Presentations
- Behavioural and psychological symptoms of dementia (BPSD)
- Confusion
- Delusions
- Disinhibition, including sexually disinhibiting behaviour
- Disorientation
- Executive dysfunction
- Functional decline
- Hallucinations
- Impaired ability to carry out motor functions (apraxia)
- Lack of insight
- Loss of receptive or expressive language skills (dysphasia / aphasia)
- Personality change
- Poor short-term memory
- Reduced motivation
- Self-neglect
- Squalor and hoarding
Conditions
- Acquired brain injury
- Alcohol-related dementia
- Alcohol-related impairment
- Cerebral amyloid angiopathy
- Delirium
- Dementia
- Alzheimer disease
- dementia with Lewy Bodies
- fronto-temporal, including sub-types
- LATE (limbic-predominant age-related TDP-43 encephalopathy)
- Parkinson disease
- vascular
- Depression and anxiety
- Mild cognitive impairment (MCI)
- Psychiatric conditions, including bipolar affective disorder and chronic schizophrenia
- Sleep apnoea
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 relevant 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
Manage
- provide evidence-based management
For less common or more complex presentations and conditions the trainee must also seek expert opinions
- 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
Conditions
- Autoimmune disease, e.g. vasculitis
- Chronic traumatic encephalopathy
- Corticobasal degeneration
- Creutzfeldt-Jakob disease (CJD)
- Down syndrome
- Encephalitis - HSV, limbic
- Familial Alzheimer disease (FAD)
- HIV-associated dementia / AIDS dementia complex (ADC)
- Huntington disease
- Multiple sclerosis
- Niemann-Pick disease type C
- Normal pressure hydrocephalus
- Progressive supranuclear palsy
- Wernicke encephalopathy
- Wilson disease
- Younger onset dementia
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 relevant 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
Manage
- provide evidence-based management
For less common or more complex presentations and conditions the trainee must also seek expert opinions
- 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
- Genetics of dementia
- Incidence and prevalence of dementia
- Normal cognitive changes with ageing
- Normal cognitive function, including attention, types of memory and higher-order executive functions
- Nutritional supplements
- Pharmacology of medications used in dementia, as well as of anti-depressant and anti-psychotic medications
- Risk factors for delirium and dementia
- Stages of progression of dementia
- The neurobiology of dementia
Examinations
- Cognitive screening tools
- 4AT / CAM
- Addenbrooke’s Cognitive Examination
- Frontal Assessment Battery (FAB)
- Mini-Mental State Examination (MMSE)
- Montreal Cognitive Assessment (MoCA)
- Rowland Universal Dementia Assessment Scale (RUDAS)
- Mental state examination
- Physical examination, including neurological examination and gait
Investigations
- Biochemistry and haematology tests, including full blood count, electrolytes, calcium, glucose, kidney and liver function
- Brain imaging, including CT, MRI, SPECT, and PET
- EEG
- Genetic testing
- Lumbar puncture
- Neuropsychology assessment, including indications for referral and interpretation of results
- Psychiatric screening tests, e.g. geriatric depression scale
- Serum vitamin B12 and folate levels
- Thyroid function tests
- Urine tests
- Advanced care planning
- Assessment for suitability of driving
- Barriers to accessing services and care
- Behavioural and environmental management strategies - knowledge of, implementation of, and providing education for colleagues, patients and families or carers
- Care for the carer
- Cautious use of psychotropic medication
- Early recognition of cognitive issues
- Ethical and legal issues, including assessing decision-making capacity and identifying proxy decision makers
- Genetic counselling
- Knowledge of new imaging and therapeutics
- Lifestyle factor risk modification
- Maintenance of respect and dignity
- Management of physical care needs
- Non-pharmacological strategies and therapies
- Promotion of cognitive health
- Psychological engagement
- Quality of life
- Refer patients with dementia onto appropriate post-diagnostic program where indicated
Delirium
- Early diagnosis and treatment of patients with delirium
- Longitudinal follow up and dementia prevention strategies
- Prevention strategies for patients at risk of delirium
