14stepsforgooddementiacareinGeneralPractice
1.Whenpatientorfamilyraiseconcerns,donotdismissas“oldage”
2.Bealerttocognitivedeclineinolderpatientsespeciallythoseaged75+,routinelyaskaboutdifficulties
3.Takehistoryregardingcognitionandfunctionfrominformant
a.Clinicalhistory–onset,progression,medications,otherillnesses,behaviouralandpsychologicalsymptoms
b.Interviewinformant,assesscarerneeds
c.Activitiesofdailyliving,instrumentalADLs,mood,driving,safety
4.Assesscognitionifanyindicationorsuspicionofimpairment
a.MMSE+ClockDrawingTest,GPCOGorRUDAS
b.Ifuncertain,repeatovertime
5.Conductmentalstateandphysicalexamination
a.Lookforspecificconditionsthatmimicdementia(depression,delirium,drugs)orcausedementiaegthyroidorvitamindeficiency,tumour,strokeandconditionsthatmayaggravatedementiaegcardiacfailure,useofanticholinergicdrugs
b.Checknutrition,hygiene,visualorhearingimpairment
6.Investigateforcausesofcognitivedecline
a.Ruleoutrare,butreversiblecausesegabnormalthyroid,calciumorVitB12,tumour
7.Diagnosecause-excludedepressionanddelirium,diagnosetypeofdementia
a.Typeofdementia–90percentAlzheimer’s,vascularormixeddementia,thenLewybodiesandfrontotemporaldementia
8.Refertospecialistif...unsureofdiagnosis,patientisyoungoratypical,symptomsandsignsareatypical,psychoticorseverebehaviouraldisturbanceoccur,orconsideringmedication.
9.Informpatientandfamilyofdiagnosis,managementplanandprognosis
10.Discusskeyissueswithpatientandfamily
a.Legalissues–EnduringPowerofAttorney,EnduringGuardianship,Advancedcareplanning,drivingandwork
b.MedicationforAlzheimer’sifappropriate
c.Lifestyle–regularexercise,mentalstimulation,establishroutine
d.Generalhealth–bloodpressure,otherhealthconditions
11.Developcareplan(includelegal/financialmatters)andmakefollow-upappointments
12.ReferpatientandfamilyforfurtherinformationandsupporttoAlzheimer’sAustraliaandto白癜风多长时间能治愈云南好的白癜风医院
