The 4D Project
Diagnosing and Detecting types of Dementia and Delirium in the community
This study aims to:
- Develop a scoring aid for healthcare professionals to distinguish between different types of dementia in memory services.
- Explore how health / social care professionals and family carers detect and manage when a person living with dementia also has delirium.
Work stream 1
Distinguishing types of dementia in memory services
The clinical differentiation of neurodegenerative disorders is a frequent challenge in specialist memory clinics. Current screening tests are especially poor at separating between the dementias. More specific tests, such as detailed neuropsychological assessments, structural or functional imaging studies are time consuming and costly and there are insufficient reliable biomarkers that aid in the differentiation of diagnoses. A pilot project in a neurology-led memory service produced a Diagnostic Scoring Aid (DSA), derived from a conversation analytic examination of the communication behaviour of patients with memory problems, drawing on different conversational and linguistic profiles. The Scoring Aid was designed to help practitioners to distinguish between those with dementia and those with Functional Memory Disorder (FMD). Conversation Analysis experts were able to reliably predict who had a diagnosis of dementia or Functional Memory Disorder, often referred to as 'Worried Well' e.g. people who say they have problems with their memory but they are not clinically recognised as having any type of memory loss. This tool did not explore the differential diagnosis between the various types of dementia such as Alzheimer's disease or Vascular Dementia.
Work stream 2
Detecting and managing delirium in the community
As an increasing number of people are being diagnosed with dementia, managing preventable conditions like delirium is a crucial part of improving care. An estimated 13%-22% of people with dementia living at home have delirium, this is referred to as delirium superimposed on dementia (DSD). Delirium is distressing for not only the individual with dementia but also their family carers. The focus to date has been on managing DSD in the acute hospital however to our knowledge, no studies have examined how community based healthcare professionals and family carers detect and manage DSD for people living at home. The purpose of this study is to understand how healthcare professionals currently detect and manage delirium in patients living with dementia in the community. We want to understand effective strategies currently used in community care and the role of family carers in this detection and management.
This project is funded by Sheffield Health and Social Care NHS Foundation Trust through the National Institute for Health Research, Research Capability Funding grant. The study started in October 2018 and will last for nine months. Information will be gathered in Sheffield only.
Patient and public involvement
The protocol for this study was developed in consultation with healthcare professionals, people living with dementia and their family carers.
Oversight of the study will be provided by an Expert Reference Panel of family carers of people living with dementia and a Project Management Group for the duration of the study. It is envisaged they will be consulted regarding processes involving analysis and dissemination.
Project materials such as the survey for family members of people living with dementia have been co-designed with our Expert Reference Panel at a meeting held in October 2018.