Podcast - Summary of NICE guidelines on dementia

This video makes reference to guidelines produced by the "National Institute for Health and Clinical Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE.

My name is Fernando Florido and I am a GP in the United Kingdom. In today’s episode I go through the Guideline in Dementia by the National Institute for health and Clinical Excellence guideline, guideline [NG97], Published: 20 June 2018:

Dementia: assessment, management and support for people living with dementia and their carers 

I am not giving medical advice; this video is intended for health care professionals; it is only my interpretation of the guidelines and you must use your clinical judgement.  

There is a YouTube version of this and other videos that you can access here: 

The full guideline can be downloaded here: 

You can download a summary of my summary / interpretation of the guidance here:  

Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]

Music provided by Audio Library Plus

Transcript

Hello everyone and welcome, I am Fernando, a GP in the UK. In this episode, we look at the NICE guidelines on dementia and we start by emphasising the importance of involving patients in the decision-making process regarding their care. As we know, Dementia has symptoms, that include memory loss, challenges in reasoning and communication, and personality changes. As a result, often, people with dementia are inadvertently excluded from these crucial decisions, and information may not be well communicated. Additionally, many patients may not readily share their thoughts on their care. Considering this, we should actively encourage and enable them to express their views and opinions, using structured tools to enhance communication.

We also need to give clear information about their specific dementia subtype. We should also discuss advance care planning to ensure a proactive approach in addressing evolving care needs. Moreover, at each care review, we must provide patients with the opportunity to revisit and modify any advance statements and decisions they have previously made."

One of the most important parts of the initial assessment and diagnosis in Primary Care is obtaining a thorough history. Ideally, this should not only come from the patient but also from someone that knows the patient well.

In cases where dementia is suspected following the initial assessment, our next step involves a full physical examination and relevant blood and urine tests to rule out any reversible causes for cognitive decline. Additionally, we should incorporate cognitive testing into the evaluation process. When using cognitive tests in primary care, we should opt for brief, validated tools like the 10-point cognitive screener (10-CS), mini COG, or the 6-item cognitive impairment test (6CIT), as opposed to longer assessments such as the MMSE. But we need to be aware that a normal score alone does not rule out dementia.

After investigating reversible causes of cognitive decline, if we still suspect dementia, we must refer the patient to a specialist dementia service.

We must remember that ordering of imaging in primary care is not recommended and this should be done by specialist services.

Furthermore, case finding for suspected dementia should only be done as part of a clinical trial. 

In terms of Interventions to promote cognition, we can offer group cognitive stimulation therapy, group reminiscence therapy and cognitive rehabilitation in mild to moderate dementia. But we will not provide acupuncture or cognitive training as part of the intervention plan.

Starting pharmacological treatment for Alzheimer's disease should be done exclusively under the guidance of a specialist. However, once the decision to commence treatment with a cholinesterase inhibitor or memantine has been made, the initial prescription may be issued in primary care.

Cholinesterase inhibitors such as donepezil, galantamine, or rivastigmine can be g...