerns were raised due to the increased risk of stoke for patients who were prescribed these drugs.

About 90% of patients with dementia develop behaviour and psychological symptoms of dementia (BPSD) and this includes:

The problems with anti-psychotic drugs:

Risperidone licenced for use for up to 6 weeks, in patients with Alzheimer’s disease for the treatment of moderate to severe symptoms.  The benefits of treatment must outweigh the risks.

Antipsychotic recommendations:

Drug Starting dose Optimum dose
Risperidone 250 ug bd 500ug bd
Olanzapine 2.5mg od 5 – 10mg od
Quertiapine 25mg od 25 – 150 mg daily

Aripiprazole

5mg od 10mg od

 

Key Symptom First Line Second Line
Depression Citalopram/Sertraline

Mirtazapine

Apathy Citalopram

Donepezil

Rivastigmine

Galatamine

Psychosis Risperidone

Olanzapine

Aripiprazole

Memantine (Alzheimers)

Aggression

Risperidone

Olanzapine

Aripiprazole

Memantine (Alzheimers)

Moderate

Agitation and anxiety
Citalopram

Trazodone

Mirtazapine

Memantine (Alzheimers)

Severe

Agitation and anxiety

Risperidone

Olanzapine

Aripiprazole

Memantine (Alzheimers)

Poor sleep

Trazodone

Zopiclone

Clonazepam (Lewy Body)

Zolpidem

 

 

Information based on presentations given by Dr Nicola Decker and Dr Emer Forde,                  two inspirational GPs who have an interest in dementia care.

Nicola is a GP in North Hampshire, the CCG GP lead for dementia and a NICE Fellow.  She talked about How do you become a “dementia friendly” Practice and does this benefit the Practice or the patient?

It is worth looking at Nicola’s presentation which is full of useful information.

Here is the link to a Dementia friendly practice toolkit.

The Dementia Friendly Practice work was supported by the Wessex Academic Health Science Network and the outcomes are currently being evaluated with a view to encouraging wider implementation of the project.

Emer is a GP in Poole and talked about improving diagnosis and the care of patients living with dementia.

Emer’s presentation looks at the CCG strategy, a locality dementia plan, and dementia friendly communities.  Emer’s practice has produced a very simple but effective dementia action plan.

It often appears that a growing problem like this means that general practice is required to undertake additional work, but do we always make effective use of social care and the voluntary sector.  This presentation showed some of the collaboration that Emer’s practice and locality are undertaking with these organisations.

This led nicely into the final section which explored some examples of the care and support provided by the local authority and a number of voluntary organisations.

The Department of Health, a CCG and the Royal College of GPs have produced a document called: Dementia Revealed: What Primary Care needs to know.

Social Care and the Voluntary Sector

Social Care

This presentation was undertaken by Hampshire County Council but each local authority has an adult services section which will have a dementia action plan.   

They should be working in partnership with the CCG and the voluntary sector to ensure the co-ordination of services in your area. 

 

The Voluntary Sector

There was a short presentation from the Alzheimer’s Society and the Princess Royal Trust.

In Hampshire there are dementia advisors and dementia support workers. 

Dementia Advisor Service

In Hampshire Dementia Advisors are able to support GPs, take referrals and signpost people with dementia on to other appropriate organisations.  The service is provided by The Alzheimer’s Society and Andover Mind.

The service:

Contact details

Please telephone: 023 92 892034 for services provided by The Alzheimer’s Society in:

Please telephone: 01264 353363 for services provided by Andover Mind in:

 In your area I am sure there are similar organisations who are superb contact points for patients and GPs for information and help.

The LMC will seek information from each CCG relating to services and contacts and publish this on our website.

 

Dementia Lunch & Learn Package

Click here to download the lunch and learn package

The Dementia Lunch and Learn package is FREE to all Wessex Practices as Wessex LMCs is keen to support all the national work on Dementia and sees this resource as a major way in getting some messages across to all who work in general practice.

This training resource is to give everyone a basic idea of what dementia is and what the common symptoms are. It looks briefly too at the main risk factors to dementia. Subsequently, there are the tools which can be used to enable you to become a dementia friendly practice.

The aim of the session is to widen awareness of the illness and the effect it can have on patients and how as a practice you can make changes to enhance the care of your dementia patients.

There are some useful video clips in the resource, so access to an internet connection would be useful if that is available. However – they are not essential.

Please do not be daunted by all the suggestions within the iSPACE programme – just making a few changes in the right direction is a great start.

All staff should benefit from this – and please encourage locums to join you if you run a lunchtime session for all staff.

Here are some further resources for learning around Dementia:

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=367

Best wishes

Nigel

Dr Nigel Watson

Chief Executive

Wessex LMCs

Churchill House, 122-124 Hursley Rd

Chandler's Ford, Eastleigh

Hants. SO53 1JB (Registered Office)

Tel: 02380253874

Mobile: 07825173326

www.wessexlmcs.com

 

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