Thursday 2 August 2007


I concede that dementia subtyping is my role, not the role of medical colleagues. To sleuth out whether someone's got Alzheimer's disease and merits drug treatment, or has vascular dementia, Lewy Body dementia, or something obscure, sits firmly in Old Age Psychiatry. This I am happy with.

A local neurologist who I respect enormously (and has a brain the size of Saturn) also diagnoses dementia subtypes in her patch and does so incredibly well. Referrals from her are a joy. This too makes me happy.

Most of the GPs in my corner are very good indeed. They are committed, receptive to ideas, often doing what's best for their patients even if that does fall a touch outside protocols, guidelines and edits of What Thou Shalt Do. GPs with common sense, this makes me happy.

Although a diagnosis of dementia can be made by a GP or Consultant colleague, then referred on to me for dementia subtyping and appropriate treatment, some GPs aren't sure and refer patients who may or may not have dementia and don't make the diagnosis themselves. I'm fine with this, too. At best we're picking up dementia early, at worst I'm reassuring the GP and his patient that all is well. I don't have to be always treating and intervening. Supporting GPs in areas they're not sure about is, to my mind, a valid use of Consultant time.

It's good that local GPs can query concerns with me and express themselves frankly.

Still, there are some basics I would hope all clinicians have an appreciation of.

What surprised me in chatter with a local GP about our services was his honest question, "What's dementia?"


A. said...

My mother-in-law died of Alzheimer's after many years having her condition "hidden" my my father-in-law. I ended up having to go to see her GP myself and make sure they were aware, but as they said, if they don't ask for help we can't force it on them. Of course by the time he did ask for help it was so late little could be done.

The distressing thing to me is that by the time a diagnosis is made, quality of life has already deteriorated quite considerably. And I freely admit (though not to him) that I'm watching my husband like a hawk.

The Shrink said...

Thank you for your comments, let's hope your husband never develops Alzheimer's. Being male halves his risk! :-)

It is worth being somewhat vigilant (but not neurotically so!) since medication certainly is of merit in maintaining the status quo for most folk, for a goodly time.

Too, much can't be forced on folk but a lot can be introduced to help.

Initially it's good to have no Council Tax to pay, getting Attendance Allowance to help with care, advice on psychological techniques that help with establishing routines and cognitive patterns that maintain cognition at least as helpfully as medication does, DVLA and driving considerations, Enduring Powers of Attorney (to become Lasting Powers of Attorney in October 2007) and support around the implications of the diagnosis.

Later through the illness it's often useful to consider a sitting services, social care visits up to 4 times a day (for prompting of medication, helping with practical care and housework), day care for stimulation and to give the partner a bit of time out or even a week's respite in a car home planned every few months.

As you say, this can't easily be forced on people but with encouragement it can be tried (and declined if not for them).

Even so, the Mental Health Act 1983, Mental Capacity Act 2005 and National Assistance Act 1948 can all be used to ensure someone with dementia gets the care they need and deserve, even if they're not in a position to consent to care.

Calavera said...

So... females have a greater risk of developing Alzheimer's, then?

The Shrink said...

Cal, welcome . . . and sadly yes, x2 the risk. Unlucky ;-) But by the time a bright young thing like you is fretting over it, happen the vaccines may be of benefit.

XE said...

Heya Shrink,
Just discovered your blog! I always enjoy your comments left at Tea at Ten and A Fortunate Man, so I'm looking forward to reading it!

The Shrink said...

Hmmm, no pressure, then ;-)