T1 Symposium: Dementia, 17/11/23, SD

Cognitive Assessment in Dementia Diagnosis

• Cognitive assessment involves patient interview, collateral history, physical examination, cognitive rating scales, and investigations.
• Patient interview covers memory, language, executive abilities, visuospatial skills, visual perception, personality, mood, delusions, and activities of daily living.
• Collateral history includes similar content to patient interview, along with family history, past medical history, medication, alcohol and drug use, and risk and safety concerns.
• Physical examination focuses on neurological features associated with various types of dementia.
• Investigations include blood tests, cognitive rating scales, and neuroimaging for conditions like Alzheimer's disease, frontotemporal dementia, vascular dementia, and dementia with Lewy bodies.
• Common presentations of dementia include symptoms such as confusion, memory loss, language difficulties, impaired attention, mood changes, and hallucinations.
• Vascular dementia presents with varying symptoms depending on the size, location, and type of damage.
• Dementia with Lewy bodies is characterized by attentional, executive, and visual processing deficits, along with visual hallucinations and parkinsonism features.
• Frontotemporal dementia is associated with personality and behavior changes, impaired judgment, lack of empathy, and language issues.
• The text aims to help understand dementia assessment, typical symptoms of common dementia types, and the importance of early diagnosis in dementia.
• The global policy emphasizes the value of early diagnosis and intervention in improving the quality of life for people with dementia.
• Surveys show that people with dementia would like early diagnosis, aligning with the proposed benefits of early diagnosis in dementia.

Early and Timely Diagnosis of Dementia and Its Impact on Patients and Carers

• The Prime Minister’s Challenge on Dementia 2020 emphasizes the importance of early intervention for people with dementia to continue living well.
• "Early" and "timely" diagnosis are interchangeable but have different meanings, with early diagnosis associated with the biomedical discourse on diagnosis.
• Early diagnosis may occur during the prodromal or pre-symptomatic stage, resulting in a diagnosis of Mild Cognitive Impairment, Subjective Cognitive Impairment, or Cognitive Impairment No Dementia.
• "Timely" diagnosis is a more person-centered approach, considering when it best suits the person and their family and when they can most benefit from the diagnosis.
• There are individuals who do not want to be informed of a dementia diagnosis, and for them, no diagnosis would be considered timely.
• The discourse on early and timely diagnosis evolved due to a lack of evidence for the benefits and harms of an early diagnosis.
• There are regional variations in the diagnosis process, with a lack of awareness of dementia and a post-code lottery of diagnosis.
• Approximately 47% of over 1,400 carers across 5 European countries reported that they wanted an earlier diagnosis for dementia.
• Empirical patient data on the benefits or harms of an early or timely dementia diagnosis allows for the development of policies and services that deliver better outcomes for service users, carers, and systems.
• DETERMIND is a project focused on early and timely diagnosis of dementia, involving 940 people with dementia and 750 carers.
• DETERMIND has created indices for early and timely diagnosis, considering factors such as time between noticing symptoms and diagnosis and clinical stage.
• The project has also assessed the impact of early and timely diagnosis on quality of life, well-being, and carer burden, finding associations with better adjustment and less negative emotional impact on carers.