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Dementia in Lewy Body - assessment diagnosis management [linked]

Discussion in 'CASC - GENERAL STATIONS' started by Johnson, Dec 14, 2015.

  1. Johnson

    Johnson Active Member

    A good video in SPMM. But have to pay for it
    When discussing the diagnosis
    To differentiate with PD and DLB
    In PD - motor symptoms precede memory problems, visual hallucinations ( well formed - people, animals) by 12 months

    In DLB
    - fluctuating cognition
    - visual hallucinations
    - motor symptoms

    Generally its diagnosed with good history taking
    Routine blood test
    DAT to differentiate between PD and DLB

    Good reference
    Last edited: May 10, 2017
  2. Johnson

    Johnson Active Member

    In Jan 2017 CASC
    I passed both stations and yesterday I attended a casc teaching day [ similar station]

    First speak to son - I addressed his concerns and explained
    Few questions I remember from actor from casc exam
    1. PD and DLB difference - It was obvious which came first, but now not sure whether there is a 12 months rule between motor and memory symptoms
    2. Why he sees things - I knew its visual hallucinations but struggled to explain the actual cause why someone might be having them....] worth reading
    3. why not start antipsychotic - I explained about sensitivity, equally mentioned that increasing the rivastigmine would be my first choice
    Rest all common chat

    - Could I have asked for a neurologist opinion ?? [ not sure whether the patient had DAT scan in the scenario]
    - Recently I learnt that in such stations , its always worth showing empathy by asking " how his dad coping" , if it was first time diagnosed , worth mentioning "I am sorry to hear about your father's diagnosis" [ worth phrasing it better than I do] This I learnt from English consultant - well what can I say , I keep learning even after 5 attempts ;)

    2nd station is speaking to her daughter

    Got to know NO carer or needs ax done -
    Patient has become more tearful looking at the photos of his late wife
    Asked for falls, constipation, pain, mobility problems
    Asked for affective symptoms, behavioural changes, cognitive decline, driving, emotional [ affective], falls, psychosis [my mnemonic ABCDEFP - I go through ABC.. and jumped to P]
    Asked whether seen by GP , recent urine test, bloods [ delirium can present with emotional lability- I have seen in many patients - so worth ruling out , believe me not just infection, even cardiac causes, anaemia, CKD... contribute to prolong delirium in real life]
    MDT approach - physio if recent falls, OT, CPN, social worker, support teams , charity
    Otherwise mostly common chat...

    In BOTH stations - I would mention that I would like to see the patient ASAP - home visit
    Capacity and consent - worth thinking about it regarding sharing information - but I think I might be a bit over the top and bit paranoid about the college what they are exactly asking after 5 failed CASC attempts

    Feedback from teaching [ consultant and actor]
    Listen 1-2 min
    Avoid jargons
    I mentioned " he is searching for his wife" actor mentioned if I mentioned " He was searching for your mother" would have meant a lot for her as a daughter [ i thought its a good one to take it]

    I know most things in day to day life, but I forget to MENTION half of things in casc, well I have learnt the hard way, practise practise practise and of course the luck factor
    Last edited: May 16, 2017
  3. Johnson

    Johnson Active Member

    Updated -

    General [ this I write after speaking to one person, I might be updating ]
    I spoke to an experienced staff nurse when we would involve social services [some wards have a social worker ]

    I was told the moment family says "can't cope", social services need to be involved esp. in old age

    So in exam - worth asking how the family is coping ? think of complimenting the carer [can be anyone in the family]

    Needs assessments are done by ward staff/ in the community ? is it social services
    Carers and financial assessments are done by social worker

    Ward social worker [ if there is one if not need to be allocated] will look into a care package doing a ? needs assessment [ I am also learning] this involves a care package
    Day centre and other activities in the community are organised by support workers in social services in the community - but I was told cost is paid by patient/family

    CPN [community psychiatric nurse or some call care coordinator]- monitors meds and s/e and coordinate appointments etc..
    Last edited: May 16, 2017
  4. Hossam

    Hossam New Member

    When asked about visual hallucinations
    I prefere to do the following
    - Show empathy : it is distressing to see your father seeing things.
    -Elaborate more about the symptom :
    Tell me more about that , how often , how long do they last , anything brings them about medicatios ,alcohol , fever or any illness , does he apppear perplexed or disoriented
    There possible causes for the visual hallucinations
    - Confusion due to medical cause
    -Part of the symptoms of the LBD
    - Side effect of levodopa.
    I would like to.talk to your father and revise qith tbe neurologist the dose of levodopa and revise the medical condition with the gp.
  5. Johnson

    Johnson Active Member

    Useful tips
    I discussed with my consultant who mentioned most organic causes affecting the occipital lobe could lead to visual hallucinations example if diffuse LBD. As mentioned above very important to rule out other organic causes.

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