Dementia in Practice

In this episode, Steph talks to Rowena Mobbs - a cognitive neurologist with a special interest in CTE and concussion, something that has been gaining interest in mainstream media and research. She talks about the theory and impact that multiple micro traumatic head injuries can have on the brain and what we can do to identify people who may have CTE, as well as talking about strategies for risk reduction.

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In this episode Hilton talks to Paul Yates, Associate Professor and geriatrician and researcher from the National Ageing Research Institute (NARI) and Austin Health. Paul describes the landscape of Alzheimer’s research in relation to biomarkers for Alzheimer’s Disease and the use of this to assist with treatments that may be available in the future. Paul talks about some of the limitations and challenges that are facing the implementation of new treatments.

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In this episode Steph talks to Madeline Healy a geriatrician from Melbourne who received a Churchill Fellowship to travel internationally and research the services for people living with dementia who also have Down syndrome. Down syndrome is associated with a significant risk of Alzheimer’s disease and there are limited specialist services for this population in Australia. Madeline talks about some of the approaches for supporting both people with Down Syndrome and Intellectual Disability and how we can learn from international examples of care.

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In this episode Hilton interviews Mark Yates a Geriatrician from Ballarat. Mark introduces some simple principles to use when assessing capacity particularly in relation to the person living with dementia. He talks about the URUC model, which stands for understanding, retain, utilise and communicate information for which they are being assessed.  Mark is able to break down what can be a very complex and challenging process for medical professionals into simpler terms that can be easily applied.

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Join Dr Stephanie Daly and her GP colleagues, Drs Hilton Koppe and Rebecca Moore for a fascinating exploration into dementia risk reduction. In light of the 2024 Lancet Commission Report in which it was announced that approximately 45 percent of dementia is attributable to modifiable risk, there are several simple lifestyle modifications which people can institute which may help mitigate their risk of developing dementia.

Resources:

Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., Ames, D., Banerjee, S., Burns, A., Brayne, C., Fox, N. C., Ferri, C. P., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Nakasujja, N., Rockwood, K., Samus, Q., … Mukadam, N. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet (London, England), 404(10452), 572–628. https://doi.org/10.1016/S0140-6736(24)01296-0

The CogD risk is an online tool available to everyone. It determines areas of strength and challenge in terms of dementia risk and individualised suggestions of ways to attenuate risk. There are also factsheets for GPs to provide patients about diet, exercise and vascular risk.

Cognitive Health and Dementia Risk Assessment

Fact Sheets for General Practitioners – Cognitive Health and Dementia Risk Assessment

CPD (RP & MO)

Reflect on the way in which you currently perform your 45 to 49 year old health checks.

Following this podcast, is there anything in your practice that you intend to change?

How might you incorporate a discussion about brain health during the 45-49 year old health check?

Identify three upcoming patients for whom a 45 to 49 year old health check would be appropriate. Recommend they complete the Cog-D risk online tool prior to their appointment.

This time, perform your usual 45 to 49 year old check but incorporate a discussion about brain health and go over their Cog-D risk results. In addition to vascular risk, consider factors including mental health and social isolation, hearing and vision loss and head injury.

How did you find the experience?

How do you think the patients responded?

Do you plan to frame your 45 to 49 year old health checks like this in the future.

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A very special episode of Dementia in Practice where one of our own GPs, Dr Steph Daly talks with her GP colleagues Drs Hilton Koppe and Rebecca Moore about the challenges she experienced as a doctor and a daughter when one of her parents was diagnosed with dementia.

Resources

Providing person centered care - About me document Dementia Support Australia – for assisting in creating information about an individual.

https://www.dementia.com.au/resource-hub/about-me-resources

Guidance for goals of care discussions in the elderly

https://www.palliaged.com.au/Evidence-Centre/Evidence-Summaries/Goals-of-Care

CPD

1. Review the palliaged document above – consider for dementia with use of resources from DTA such as the trajectory slide and stages framework, how you might advise patients or assist patients in advanced care directive conversations.
2. If you work in aged care, consider the utility of a document such as the about me resource, and how this might assist in your ability to provide person centered care for an individual
3. If you have a family member affected by dementia, reflect on whether this has impacted your practice and how you care for other people whom you see living with dementia.

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In this, the first episode for Season 4, Dr Hilton Koppe interviews Occupational Therapist and Professional Practice Advisor for Aged Care, Christina Wyatt.

Occupational therapists are considered underutilized in the post-diagnostic care of people living with dementia and Christina explains the important role an occupational therapist can play. OTs apply an individualized, strength-based approach in the home, which helps enable the person living with dementia to flourish in their environment.

