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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 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
    http://www.psychclub.com/topic/14879-lewy-body-dementia/
     
    Last edited: May 10, 2017
  2. Johnson

    Johnson 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

    Reflecting
    - 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]
    Compliment

    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 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

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