Dr. Aisling Denihan, Consultant Psychiatrist for OlderPeople,

Co. Meath

My time in M.I.R.A. From M.I.R.A. To Navan Green-field site Lots of “no’s” Oh, and no office 2003-2010 MMSE, CDT, abbrev. CAPE Tertiary referral

Ceiling effect – MMSE Resources even scarcer Unmet need, late presentations Early 2009 – something new needed Enthusiastic SR, keen team Support of Robert Coen/M.I.R.A.

Where? Who to contact? Cognitive Assessment team Clerical support? Pharma money? Referral form Exclusion criteria

Patient plus Doctor and S/W Informant plus Doctor and S/W Collateral Hx., NPI, PSMS, IADL S/W – supports, legal, financial Patient plus Nurses – neuropsych. testing MDT consensus meeting Feedback session

Addenbrooke’s Cognitive Examination Montreal Cognitive Assessment (MoCA) Delayed Word Recall Test (DWR) MMSE +/- Frontal Assessment Battery (FAB) Interesting observations

OPD unsuitable Too many chiefs... 2 locations do not work Quality-control issues Inappropriate referrals Incomplete referrals

48 referrals, 38(80%) met criteria Of 38, 28 via GP, 5 via Cons. Psychs., 5 via our

community case load 38 assessments scheduled, 2 DNA’s, 4 pending 32 full assessments, most within 4/52 19 (59%) female, 13 male Mean age (range 51-85y)

10 (20%) in total Reasons – Incomplete referrals - 5 Patient deceased - 1 Established dx., on Rx - 2 MMSE < 19 - 2

DIAGNOSIS NUMBERAlzheimer’sDisease

10 (early onset = 2) 31%

Mixed AD/VaD 619%

Pure VaD 3 (MID = 1) 9%Frontal Dementia 1 3%

Alcohol- Related 1 3%

MCI 8 25%

Other Dx 3 9%

28/32 (88%) came for feedback 3 DNA, 1 did not want feedback 15/32 – drug Rx. Suggested Information folder provided Follow-up - GP 13 Us 11 Other 8

To scan or not? Blood dementia screen? No physical exam Copyright issues – MMSE Managing expectations - preseniles ADL in males?

Truth-telling or fudge? Driving advice – rural pop. Schiz/BAD neuropsych. No-shows for feedback? MCI is not a dx. Ref. Rate waxes and wanes No monitoring clinic

MCI Link up with GM regionally? Monitoring Clinic at 6/12? No S/W for 9/12 – buy sessions? Carer support – Zarit B.I., group Not in Vision for Change