Related conditions, e.g. dementia, vascular disease, depression
Living situation, carer/home support
Effect on function/coping with activities of daily living: washing, dressing, cooking, cleaning
Smoking, alcohol and other cardiovascular risk factors
To self: wandering, leaving gas on, abuse, neglect by self or others
To others: aggression, risky behaviour
Carer’s needs: empathise with the demands; ask about stress, coping, and support
ICE (Ideas, Concerns, Expectations): how does the relative/carer expect you to help? What are they worried about?
Summarise situation and patient needs. Thank relative.
Causes of dementia
Alzheimer’s: most common; prevalence increases with age; some genetic association. Slowly progressive. Presents with memory/cognitive impairment (5A’s: Anomia, Apraxia, Agnosia, Amnesia, Aphasia). Due to generalised atrophy of cortex with amyloid plaques and neurofibrillary tangles.
Vascular Dementia: stepwise deterioration. Often have multiple cardiovascular risk factors. May have focal neurology. CT head may show areas of ischemia or small vessel disease.
Lewy-Body Dementia: progressive dementia with daily fluctuations of awareness due to Lewy bodies in the cerebral cortex. Parkinsonian features (e.g. bradykinesia, tremor, rigidity) and psychiatric symptoms (e.g. hallucinations) are common.