I attended the Cambridge Dementia course in December 2017, in my first year as a neurology registrar. It had been recommended it by colleagues, and I found that it gave a practical and fascinating overview of this field. In my view, the balance between the clinical aspects and the underlying pathology and science was well conceived. There were talks from world-class speakers, all of whom were clearly passionate about their fields and gave insight into current research and potential future therapies.
The conference was held over three days at the Homerton College, Cambridge. It was a picturesque setting, from arriving and walking through the grounds to the college, to lunch in the great hall, complete with giant Christmas tree. But despite the chilly, grey December days, the conference venue itself was surprisingly cosy. Plus, we were we were plied with regular hot drinks and selections of biscuits and tasty pastries.
The course was attended by professionals from a range of backgrounds. From the beginning we were asked to identify with “team neurology” or “team psychiatry”. My choice has already been made, but I was entertained that my friend, a geriatrician, chose to side with the psychiatrists. It was fun, of course, and equally there were clearly other disciplines represented, including GPs, psychologists and specialist nurses. But this was a theme that ran through the conference; there are different perspectives on each of the conditions that were discussed. It certainly encouraged a very holistic view.
The event started with an introduction from Dr Jeremy Brown and Dr Andrew Graham. Their enthusiasm for the subject and dedication to teaching was palpable from the onset and set the tone. Together they chaired the sessions over the three days. The introduction covered a structured clinical approach to a patient presenting with memory problems. Particularly useful were pointers on how to discriminate the patient with cognitive problems from the worried well. Would I ever make that mistake? (With the case of “Do you have to be told the same things many times?” just ask my husband).
For me, it was the videos that elevated the conference. Like most of my colleagues, I find that it is the individual patients and their stories that illustrate a learning point. We saw examples of a wide range of conditions, from typical Alzheimer’s disease, with which we were all familiar, to semantic dementia and posterior cortical atrophy. The videos gave us a chance to sit back and concentrate on watching and listening.
Like most of my colleagues, I find that it is the individual patients and their stories that illustrate a learning point
Within a short space of time, we all felt like experts. We were spotting the “head-turn” sign with confidence (a patient with dementia turning to look at their spouse after being asked a question, apparently equating to approximately moderate dementia).
The videos also illustrated how to examine patients with cognitive impairment in a way that flowed seamlessly from the history. We learnt about the technique of “repeat and define”, which has led me to practise saying the word “chrysanthemum”. Present in all of these examinations were small plastic animals; which emerged from beneath the table as if this was an expected part of a consultation with any doctor. The use of these animals in the videos illustrated different language impairments more eloquently than could possibly be achieved solely through lectures.
The lectures thoroughly covered the range of conditions that might present to a memory clinic, including some rarities. From Professor John Hodges we heard about the frontotemporal dementias. We followed these conditions from the underlying pathology, the genetic component and the imaging findings to the clinical presentations and related conditions. There were more videos, consolidating our knowledge. The plastic animals made yet more appearances, and we watched a woman with semantic dementia who had seemed to navigate the consultation fluently struggle to define a caterpillar; “Not a cat”.
Dr Amanda Cox talked about limbic encephalitis, giving an insight into the expanding array of antibodies and the management and prognosis of this treatable set of conditions. Another highlight was the talk on prion disease by Professor Simon Mead, who stressed the variability of its presentation and the clues for diagnosis on imaging and the RT-QUIC test.
Psychiatry was also represented. From a very practical guide on managing behavioural and psychological symptoms in dementia, to a talk by Dr Fiona Thompson about the importance of considering depression in patients with dementia, though illustrating how sometimes it can be difficult to differentiate the two clinically. Prof Rob Howard summed up a number of key points in a talk entitled “Psychiatry for neurologists”.
PSP and CBD were presented by Professor James Rowe, and Huntington’s disease by Prof Roger Barker. We learnt from both of their extensive clinical experience and gained new insight into symptomatic treatment, imaging techniques and current research in these conditions.
The lectures were broken up with smaller group workshops which were run by neuropsychologists. These gave us a first-hand and informative way to find out about the various cognitive tests and how they can discriminate between different domains of cognition. We tested our executive function with the Stroop test and tried to copy the Rey complex figure. Importantly, the neuropsychology score sheets that we had been given to interpret slowly became decipherable.
Furthermore, there was a specific focus on imaging on days two and three. As a new trainee, I found that Prof Nick Fox took a clear approach, starting from the basics. He thoroughly illustrated the diagnostic benefit of imaging in dementia, beyond ruling out other pathology.
The course was an intense three days. However, I enjoyed being immersed in the topic. The speakers were all approachable, questions were encouraged and there was a good amount of audience participation, culminating in an interactive quiz.
Currently my young son only has a set of plastic dinosaurs. I think it might be a little unfair to ask someone with cognitive problems to name an iguanodon. Or repeat micropachycephalosaurus. So instead, the dementia course has convinced me that I need to invest in a set of small model farm-yard animals. My son might be a little disappointed when they end up living in my work bag.