Dementia Pathways. For Primary Care in ireland
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Dementia differs from Mild Cognitive Impairment in that in addition to a decline in cognitive function there is also an impairment in daily function/activities of daily living. 

 

Dementia Subtypes

Dementia is an umbrella term and includes the following conditions:

  • Alzheimers disease
  • Vascular Dementia
  • Dementia with Lewy Bodies
  • Fronto- temporal dementia
  • Mixed Dementia

It is important to identify the correct sub-type where possible for two reasons:

  1. The different types of dementia will have different symptoms and disease progression
  2. Different diseases will require different treatments. In particular it is important to avoid the use of antipsychotics in Lewy Body Dementia.

Although GPs can proficiently diagnose and disclose the diagnosis of dementia, determining the exact subtype usually requires specialist assessment and access to brain imaging.

For the interested reader a PDF below provides some information on the different dementia subtypes.

 

Importance of making a diagnosis

  • Person has a right to know- if they wish to
  • To facilitate planning for the future – medical, legal, financial
  • Psychological benefit to person with dementia and/or family
  • To maximise treatment possibilities (cholinesterase inhibitors/memantine)
  • Facilitate access to patient services and supports
  • Allows for the coding for dementia in patient records 
  • Allows potential risks to patient to be addressed – driving, financial, self-care

Disclosure & Advice

  • Disclosing the diagnosis of dementia is complex.
  • A person-centred approach should be adopted. First you need to establish what the patient wants to know and how much detail they would like on the diagnosis.
  • If the patient would like further information you can provide them with information leaflets available below. Please visit the Patient Information Leaflet of this site for more information.
  • See the Post Diagnostic Support section of this site for more information on how to support a patient with a new diagnosis of dementia
  • See below for some helpful training videos produced by the Hospice Foundation on Breaking Bad News.

 

When to refer a person with suspected dementia

Refer if :

  • Diagnostic uncertainty
  • Parkinsons Disease with new onset dementia.
  • Dementia in a person aged <65
  • Non-typical presentation or course
  • High risk situations at presentation e.g. challenging behaviour, wandering, psychosis.
  • Potentially contentious legal issues
  • Associated psychiatric morbidity
  • Patients with a learning disability or significant previous head injury, who may be difficult to assess.
  • Suspected alcohol related dementia
  • Patient request referral

 

Situations where you may not refer:

  • Definite non-complex alzheimers-type dementia
  • Patient declines referral