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I completed my medical school and background EM training from India (Christian Medical College, Vellore and Apollo Hospitals, Hyderabad) where I worked for 4 years. Following this, I devoted (with all my heart) about 1.5 years to do US Medical Licensing Exams. My stint towards an EM Residency in States did not work but it took me to places and it has been quite a journey. I then relocated to London, England to work as a Registrar (Non-Trainee) in A&E. This gave me an opportunity to better understand NHS, EM training pathways and more importantly the EM Mindsets in the United Kingdom. 

Currently, I am pursuing Higher Specialist Training in Emergency Medicine at South East Scotland Deanery where I have the honour and privilege of training under some of the most innovative brains in the field of Emergency Medicine. Over the past few years, I have realised that LEARNING and UNLEARNING (which can be challenging!) is equally important to deliver cutting edge care to our patients.And through this blog, I aspire to disseminate knowledge, assist trainees with exams and stay up to date with contemporary EM literature. I have always been an avid FOAMed supporter because FOAMed has always played an indispensable role during my training. 


Lakshay Chanana
ST4 EM Trainee 
Edinburgh, Scotland
drlakshayem@gmail.com

Monday, December 11, 2017

ED Dementia Screening

Dementia

Diagnosing dementia constitutes "memory loss" in addition to one of the following:
  • Apraxia (difficulty executing motor tasks)
  • Aphasia (language impairment)
  • Agnosia (difficulty recognising familiar objects)
  • Loss of executive function (planning, organising)
More than 50% of the patients presenting to Emergency Department have dementia and in about 3/4 the of the patients, the diagnosis is not yet established. Patients with a new diagnosis of dementia may have several implications on continuation of care as dementia can be associated with poor drug compliance, self-neglect, depression, suicidal risk. It is paramount to discuss these concerns with social services prior to discharging these patients. 



Mini-Cog Assessment 

  1. Ask the patient to repeat and then remember 3 unrelated words (ex. apple table tree)
  2. Give the patient a piece of paper with a circle on it
  3. Instruct the patient to place numbers on it to represent the face of a clock. After the patient puts the numbers on the clock face, ask him to draw the hands of the clock to read any specific time
  4. Ask the patient to repeat the 3 previously presented words
Scoring Mini-Cog Assessment (Minimum score 0, Maximum 3)
Give 1 point for each recalled word 

  • 0 - positive screen for dementia
  • 1 or 2 with an abnormal clock -  positive screen for dementia
  • 1 or 2 with a normal clock - negative screen for dementia
  • 3 - negative screen for dementia
    Patients who are called "poor historians" often have underlying dementia. If you suspect dementia in ED, then arrange follow up care with Neurology for thorough assessment. 


    Discharge checklist for Dementia-

    • Ask them their home address and how will they get there?
    • Sucidal Thoughts/Depression screen? 
    • Carers/Next of kin informed?


    Further Reading:

    Borson, S., Scanlan, J. M., Chen, P. and Ganguli, M. (2003), The Mini-Cog as a Screen for Dementia: Validation in a Population-Based Sample. Journal of the American Geriatrics Society, 51: 1451–1454. doi:10.1046/j.1532-5415.2003.51465.

    Posted by:

                  
         Lakshay Chanana
         
         Speciality Doctor
         Northwick Park Hospital
         Department of Emergency Medicine
         England

         @EMDidactic




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