Dr. Aisling Denihan, Consultant Psychiatrist for Older...
Transcript of Dr. Aisling Denihan, Consultant Psychiatrist for Older...
Dr. Aisling Denihan, Consultant Psychiatrist for OlderPeople,
Co. Meath
My time in M.I.R.A. From M.I.R.A. To Navan Green-field site Lots of “no’s” Oh, and no office 2003-2010 MMSE, CDT, abbrev. CAPE Tertiary referral
Ceiling effect – MMSE Resources even scarcer Unmet need, late presentations Early 2009 – something new needed Enthusiastic SR, keen team Support of Robert Coen/M.I.R.A.
Where? Who to contact? Cognitive Assessment team Clerical support? Pharma money? Referral form Exclusion criteria
Patient plus Doctor and S/W Informant plus Doctor and S/W Collateral Hx., NPI, PSMS, IADL S/W – supports, legal, financial Patient plus Nurses – neuropsych. testing MDT consensus meeting Feedback session
Addenbrooke’s Cognitive Examination Montreal Cognitive Assessment (MoCA) Delayed Word Recall Test (DWR) MMSE +/- Frontal Assessment Battery (FAB) Interesting observations
OPD unsuitable Too many chiefs... 2 locations do not work Quality-control issues Inappropriate referrals Incomplete referrals
48 referrals, 38(80%) met criteria Of 38, 28 via GP, 5 via Cons. Psychs., 5 via our
community case load 38 assessments scheduled, 2 DNA’s, 4 pending 32 full assessments, most within 4/52 19 (59%) female, 13 male Mean age (range 51-85y)
10 (20%) in total Reasons – Incomplete referrals - 5 Patient deceased - 1 Established dx., on Rx - 2 MMSE < 19 - 2
DIAGNOSIS NUMBERAlzheimer’sDisease
10 (early onset = 2) 31%
Mixed AD/VaD 619%
Pure VaD 3 (MID = 1) 9%Frontal Dementia 1 3%
Alcohol- Related 1 3%
MCI 8 25%
Other Dx 3 9%
28/32 (88%) came for feedback 3 DNA, 1 did not want feedback 15/32 – drug Rx. Suggested Information folder provided Follow-up - GP 13 Us 11 Other 8
To scan or not? Blood dementia screen? No physical exam Copyright issues – MMSE Managing expectations - preseniles ADL in males?
Truth-telling or fudge? Driving advice – rural pop. Schiz/BAD neuropsych. No-shows for feedback? MCI is not a dx. Ref. Rate waxes and wanes No monitoring clinic
MCI Link up with GM regionally? Monitoring Clinic at 6/12? No S/W for 9/12 – buy sessions? Carer support – Zarit B.I., group Not in Vision for Change