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New guidelines for diagnosis, treatment of dementia, Australia

New practice guidelines for the diagnosis and treatment of dementia in Australia promise to help frontline health care professionals to improve the quality and consistency of the care they offer their dementia patients, according to a Clinical Focus published online by the Medical Journal of Australia.

A collaboration of 23 authors, including consumer representatives, from 17 institutions developed the guidelines, which were adapted for the Australian context from the UK’s National Institute for Health and Care Excellence recommendations.

“The quality of clinical practice in dementia care in Australia is variable,” wrote Dr Kate Laver, Research Fellow at Flinders University and coauthors of the new guidelines. “The availability of high-quality services to support workforce training, diagnosis and ongoing care, advance care planning and support for families to provide care is inconsistent.

“Clinical practice guidelines can improve uptake of research findings by identifying, synthesising and disseminating evidence to clinicians. Most importantly, adherence to clinical practice guidelines can improve the quality and consistency of care.”

The guidelines provide 109 recommendations. Key among them are:

  • Timely diagnosis by recommending that symptoms are explored when first raised by the person experiencing the symptoms and/or their carer or family and are not dismissed as “just a part of ageing”.
  • A systematic approach to diagnosing dementia; 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.
  • Clinical cognitive assessment should include examination with a screening tool with established reliability and validity.
  • A review of people with mild cognitive impairment after 6-18 months.
  • At the time of diagnosis of dementia, and at regular intervals subsequently, assessment should be made 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.
  • Greater emphasis on promoting and maintaining independence through activities of daily living, continuing exercise and supporting people to pursue activities that are meaningful and of interest to them.
  • Understand the person and symptoms via a comprehensive assessment and analysis of the behaviour, antecedent, behaviour description and consequence.
  • People with mild to moderate behavioural and psychological symptoms of dementia should not usually be prescribed antipsychotic medications, owing to the increased risk of cerebrovascular adverse events and death.
  • Care for people with advanced dementia should be based on a palliative approach and involve a palliative care service if indicated.
  • Carers and families should be included in the planning, decision making and care and management of people with dementia.
  • Carers should have access to programs which include education regarding dementia.

The guidelines were developed within the $25 Million NHMRC Partnership Centre: Dealing with Cognitive and Related Functional Decline in Older People and forms part of the Federal Government’s Boosting Dementia Research Initiative.