Management

A valid consent should be obtained from the patient before starting management. If the patient lacks the capacity to make any decisions on their own, the provisions of the Mental Capacity Act 2005 should be followed (1).

It is sometimes desirable to admit the patient for observation and investigation with blood tests, CSF analysis and brain imaging. The tests can be performed as an outpatient but several visits should be arranged to permit repeated assessment. The tests are aimed at diagnosing the treatable minority of demented patients. The patient is informed of the diagnosis as fully as they are able to comprehend. The patient's next of kin should be advised of the diagnosis and prognosis. Suitable social arrangements should be made to ensure the safety of the patient in the community or residential setting.

Also patients should be offered written information and advice about

• signs and symptoms of dementia
• course and prognosis of the disease
• treatments
• local care and support services
• support groups
• sources of financial and legal advice and advocacy
• medico-legal issues, including driving
• local information sources, including libraries and voluntary organizations (1)

Interventions in dementia can be aimed at

• cognitive symptoms
• noncognitive symptoms and challenging behavior
• reduction of comorbid emotional disorders (1)

Reference:

• 1. National Collaborating center for mental health 2007: Dementia: A NICE-SCIE guideline on supporting people with dementia and their carers in health and social care