Dr. Aisling Denihan, Consultant Psychiatrist for
Older People,
Co. Meath
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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
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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.
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Where?
Who to contact?
Cognitive Assessment team
Clerical support?
Pharma money?
Referral form
Exclusion criteria
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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
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Addenbrooke’s Cognitive Examination
Montreal Cognitive Assessment (MoCA)
Delayed Word Recall Test (DWR)
MMSE
+/- Frontal Assessment Battery (FAB)
Interesting observations
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OPD unsuitable
Too many chiefs...
2 locations do not work
Quality-control issues
Inappropriate referrals
Incomplete referrals
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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)
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10 (20%) in total
Reasons –
Incomplete referrals - 5
Patient deceased
1
Established dx., on Rx - 2
MMSE < 19
2
DIAGNOSIS
NUMBER
Alzheimer’s
Disease
10 (early onset = 2)
31%
Mixed AD/VaD
6
19%
Pure VaD
3 (MID = 1)
9%
Frontal
Dementia
1
3%
Alcohol- Related 1
3%
MCI
8
25%
Other Dx
3
9%
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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
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To scan or not?
Blood dementia screen?
No physical exam
Copyright issues – MMSE
Managing expectations - preseniles
ADL in males?
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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
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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