Resources:

Occupational Therapy Australia. The Find an OT service helps you find registered, local OTs, those with special interests and a variety of funding sources

Find occupational therapists

Some excellent fact sheets

• the role of OT in dementia care
• the role of OT in Community based Aged Care
• the role of OT in Residential Aged Care
• the role of OT in Behaviour Support Plans
• the role of OT in preventing falls
• the role of OT in mealtimes
• the role of OT in supporting the older driver

Wyatt, Christina (2024) Creating Dementia Enabling Homes: Safety and Mobility. Australian Journal of Dementia Care

Subscribe to read 👉 https://lnkd.in/gMnx2RPQ

The COPE (Care of people with dementia in their environments) Programme is an OT and nursing initiative which provides a strength-based enablement approach to help the person living with dementia manage better in their home environment. 

Home - COPE Program

CPD

Access the Find an OT webpage Find occupational therapists

Search for all OTs in your local area and using the filters, determine those with dementia as a special interest.

Write a list of these and use it for future referrals.

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Dr Marita Long speaks with neuropsychologist and researcher, Prof Caroline Gurvich about the interplay between gender and dementia, with a particular focus on what happens during the menopause.

Australian Menopause Society

https://www.menopause.org.au/images/stories/infosheets/docs/AMS_Oestrogen_and_cognition_in_the_perimenopause_and_menopause.pdf 

Brain fog in menopause: a health-care professional’s guide for decision-making and counseling on cognition

https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792 

Dementia Training Australia

Providing education for GPs and other health practitioners

GP resource page - https://dta.com.au/general-practitioners/ 

DTA home page - https://dta.com.au/ 

Dementia Australia
Providing support, information and services for people living with dementia, carers, family and health professionals

National Dementia Helpline – 1800100500
https://www.dementia.org.au/

Forward with Dementia 

A guide for the first year after diagnosis 

https://forwardwithdementia.au/ 

Dementia Support Australia (DSA)
Dementia Support Australia (DSA) provides the Dementia Behaviour Management Advisory Service (DBMAS) and Severe Behaviour Response Teams (SBRT) nationwide. 

24 hour Helpline 18000699799
https://www.dementia.com.au/

Wicking Dementia Research and Education Centre
Master of Dementia Program - https://www.utas.edu.au/wicking/mdem

Understanding Dementia: free online course - https://www.utas.edu.au/wicking/understanding-dementia

Preventing Dementia: free online course - http://www.utas.edu.au/wicking/preventing-dementiaCarers Australia
Carers Australia is the national peak body representing Australia’s unpaid carers, advocating on their behalf to influence policies and services at a national level. 

Phone 1800242636
https://www.carersaustralia.com.au/

RACGP Silver Book
Medical care of older persons in residential aged care facilities (Silver Book) aims to provide GPs and other health professionals including residential aged care nurses, with a resource for delivering quality health care in residential aged care facilities.

https://www.racgp.org.au/clinical-resources/clinical-guidelines/ key-racgp-guidelines/view-all-racgp-guidelines/silver-book

RACGP Red Book - Guidelines for preventative activities in general practice - Dementia 
https://www.racgp.org.au/clinical-resources/clinical-guidelines/ key-racgp-guidelines/view-all-racgp-guidelines/red-book/ preventive-activities-in-older-age/dementia

My Aged Care - dementia resources
https://www.myagedcare.gov.au/getting-started/health- conditions/dementia

Austroads

Assessing fitness to drive in people living with dementia and cognitive impairment

https://austroads.com.au/publications/assessing-fitness-to-drive/ap-g56/neurological-conditions/dementia 

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Our team of Dementia Training Australia’s GP Educators, Steph Daly, Marita Long and Hilton Koppe discuss the strengths and weaknesses of cognitive assessment tools, and how they can be optimally used in the assessment of people with possible cognitive impairment. 

Standardised Mini Mental State Exam (SMMSE)

The test: https://www.ihacpa.gov.au/sites/default/files/2022-08/smmse-tool-v2.pdf 

Guidelines for administration and scoring instructions: https://www.ihacpa.gov.au/sites/default/files/2022-08/smmse-guidelines-v2.pdf

GP Assessment of Cognition (GPCog)

https://gpcog.com.au/ 

Indigenous Cognitive Assessment (KICA)

https://www.nari.net.au/indigenous-cognitive-assessment 

Rowland Universal Dementia Assessment Scale (RUDAS)

https://www.dementia.org.au/resources/rowland-universal-dementia-assessment-scale-rudas 

Montreal Cognitive Assessment (MoCA)

https://mocacognition.com/ 

CogD Risk

Homepage - https://cogdrisk.neura.edu.au/ 

Factsheets - https://cogdrisk.neura.edu.au/factsheets-for-general-practitioners/ 

IQ Code

https://nceph.anu.edu.au/research/tools-resources/informant-questionnaire-cognitive-decline-elderly 

Clock Drawing Test

https://www.dementiacarecentral.com/alzheimers-clock-test/

Trailmaking A and B tests

https://eatspeakthink.com/wp-content/uploads/2018/06/IowaTrailMaking.pdf

Snellgrove Maze Test

https://www.safemobilityfl.com/pdfs/CliniciansGuide/SnellgroveMazeTest4thEdition.pdf 

