Scenario: You are the Psychiatry SpR in the memory clinic seeing Mr John Foster, son of Mrs. Brenda Foster, a 72-year-old woman. Mrs. Foster was referred following concerns about her memory and confusion. She has a history of hypertension (on amlodipine and ramipril), type 2 diabetes (on metformin 1g twice daily), and had a stroke 18 months ago (left middle cerebral artery infarct) with residual right-sided weakness. Assessment reveals: MMSE 21/30 with particular difficulties in executive function and attention, fluctuating course with stepwise decline, MRI showing extensive white matter disease and multiple lacunar infarcts, cognitive impairment affecting memory, planning, and speed of thinking. You have diagnosed vascular dementia.
Your tasks are to:
- Explain the diagnosis of vascular dementia
- Discuss the relationship to her stroke and vascular risk factors
- Explain the management approach
- Address concerns and prognosis, and answer any questions.
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Disclaimer: This video is intended for educational purposes only, targeted for the CASC exam – taken by psychiatry UK trainees in order to achieve membership of the Royal College of Psychiatrists. It should not be taken as clinical guidance or advice. It is also not intended to be an accurate portrayal of a real psychiatry consultation. For those revising for the CASC exam, this video should be used as a guidance and does not necessarily depict a gold-standard approach. Depending on when this video is viewed, information may be outdated.
Video Contributors:
Dr Leola Foscoe is a Psychiatry Speciality Registrar, specialising in Older Adults Psychiatry.
Dr Damir Rafi is a Psychiatry Speciality Registrar in Forensic Psychiatry, currently working in London.