Dementia

Objectives

1. In patients with early, non-specific signs of cognitive impairment:
   • Suspect dementia as a diagnosis.
   • Use validated tests of cognitive function and careful functional inquiry, as well as a careful history (including collateral history from family and caregivers if available) and physical examination, to make an early positive diagnosis.
2. In patients with obvious cognitive impairment,
   • Select proper laboratory investigations and neuroimaging techniques to complement the history and physical findings and to distinguish between dementia, delirium, and depression
   • Consider possible contributing causes, including mental health, alcohol or substance use problems, or delirium
3. In patients with dementia, distinguish Alzheimer’s disease from other dementias, as treatment and prognosis differ.
4. In patients with dementia who exhibit worsening function, look for other diagnoses (i.e., don’t assume the dementia is worsening). These diagnoses may include depression, infection, concurrent medical illness, substance use, etc.
5. When disclosing the diagnosis of dementia,
   • Do so compassionately
   • Respect the patient’s right to autonomy, confidentiality, and safety
6. In patients with dementia, assess competency to involve them in decision making, as appropriate to the situation
7. In following patients diagnosed with dementia:
   • Assess function and cognitive impairment on an ongoing basis.
   • Assist with and plan for appropriate interventions (e.g., deal with medication issues, behavioural disturbance management, safety issues, caregiver issues, comprehensive care plans, advanced care planning, driving safety, placement) in the context of disease progression
   • Manage comorbidities, including mental health problems based on the goals of care
   • Review pharmacotherapy (e.g. side effects, drug interaction, polypharmacy)
8. Assess the needs of and supports for caregivers of patients with dementia.
9. Report patients with dementia to the appropriate authorities if you suspect they should not be driving.
10. In patients with early-onset dementia, consider genetic testing