Dementia Training Australia

Providing education for GPs and other health practitioners

GP resource page - https://dta.com.au/general-practitioners/ 

DTA home page - https://dta.com.au/ 

Dementia Australia
Providing support, information and services for people living with dementia, carers, family and health professionals

National Dementia Helpline – 1800100500
https://www.dementia.org.au/

Forward with Dementia 

A guide for the first year after diagnosis 

https://forwardwithdementia.au/ 

Dementia Support Australia (DSA)
Dementia Support Australia (DSA) provides the Dementia Behaviour Management Advisory Service (DBMAS) and Severe Behaviour Response Teams (SBRT) nationwide. 

24 hour Helpline 18000699799
https://www.dementia.com.au/

Wicking Dementia Research and Education Centre
Master of Dementia Program - https://www.utas.edu.au/wicking/mdem

Understanding Dementia: free online course - https://www.utas.edu.au/wicking/understanding-dementia

Preventing Dementia: free online course - http://www.utas.edu.au/wicking/preventing-dementiaCarers Australia
Carers Australia is the national peak body representing Australia’s unpaid carers, advocating on their behalf to influence policies and services at a national level. 

Phone 1800242636
https://www.carersaustralia.com.au/

RACGP Silver Book
Medical care of older persons in residential aged care facilities (Silver Book) aims to provide GPs and other health professionals including residential aged care nurses, with a resource for delivering quality health care in residential aged care facilities.

https://www.racgp.org.au/clinical-resources/clinical-guidelines/ key-racgp-guidelines/view-all-racgp-guidelines/silver-book

RACGP Red Book - Guidelines for preventative activities in general practice - Dementia 
https://www.racgp.org.au/clinical-resources/clinical-guidelines/ key-racgp-guidelines/view-all-racgp-guidelines/red-book/ preventive-activities-in-older-age/dementia

My Aged Care - dementia resources
https://www.myagedcare.gov.au/getting-started/health- conditions/dementia

Austroads

Assessing fitness to drive in people living with dementia and cognitive impairment

https://austroads.com.au/publications/assessing-fitness-to-drive/ap-g56/neurological-conditions/dementia 

See omnystudio.com/listener for privacy information.

In this episode, Dr Hilton Koppe speaks with Spencer Ratliff whose father died from younger onset dementia. We hear about the challenges his family overcame and how they were able to create a legacy as a result of their experiences.

Able Foods

Ready made foods for people living with disabilities https://ablefoods.com.au/ 

Dementia Australia – About younger onset dementia

https://yod.dementia.org.au/about-younger-onset-dementia

Dementia Training Australia

Providing education for GPs and other health practitioners

GP resource page - https://dta.com.au/general-practitioners/ 

DTA home page - https://dta.com.au/ 

Dementia Australia
Providing support, information and services for people living with dementia, carers, family and health professionals

National Dementia Helpline – 1800100500
https://www.dementia.org.au/

Forward with Dementia 

A guide for the first year after diagnosis 

https://forwardwithdementia.au/ 

Dementia Support Australia (DSA)
Dementia Support Australia (DSA) provides the Dementia Behaviour Management Advisory Service (DBMAS) and Severe Behaviour Response Teams (SBRT) nationwide. 

24 hour Helpline 18000699799
https://www.dementia.com.au/

Wicking Dementia Research and Education Centre
Master of Dementia Program - https://www.utas.edu.au/wicking/mdem

Understanding Dementia: free online course - https://www.utas.edu.au/wicking/understanding-dementia

Preventing Dementia: free online course - http://www.utas.edu.au/wicking/preventing-dementia

Carers Australia
Carers Australia is the national peak body representing Australia’s unpaid carers, advocating on their behalf to influence policies and services at a national level. 

Phone 1800242636
https://www.carersaustralia.com.au/

RACGP Silver Book
Medical care of older persons in residential aged care facilities (Silver Book) aims to provide GPs and other health professionals including residential aged care nurses, with a resource for delivering quality health care in residential aged care facilities.

https://www.racgp.org.au/clinical-resources/clinical-guidelines/ key-racgp-guidelines/view-all-racgp-guidelines/silver-book

RACGP Red Book - Guidelines for preventative activities in general practice - Dementia 
https://www.racgp.org.au/clinical-resources/clinical-guidelines/ key-racgp-guidelines/view-all-racgp-guidelines/red-book/ preventive-activities-in-older-age/dementia

My Aged Care - dementia resources
https://www.myagedcare.gov.au/getting-started/health- conditions/dementia

Austroads

Assessing fitness to drive in people living with dementia and cognitive impairment

https://austroads.com.au/publications/assessing-fitness-to-drive/ap-g56/neurological-conditions/dementia 

See omnystudio.com/listener for privacy information.