The at-risk symptoms referred to in Box 1 are often ‘soft’ symptoms such as memory complaints or decline in thinking, planning or organising (eg inability to manage medications, missed appointments) or reduced emotional control (eg aggression towards staff and family members). It should always be remembered that dementia can affect any age group, although it is more common as age progresses. However, ‘case finding’ is promoted for those at moderate risk of dementia (Box 1). Given the lack of a curative treatment, the high rates of false positives in the primary care population when using a cognitive function test alone, and the possible harms, including severe anxiety and loss of autonomy produced by a positive result, this is understandable. 5 The recently released National Health and Medical Research Council (NHMRC) Clinical practice guidelines and principles of care for people with dementia, known hereafter as the ‘NHMRC Dementia Guidelines’, 6 also do not recommend screening. The Royal Australian College of General Practitioners (RACGP) Guidelines for preventive activities in general practice 9th edition (Red Book) does not suggest that GPs screen a whole population (eg those aged 75 years and over) for dementia, 4 as there is insufficient evidence of benefit from this. ![]() For the GP, this includes full attention to cardiovascular risk factors and advice about diet, physical activity and social and cognitive engagement. If a diagnosis is made, whether of dementia or a milder degree of cognitive impairment that may progress to dementia, there is mounting evidence for secondary prevention that can slow the progression of the condition. Once cognitive impairment is identified, the GP should also tailor management of comorbidities, putting in more structure and reminders, perhaps with the assistance of a care plan and the practice nurse. Family and other carers should be educated about the implications of the diagnosis, as this aids understanding of prognosis and facilitates access to social care services. However, as with other terminal illnesses, it may be helpful for a person to know what is happening: while they still have capacity, they can complete their advance care planning (will, appointment of health and financial spokespeople, advance care directive), fulfil ‘bucket list’ plans and perhaps access anti-dementia medications and implement diet and exercise interventions to slow progression. 3 Indeed, the diagnosis is a grim one of a terminal illness with progressive deterioration. Patients themselves have a range of views about this, and a large minority are not keen to be diagnosed with dementia. *The presence of one or more of these factors places a person at moderate risk of dementia and warrants case finding for cognitive impairmentīefore proceeding with investigation of cognitive impairment, it is worth asking whether the potential benefits of this assessment are likely to outweigh possible harms. Identifying as an Aboriginal or Torres Strait Islander person Factors associated with moderate risk of dementia* 4,11Įlevated cardiovascular risk (eg heart disease, stroke, hypertension, obesity, diabetes, elevated homocysteine, elevated cholesterol, smoking, sedentary lifestyle) This article will discuss the steps for GPs to assess cognitive impairment in the case-finding group (ie those at moderate risk of dementia ) in order to minimise visits and provide the specialist with a rationale for their decision‑making.īox 1. However, some GPs may still prefer to refer cases for confirmation of the diagnosis. ![]() Some patients may be interested in referral to a centre conducting clinical trials of potential new treatments. However, as the numbers of people developing dementia increase, specialist referral is becoming less feasible economically and logistically, and so is now recommended only for those who wish to take anti-dementia medication, for complex cases where the diagnosis is unclear, or for those requesting to see another specialist. What, then, is the role of the general practitioner (GP)? More than a decade ago, many GPs expected to refer their few incident cases of dementia to other specialists for investigation and diagnosis. 1 Australia is no exception, with population numbers living with dementia expected to exceed one million by 2056. This number is expected to increase to 131 million by 2050 because of the increasing longevity of the world population. ![]() Over 46 million people live with dementia worldwide. Dementia is a condition with variable manifestations, affecting cognition, behaviour and the person’s ability to perform activities of daily living.
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