BPAC publishes guidelines for recognising and managing early dementia
Published on 15/3/2020
BPAC (Best Practice Advocacy Centre) released new New Zealand guidance on recognising and managing early dementia in February 2020.
BPAC notes that dementia (mate ware ware) is a growing healthcare challenge. There are an estimated 70,000 people with dementia in New Zealand; this number is predicted to increase to over 170,000 by 2050, due to factors such as population growth and increased longevity. Without a curative treatment or ability to prevent progression of dementia, the main management goal, as for other terminal conditions, is to help people maintain their quality of life for as long as possible. Early diagnosis enables patients and their family/whānau to access support, information and appropriate symptomatic treatments, and allows time to plan for the future. The guidance is available online: click here
The key points in the guidance are:
- Discussions about cognitive decline and dementia (mate wareware) can be difficult; patients or their family/whānau may be reluctant to disclose symptoms due to fear, embarrassment, shame or denial
- Symptoms of cognitive decline should be assessed when first reported or noticed. In many cases, reassurance that the symptoms are due to age-related cognitive decline will be appropriate. However, if the symptoms are indicative of a potentially clinically significant change in cognitive function or are affecting the person’s activities of daily living, they should be assessed for dementia.
- The initial consultation should focus on the clinical history (obtained from the patient and someone who knows them well), investigations to exclude other causes of cognitive impairment (e.g. medicine adverse effects, delirium, depression) and evaluation with a cognitive assessment tool
- Most patients with dementia can be diagnosed and managed in primary care. Referral to secondary care is appropriate if there is diagnostic or management uncertainty.
- Allow additional time when discussing a dementia diagnosis with a patient and their family/whānau to explain what the diagnosis means, how it was made, the management plan and where to access support. Strongly encourage early engagement with the local branch of Alzheimers New Zealand or Dementia New Zealand as these organisations are often the main providers of personal support, information, dementia service navigation, “living well” services and programmes such as cognitive stimulation treatment.
- There are currently no treatments available that can cure or prevent the progression of the common subtypes of dementia such as Alzheimer’s disease or vascular dementia. Non-pharmacological and pharmacological interventions may help to delay or slow the development of cognitive and functional symptoms.