Return to Scenario ListShow Learning Points most relevant to Phase 1:

Dementia / disturbance of memory / cognitive function

Clinical Discipline(s)/Organ System(s)
General Practice, Geriatric Medicine, Nervous System, Neurology, Psychiatry/Health Psychology
Progress Test Topic(s)
A 70 year old NZ European man attends the GP clinic with his middle-aged daughter. The daughter, who lives in the same town as him, is concerned about her father's memory and asks you if he is developing Alzheimer's disease. The man has been a patient of yours for some time; he has been active and independent and his health has always been good. You have not seen him since his wife died 18 months ago.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the cerebral structures associated with memory and behaviour
   - Physiology of ageing
   - Pathophysiology of neurodegenerative diseases
   - Characteristics of multifactorial diseases; associations with single nucleotide polymorphisms and identification of genes with a causal role; personalised and precision medicine
   - Genetics of Alzheimer's disease and other illnesses associated with dementia
   - Definition of dementia and delirium
   - Depressive pseudodementia
Clinical and Communication Skills 
   - Perform a cognitive function assessment including a screening dementia test such as the Montreal Cognitive Assessment (MOCA) or Addenbrooke’s Cognitive Examination-III (ACE-III)
   - Role of multidisciplinary care in patients with dementia, including assessing patient safety
   - History from a patient with progressive cognitive decline, including a collateral history and medication history (as causes of delirium)
   - Complications of dementia
   - Differential diagnosis of dementia and delirium
   - Indications for CT and MRI imaging in dementia
   - Management of dementia and delirium
   - Structuring and framing of consultation including managing multiple participants in consultation
Personal and Professional Skills 
   - Empathise with and understand the impact on the patient and carers living with
   - Principles of consent and assent, competence and the role of the family in these areas for a patient with dementia
   - Legal issues with power of attorney and living will
   - Awareness of the risks of abuse of older adults
   - Principles of care of older people and understanding their specific ageing
   - Health needs assessment in older people and awareness of ageism
Hauora Māori 
   - Understanding the place of kaumātua among Māori
   - Understanding the mana held by Māori elders
   - Whānau care giving and reimbursement
   - Understanding the importance of whānau-centred care and Māori attitudes toward residential care
Population Health 
   - Demographic projections for New Zealand: age, ethnicity, disability
   - Cost-benefit analysis of drugs used to treat dementia
   - Risk factors for mental impairment and dementia
   - Service provision for those with dementia and their carers
Conditions to be considered relating to this scenario
Alzheimer's disease, chronic subdural haematoma, vascular dementia, fronto-temporal dementia, Parkinson's disease, Lewy body dementia, depression, delirium, normal pressure hydrocephalus, hypothyroidism
Less common but 'important not to miss'
alcohol/drug abuse, lymphoma, cerebral tumour
Huntington's disease, HIV, cryptococcosis, progressive multifocal leukoencephalopathy