Dementia
We tend not to think of dementia, a chronic disease, as an Emergency Medicine sensitive diagnosis. However as an increasing absolute number of people presenting to EDs have dementia (12.5% >70; 25% >80; 50% >90). This disease often is not diagnosed, so it is important for Emergency docs to have a good working knowledge of this chronic cognitive decline.
- We don’t generally think of dementia as an ED diagnosis though it often impacts on management and disposition
- Diagnosis is often not already established (70%)
- Important to distinguish confidently from delirium and depression
- Valuable to have a quick screening tool (not the MMSE — too long to be practical in the ED)
- There is a tendency to assume that ‘someone else’ has already established the diagnosis of dementia and that anyone who is not on donepezil does not have dementia! Although half of the population over 85 has some degree of dementia, the diagnosis is often not established until significant functional impairment has taken place – in other words – lots of older patients you see in ED have undiagnosed dementia!
- The diagnosis of dementia is relevant to establishing a discharge plan – poor medication compliance, impaired self-care, insufficient home support need to be considered if you are planning to manage a new medical diagnosis at home.
What is dementia?
- Chronic memory loss (short-term more than long-term) of such severity as to interfere with function AND
- One of :
- Apraxia (difficulty executing motor tasks eg. dressing, self-care)
- Aphasia (any language impairment, often word finding )
- Agnosia (difficulty recognizing familiar objects)
- Loss of executive functioning (planning, organizing, sequencing, abstracting)
Discussion: Dementia
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More researches should involve for this diagnosis
yes
We get it: not every single older patient had the right diagnosis before
It takes further investigation in to why there is delirium
okay
.
good content
great information
Great information
ok
i like the idea of identifying/ giving the diagnosis if not already done
thanks
good info
Ok
ok
okay
ok
ok
helpful
repetitive questions
ok
the problem diagnosing dementia, depression, and delirium is that all three can co exist with each other and all three can mask each other.
Thanks
yep
very useful
great definition
good definition
true
need caretaker
someone who cares about the patient should be involved
IT is important
right
know tests to identify the patient with dementia or cognitive impairment
agree
thought provoking
…
sometimes difficult to diagnose unless you know the pt well
Agree
.
new onset dementia is deceptive and often not noticed unless spend good time with the patient
I do not agree with that
I find the numbers amazing. 70% seems very high. I do agree with the importance of having a very different DC plan for those with dementia.
Agreed
ok
Good review
ok
Ok
ok
ok
ok
great teaching points for physicians
Thanks for this.
ok
good teaching
Good review
Good info
Important statistic of a presentation to ED
Such a high % of people over 70- good to know
follow up with social services.
325
Dementia is not a normal finding in elderly people. It is more commonly diagnosed in elderly people.
great
great information
great info …
Listen to family and get a good history. I like this simplified definition.
a standardized short tool would be helpful too
Muy útil para comprender los cambios y necesidades de los pacientes con demencia
Agree
Obtaining history from family/friends would also be helpful
Agreed
Helpful
Helpful
Great.
helpful
very helpful
very helpful
Helpful!
agreed
Important to ID these issues in ED
Learned the symptoms in school as “AH-YEE” –> A,A,A,E
thank you for this
good simple review of dementia, seen a lot of seniors in the community needing social and community support to help living with dementia. Often not much support and end up in the ER often.
Agreed
Useful tool for diagnosing dementia
Great info to have
good
good things to think about, maybe having home care team check on patient at least a few times to see compliance and more in home assessment of function
agree family input is important
MOCA is a great and easy to administer screening tool.
ok
The MOCA assessment when properly done can show where specific difficulties lie, ie executive thinking, language or recognizing familiar objects.
helpful overview
helpful
As a new graduate NP, I am often reluctant to make the diagnosis of dementia, however it is evident that doing so would greatly benefit residents
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DonM May 7, 2013
I think it’s not uncommon for cellulitis to go unnoticed both by a patient and by caregivers — I have occasionally pulled back the sheets to discover a huge swollen leg or buttock which is clearly the
aghazam March 10, 2014
Great teaching points for nursing students
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geriNP42 January 7, 2014
thank you for giving dementia a clear simple definition, leads me to reevaluate some questionalbe patients
Reply
Dr. Mark November 3, 2013
Socially isolated seniors with dementia need to be identified in the ER and referred for increased supports at home.
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Rocky Mountain October 10, 2013
Like this simple definition of dementiainfectious cause of the confusion.
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bharatbahl April 15, 2013
A woman admitted on the psychiatry floor with depression kept talking about her marriage breaking up 4 months ago. After talking to family we realized it was 2 years ago. Turns out she had a massive intracranial tumour compressing her hippocampus! And was alt
good notes, thanks
thanks. great points
GREAT INFORMATION.
great information
don’t assume all elderly have dementia or Alzheimers…many do not
Home care is and CCAC involvement is a must.
interesting
Labelling is half the battle. Patients with dementia vs. demented patients.
Often family will have noticed cognitive impairment for a long time, but patient has not been diagnosed with dementia.
Excellent information. A few factors not thought of.
Motor, language, recognize, plan
Demented patient should be looked at a a bit closer and be diagnosed earlier either by their family doctor who knows them best or Emergency Dept.
good to review this information again.
dementia affects the ability of the patient to care for themselves and medical conditions effectively and therefore affects the disposition from the ED.
for a diagnosis of dementia, it must impact function. Cognitive impairment without functional impairment (ADLS and IADLS), is MCI
Dementia should always be kept under differential diagnosis when patient has poor medication compliance, impaired self-care, insufficient home support.
good to know
As a rural provider, many of our patients that visit the ER are local, so their health history is either well-established or easily accessed. That helps improve efficiency in the ER visit, however having a simple tool to do a quick dementia assessment is still essential.
Easy to remember
Concise and clear. Thanks.
simple definition of dementia,good
Agree with the above comment
great points – have to keep this in differential
UNDERSTOOD
Pretty straight forward def’n
.
–
strikes home…parent has dementia
OKAY
good discussion
Good definition
good definition
This is a good, practical definition of dementia.
So often not enough time to proper dx dementia when it such an important condition to stabilize sooner rather than later.
must distinguish between delirium and depression
So many subtypes by AD ~ 70% of dementia Dx
simple to learn
keep in mind the difference between delirium and dementia
It is as important to know the difference between delirium presisa and demensia since both are presented in the emergency services
Important distinguish delirium and depression.
🙂
Simply definition of dementia, I like
This is helpful.
good definition
xx
xx
Its difficult to understand dementia unless we have people to help us understand the patients baseline mental status
insightful
Simple definition easily missed and not investigated or followed post discharge.
Easy , simple definition, I like it.
Dementia easily missed in ER, we need to focus and consider it all times with seniors.
Diagnosing dementia is key as it dictates many other interventions. For example, I had a LTC pt with mod-severe dementia with a history of COPD he was not a good candidate for using Spiriva as recommended by a consultant.
Great teaching points for nursing students
thank you for giving dementia a clear simple definition, leads me to reevaluate some questionalbe patients
Socially isolated seniors with dementia need to be identified in the ER and referred for increased supports at home.
Like this simple definition of dementia