Curriculum standards
Knowledge guides
LG18: Disorders of memory, including dementia
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Autonomic dysfunction
- Behavioural / Personality changes, such as:
- apathy
- Confusion
- Emotional changes, such as:
- anxiety
- depression
- Language difficulty
- Loss of balance
- Memory problems
- Speech abnormalities
- Perception / Vision changes
- Weakness
Conditions
- Alzheimer disease and related dementias
- Atypical Parkinsonian disorders
- Cerebrovascular inflammatory disease
- Delirium
- Dementia with Lewy bodies
- Frontotemporal lobar degeneration syndromes, including:
- progressive aphasias
- Immune-related encephalopathies
- Metabolic disease
- Normal pressure hydrocephalus
- Parkinson disease
- Poisoning / Toxins
- Psychiatric diseases, including:
- depression
- schizophrenia
- Systemic / Cerebrovascular inflammatory disease
- Thyroid dysfunction
- Toxins, including ethyl alcohol or ethanol (EtOH)
- Transient epileptic amnesia
- Transient global amnesia
- Vascular dementia
- Vitamin or mineral deficiency
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Catatonia
- Hyperkinetic movement disorder(s)
- Myoclonus
- Neuroimaging abnormalities
- Rapidly progressive cognitive decline
Conditions
- Genetic / Inherited neurodegenerative disease
- Inborn errors of metabolism
- Leukodystrophies
- Mitochondrial disease
- Prion disease:
- Creutzfeldt–Jakob disease
- familial prion disorders
- Repeat expansion disorders
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Acute, chronic, common, and rare diseases that result in disorders of behavioural change, language, memory, or movement
- Neuroanatomy, neuropharmacology, and neurophysiology of normal memory and language function
- Pathological mechanisms that result in disturbed memory or behavioural function
Cerebrospinal fluid (CSF) procedures and investigations
- Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
- cell count
- cytology
- glucose level
- immunological tests
- microbiological tests
- protein level
- xanthochromia
- opening pressure
- special tests:
- 14-3-3 protein
- amyloid and tau levels
- neurofilament light chain
- oligoclonal bands
- basic CSF analysis:
Clinical neurophysiology investigations
- EEG:
- sleep-deprived EEG
- standard EEG
- video EEG
- Electromyography (EMG) / Nerve conduction studies (NCS):
- motor and sensory studies
- needle EMG
Neurogenetic investigations
- Genetic testing, including, but not limited to:
- chromosomal testing, such as:
- karyotype
- microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
- chromosomal testing, such as:
- Referral to a neurogeneticist
Neuroimaging investigations
- CT, including:
- CT angiography
- perfusion
- venography
- MRI, including:
- functional (fMRI)
- magnetic resonance:
- angiography (MRA)
- spectroscopy (MRS)
- venogram (MRV)
- with contrast
- PET
- Single photon emission computed tomography (SPECT)
- Vascular imaging:
- catheter angiography
Neuroimmmunology investigations
- Autoantibody measurement:
- limbic encephalitis panel
- paraneoplastic antibodies
- Referral to a neuroimmunologist
Neuropathology investigations
- Brain biopsy
Neuropsychological investigations
- Cognitive screening:
- Addenbrooke’s Cognitive Examination
- Mini-Mental State Examination
- Montreal Cognitive Assessment
- Rowland Universal Dementia Assessment Scale
- Referral to a neuropsychologist
Other investigations
- Ethanol / Heavy metals / Toxins:
- autoimmune antibodies
- infective serology
- Other laboratory tests:
- acanthocytes
- urinary porphyrins
- urine drug screen
- Polysomnography
- Serum investigations:
- electrolytes
- full blood count
- glucose level
- mineral and vitamin levels
- Consider cultural implications and stigma related to diagnosis of neurodegeneration
- Consider implications of genetic / inherited causes of neurodegenerative disease
- Prognosis and implications of neurodegenerative diseases, such as:
- advance care planning
- driving
- increased care needs
- institutional care
- Specific conditions that mimic disturbance of memory, including psychiatric disorders