Dementia Protocol

When to request for it?

1. To ascertain whether an individual is suffering from a memory disorder or if the symptoms are due to something else;
2. To uncover wherever possible, once the diagnosis of memory disorder had been established, the underlying cause of the impairment;
3. To organize appropriate treatment plans and follow-ups for individuals with treatable and reversible conditions underlying the memory disorder; and
4. To set-up appropriate management plans for individuals with irreversible dementia, the leading cause of which is Alzheimer’s Disease, and to offer follow-up visits to monitor disease progression so as to appropriately counsel and to adjust the management strategy to suit the patient’s current needs.

1. patients who feel they are developing memory difficulties severe enough to affect daily functioning;
2. “worried well” elderly individuals (65 years and above) who are afraid they are “losing their memory”;
3. individuals with depression and memory impairment;
4. relatives concerned about a loved one’s memory and ability to care for himself / herself;
5. referring physicians with diagnostically difficult cases of memory impairment and other cognitive / behavioral symptoms; and
6. individuals with mild cognitive impairment (MCI) and very early stages of dementia.

• The specialist and a nurse clinician meet with the patient and his or her family jointly, then separately, to evaluate the patient’s clinical history, behavioral and psychiatric status and current level of functioning.
  
• The patient undergoes meticulous physical and neurological examinations conducted by the specialist.
  
• A battery of neuropsychological tests with the designated psychologist to assess all aspects of cognitive functioning.
  
• Laboratory blood tests and neuro-imaging strategies are employed when deemed necessary and scheduled accordingly.
  
• The clinic team makes a diagnosis, and draws up a treatment plan and recommendations.
  
• The treatment plan and recommendations are shared by the specialist in a feedback conference with the patient and his / her family. The latter are also provided with a comprehensive feedback information sheet accomplished by the nurse clinician.
  
• Referring doctors are provided with a detailed clinical report, summary of recommendations prepared by the specialist and all laboratory and neuro-imaging test results.

• Family counseling may be arranged so as to assist the family and most specially, the primary caregiver, in coping with the patient’s illness and how to optimally care for the family member afflicted with dementia and make necessary referrals to institutions that will assist them in their additional needs.
  
• Follow-up visits (every six months) to monitor response to treatment or progression of the disease.

1. Structured history elicited from the patient and more importantly, if possible from a reliable informant
2. Complete physical and neurological examination
3. Psychometric Test

a. Verbal Fluency
b. Modified Boston Naming Test
c. Mini Mental State Exam (MMSE)
d. Test of constructional Praxis
e. Word List Memory Test
f. Digit Symbol
g. Word List Recognition
h. Word Recall List
i. Short Blessed
j. Trails A and B
k. Diagnostic Aphasia Test
l. ADAS- Cognitive Subset

a. Neuro-Psychiatric Inventory (NPI)
b. Assessment of Functional Abilities
m. Bristol Activities of Daily Living

1. CBC
2. ESR
3. FBS, BUN, Creatinine, Uric Acid, Cholesterol, Triglycerides, LDL, HDL, VLDL
4. B12
5. T3, T4 and TSH
6. VDRL

• identify reversible structural intracranial causes of memory impairment / dementia ( e.g.: brain tumors, blood clots)
  
• correlate early structural changes in individuals with mild cognitive impairment (MCI)
  
• correlate early structural changes in individuals with early stages of irreversible, neurodegenerative dementias

• To determine vascular causes of dementia.