PsychEd Episode 49: Dementia Assessment with Dr. Lesley Wiesenfeld

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we’ll explore a topic that we’re sure many listeners are eager to learn about: The Assessment of Major Neurocognitive Disorder, also known as dementia with Dr. Lesley Wiesenfeld who is a Geriatric Psychiatrist and Psychiatrist-in-Chief at Mount Sinai Hospital in Toronto, where she leads the Geriatric Consult Liaison Psychiatry Service. She is also an Associate Professor in the Department of Psychiatry at the University of Toronto.

 

The learning objectives for this episode are as follows:

 

1. Define Major Neurocognitive Disorder (aka Dementia) as per DSM-5 diagnostic criteria

2. Identify differential diagnoses for cognitive decline and list differentiating clinical features 

3. Outline an approach to the assessment of a patient presenting with cognitive decline, including the role of a comprehensive history, psychometric tools and other investigations [ Relevant PMH/risk factors, ADLs/IADLs to cover on history, psychometric tools such as MMSE, MoCA and tie this back into major cognitive domains when to consider imaging, bloodwork including specialized testing such as ApoE genetic tests] 

4. Classify the major subtypes of Neurocognitive Disorders, their epidemiology, and clinical presentations [ Vascular dementia, Alzheimer’s, Frontotemporal, Lewy Body, Parkinson’s,    Mixed dementia - Early onset dementia]

 

Guest: Dr. Lesley Wiesenfeld ( Lesley.Wiesenfeld@sinaihealthsystem.ca )

 

Hosts: Dr. Luke Fraccaro (PGY-3), Dr. Mark Fraccaro (PGY-4), Sena Gok (international medical graduate)

 

Audio editing by: Sena Gok

 

Show notes by: Sena Gok

 

Interview Content:

Introduction: 0:13

Learning Objectives: 02:35

Diagnostic criteria of Major Neurocognitive Disorder: 03:20

Difference between Major and Mild Neurocognitive Disorder: 05:20

Red Flags of Cognitive Declines: 06:50

Normal Aging vs Major Neurocognitive Disorder: 10:00

Clinical Vignette – introduction: 11:35

Patient Assessment: 16:50

Past medical/family / Psychosocial history: 21:55

Clinical Vignette - Assessment: 37:45

Physical examination: 43:50

Investigations: 45:53

Role of genetic testing: 53:24

Clinical Vignette – Diagnosis: 57:50

 

References:

 

• American Psychiatric Association. (2022). Neurocognitive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

 

• Sadock, B. J., Sadock, V. A., Ruiz, P., & Kaplan, H. I. (2015). Neurocognitive Disorders. Kaplan and Sadock’s Synopsis of Psychiatry (11th ed.). Wolters Kluwer

 

• DSM-5-TR Fact Sheets (https://psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-tr-fact-sheets )

 

• Gauthier S, Patterson C, Chertkow H, Gordon M, Herrmann N, Rockwood K, Rosa-Neto P, Soucy JP. Recommendations of the 4th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4). Can Geriatr J. 2012 Dec;15(4):120-6. doi: 10.5770/cgj.15.49. Epub 2012 Dec 4. PMID: 23259025; PMCID: PMC3516356.

 

• Gauthier S, Chertkow H, Theriault J, Chayer C, Ménard MC, Lacombe G, Rosa-Neto P, Ismail Z. CCCDTD5: research diagnostic criteria for Alzheimer's Disease. Alzheimers Dement (N Y). 2020 Aug 25;6(1):e12036. doi: 10.1002/trc2.12036. Erratum in: Alzheimers Dement (N Y). 2022 Feb 03;6(1):e12088. PMID: 32864413; PMCID: PMC7446944.

CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.

 

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