Dementia
  • Progressive disturbance of thinking and behaviour, overall loss of function, often loss of ability to learn or remember new information
  • Usually slow onset
  • No cure but can be managed with support

Risk factors

  • History of repeated head trauma
  • Depression or history of depression
  • Elevated cardiovascular risk or diabetes
  • Substance abuse
  • Downs syndrome

Ask

  • What is worrying person or family
  • How long have the symptoms been developing — if fast onset rule out delirium
  • Day-to-day living and independence — eating and drinking as usual, sleeping patterns changed, manage own money and travel (eg able to buy food at shop or get themselves onto bush bus), access own food, dress themselves, maintain own hygiene, more or less active than usual, level of awareness changes
  • Any issues with bowels or bladder
  • Any pain
  • Any changes to medications, medication adherence, access to seizure medicines
  • Previous or current use of alcohol or other drugs
  • Any changes in personality or behaviour — more withdrawn, agitated, forgetful or unable to learn new things
  • Is the person repetitive, accusing others stealing, having word finding or naming difficulties

Check

  • Calculate REWS — AVPU, RR, O2 sats, pulse, BP, Temp
  • Weight, BGL 
  • U/A, pregnancy test
  • Head-to-toe exam
    • Consider delirium, physical sickness, injury, depression

Do

  • Blood for FBC, ESR, CRP, UEC, LFT, Ca/Mg, PO4, TFT, vitamin B12, serum folate, lipid profile, HbA1c, syphilis serology, HIV, vitamin D, Urine for MC&S
  • Manage any physical illnesses
  • Check hearing — history of ear infections or problems
  • Check vision — glasses, blinding eye disease
  • Assess cognition (person's thinking) with cognitive assessment — KICA screen with interpreter
    • If score more than 21 — monitor with annual health check or recall for assessment in 6 months
    • If score under 21 — medical consult and full KICA with interpreter AND medicine review every 3 months, management plan

Follow-up

  • Appropriate referrals
    • Geriatrician
    • Arrange for MAC/ACAT assessment for Aged Care Support Services approvals
    • Aged care team if eligible  — can help with advice re supports CHSP, HCP, respite, nursing home placement in future
    • If not eligible for aged care services — NDIS
    • Hearing and vision
  • Consider support for carers, education about dealing with difficult behaviour
  • If person can make decisions for themselves — talk with person about
    • Who they want to make decisions for them and document in file notes advanced care planning
    • Support person to do an Advance Personal Plan (APP) — early in the course of the disease while they can still say who they want to make decisions for them if they become unable to do so
  • If a person is no longer able to make decisions for themselves and has not filled out an APP — their family will need to consider guardianship

Supporting resources

  • KICA-Screening tool
  • Full KICA-Cog tool
  • Dementia Support Australia website
  • Dementia Australia website