First national dementia clinical guidelines released
The first national clinical guidelines for dementia have been released, in a move welcomed by experts.
The guidelines were outlined in a Medical Journal of Australia article after being developed by the National Health and Medical Research Council (NHMRC) Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People.
The dementia clinical guidelines are a collaboration of 23 authors from 17 institutions around the country. They are an adaptation of the UK’s National Institute for Health and Care Excellence recommendations.
The guidelines focus on timely diagnosis as well as living well with dementia and delaying functional decline. It also looks into training and supporting staff and carers in providing optimal care and non-pharmacological treatment options.
There are 109 recommendations in the guidelines. Key recommendations include:
- Getting a timely diagnosis but exploring symptoms when they’re first raised.
- Finding a systematic approach to diagnosis. This includes patient and informant history taking, cognitive assessment, medication review, blood tests and computed tomography or magnetic resonance imaging to exclude other cerebral pathologies.
- A clinical cognitive assessment which should include examination with a screening tool with established reliability and validity.
- Reviewing people with mild cognitive impairment after 6-18 months.
- At diagnosis of dementia and regular intervals afterwards, there should be assessment for medical comorbidities and key psychiatric features associated with dementia, including depression, to ensure optimal management of coexisting conditions.
- Comprehensive role-appropriate dementia-specific training for health and aged care professionals.
- Emphasising promoting and maintaining independence. This can be through activities of daily living, continuing exercise and supporting patients to continue maintaining activities that are of interest to them.
- Understand the person and symptoms via a comprehensive assessment and analysis of the behaviour, antecedent, behaviour description and consequence.
- Those with mild to moderate behavioural and psychological symptoms of dementia shouldn’t usually be prescribed antipsychotic medications. This is because it leads to increased risk of cerebrovascular adverse events and death.
- Those with advanced dementia should have a palliative care approach and involve a palliative care service if indicated.
- Family and carers should be involved in the planning and decision making of the care and management of people with dementia.
- Programs including dementia education should be provided to carers.
Read the summary of the guidelines Medical Journal of Australia.