Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital,...
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Transcript of Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital,...
Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,
Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health
Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,
Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health
Diagnosis and Early Management of Dementia
Madeleine Adams
Occupational Therapist
Team Leader SACS Cognitive Services
Ph: 9955 1230
Overview
• Eastern Health SACS Cognitive Service
• How to refer - Inclusion/Exclusion Criteria
• Cognitive enhancing medication
• Future Planning
Eastern Health Cognitive Service
• Cognitive, Dementia and Memory Service (CDAMS)
• Geriatric Evaluation and Management (GEM)
• Knox, Maroondah, Monash, Manningham, Whitehorse, Yarra Ranges
CDAMS
• CDAMS targets people with early changes that may include:– Increased forgetfulness of recent events– Changes in language skills– Difficulty with complex tasks– Decreased interest in hobbies and activities– Slowed thinking– Altered behaviour
CDAMS Service & Location
• CDAMS operates at two sites:
– Wantirna Health• Services clients from mainly from council areas of Monash,
Whitehorse, Knox, Manningham
– Yarra Ranges Health (Lilydale)• Services clients mainly from council areas of Yarra Ranges
and Maroondah
CDAMS - Referral Criteria
• For cognitive assessment where:– No previous diagnosis of dementia– Diagnosis is the primary reason for referral– Specialist diagnosis is required for medication– Person is medically stable– Person agrees to attend
CDAMS - Exclusion Criteria
• Recent onset of cognitive decline
• Urgent assessment
• People with longstanding impairment (e.g. ABI)
• People aged < 50 complaining of memory problems in the context of
stress, anxiety, depression
• People whose diagnosis is known
• People requiring neuropsychological assessment only
CDAMS - Exclusion Criteria
• People with moderate to severe dementia symptoms
• People with complex psychiatric conditions who may also have cognitive changes
• People who are physically unable to attend the clinic
GEM• People with more severe impairment may be more appropriate
for GEM:– Difficulties managing own personal care
– Becoming lost in own home
– Difficulties recognizing family and friends
– Have a diagnosis but need Geriatrician advice for a medication trial
GEM – Service & Location
– GEM operates at two sites:– Peter James Centre (East Burwood) – Wantirna Health
• Clients attend closest clinic or fastest appointment
GEM Referral Criteria
• Referral is for cognitive assessment and diagnosis is the primary reason for referral
• Specialist opinion is required for consideration or review of medication
• The person is medically stable• The person is physically able to attend centre based appointments• The person agrees to attend or can be persuaded by family/carer
GEM Exclusion Criteria• Recent onset of cognitive decline• People with complex psychiatric conditions• People with early changes to memory and thinking or who require
multidimensional evaluation• People from a CALD background are strongly preferred to be
referred to CDAMS for cognitive assessment• Where carer stress or need for counselling/education/community
supports is the primary reason for referral
GEM Exclusion Criteria
• People whose diagnosis is known and behavioural or psychological
disturbance is the primary issue
• People requiring allied health/nursing assessment and treatment
• People who are physically unable to attend the clinic
• Referrals for testamentary capacity or neuropsychological
assessment only
Referral to CDAMS/GEM
• Referrals are received via the Access Unit at Peter
James Centre on the EH SACS referral form
• Anyone can refer to CDAMS and GEM, however it is our
strong preference that the GP is involved
• Wait times vary contact EH Access Unit Ph: 9881 1100
Cognitive Enhancing Medication
• Both GEM and CDAMS provide this service • For people given a diagnosis of Alzheimer’s Disease or
Dementia with Lewy Bodies• Involves screening for risk factors and consideration of
side effects• Standardised cognitive testing before and after a 6
month trial
Cognitive Enhancing Medication
• Two main types of medication– Acetylcholinesterase inhibitors
• Mild-moderate dementia
– Mematine• Moderate –severe dementia
• Both work by moderating the effects of neurotransmitters in the brain
Treatment Options
• The current medication is only available for a diagnosis of Alzheimer’s Disease (or mixed dementia)
• Medication is initiated as a trial - client can receive 6 months supply through PBS, but needs to demonstrate a beneficial effect of the medication to qualify for ongoing PBS subsidy.
CRITERIA FOR CONTINUED PBS SUBSIDY
• Improvement of 2 points or more in MMSE
• Improvement (decrease) of 4 points or more in ADAS-Cog score
Medication Issues
• The medication can have side effects so there needs to be consideration of the benefit versus the risk
• Trial needs to be well managed - start at a low dose and increase to full dose after 1 month if well tolerated
• Client needs to reliably take medications/assistance needs to be organised
• If no improvement is seen, ongoing prescriptions must be privately purchased.
Future Planning
• CDAMS provides advice about future planning in the context of a dementia diagnosis
• This involves looking at:– Driving ability– Legal Issues – eg. Enduring Powers of Attorney– Advanced Care Planning– Services, supports and residential care
Future Planning
• Linkage with services from community service providers:– Alzheimer's Australia Victoria (AAV)
• Living With Memory Loss programs• Counselling/Education• Memory Lane Café
– Planned Activity Groups/Day Centres