Excerpt

Dementia is a term used to describe a range of cognitive and behavioural symptoms that can include memory loss, problems with reasoning and communication and change in personality, and a reduction in a person’s ability to carry out daily activities, such as shopping, washing, dressing and cooking. The most common types of dementia are: Alzheimer’s disease, vascular dementia, mixed dementia, dementia with Lewy bodies and frontotemporal dementia. Dementia is a progressive condition, which means that the symptoms will gradually get worse. This progression will vary from person to person and each will experience dementia in a different way - people may often have some of the same general symptoms, but the degree to which these affect each person will vary (Dementia Gateway, Social Care Institute for Excellence).

This guideline addresses how dementia should be assessed and diagnosed. It covers person-centred care and support, tailored to the specific needs of each person living with dementia. As part of this, it can help professionals involve people living with dementia and their carers in decision-making, so they can get the care and support they need. It also addresses care coordination and staff training, and how dementia may impact on the care offered for other conditions.

Contents

• Context
• 1. Guideline committee membership and NICE technical team
  • 1.1. Guideline committee
  • 1.2. Guideline social care subgroup
  • 1.3. NICE Centre for Guidelines Team
• 2. Strength of recommendation
  • Interventions that must (or must not) be used
  • Interventions that should (or should not) be used – a ‘strong’ recommendation
  • Interventions that could be used
• 3. Methods
  • 3.1. Evidence synthesis and meta-analyses
  • 3.2. Evidence of effectiveness of interventions
  • 3.3. Methods for combining direct and indirect evidence (network meta-analysis) for interventions
  • 3.4. Diagnostic test accuracy evidence
  • 3.5. Qualitative evidence
  • 3.6. Health economics
• 4. Summary of recommendations
  • 4.1. Recommendations summary
  • 4.2. Research recommendations summary
• 5. Dementia diagnosis
  • 5.1. Dementia diagnosis
  • 5.2. Distinguishing dementia from delirium or delirium with dementia
  • 5.3. Case finding for people at high risk of dementia
• 6. Involving people living with dementia in decisions about care
  • 6.1. Barriers and facilitators to involvement in decision making for people living with dementia
• 7. Care planning, review and co-ordination
  • 7.1. Health and social care co-ordination
  • 7.2. Post diagnosis review for people living with dementia
• 8. Inpatient care
  • 8.1. Caring for people living with dementia who are admitted to hospital
• 9. Care setting transitions
  • 9.1. Managing the transition between different settings for people living with dementia
• 10. Modifying risk factors for dementia progression
  • 10.1. Risk factors for dementia progression
• 11. Cholinesterase inhibitors and memantine for dementia
  • 11.1. Cholinesterase inhibitors and memantine for people living with Alzheimer’s disease
  • 11.2. Co-prescription and withdrawal of cholinesterase inhibitors and memantine in Alzheimer’s disease
  • 11.3. Pharmacological management of dementia with Lewy bodies
  • 11.4. Cholinesterase inhibitors and memantine for types of dementia other than typical Alzheimer’s disease
• 12. Drugs that may worsen cognitive decline
  • 12.1. Drugs that may cause cognitive decline
• 13. Non-pharmacological interventions for people living with dementia
  • 13.1. Pre-, peri- and post-diagnostic counselling and support for people living with dementia and their families
  • 13.2. Interventions to promote cognition, independence and wellbeing
• 14. Managing non-cognitive symptoms
  • 14.1. Interventions for treating illness emergent non-cognitive symptoms in people living with dementia
• 15. Supporting informal carers
  • 15.1. Supporting informal carers of people living with dementia
• 16. Staff training
  • 16.1. Staff training
• 17. Needs of younger people living with dementia
  • 17.1. The specific needs of younger people living with dementia
• 18. Assessing and managing comorbidities
  • 18.1. Assessing and treating intercurrent illness in people living with dementia
  • 18.2. Management strategies for people living with dementia and co-existing physical long term conditions
  • 18.3. Managing mental health conditions alongside dementia
• 19. Palliative care: care towards and at the end of life
  • 19.1. Palliative care
• 20. Glossary
• Appendix A. Committee membership list – Dementia Guideline
• Appendix B. Scope
• Appendix C. Review Protocols
• Appendix D. Review search strategies
• Appendix E. Evidence tables
• Appendix F. Excluded studies
• Appendix G. GRADE and CERQual tables
• Appendix H. Meta-analysis & network meta-analysis results
• Appendix I. References
• Appendix J. Health Economics
• Appendix K. Evidence review flow charts
• Appendix L. Research recommendations
• Appendix M. Health Economics Evidence Tables
• Appendix N. POMH Report
• Appendix O. Overview of Systematic Reviews of Non-pharmacological Interventions for Dementia
• Appendix P. Diagnosis
  • P.1. Evidence tables
  • P.2. GRADE tables
  • P.3. Meta-analyses

Final

Commissioned by the National Institute for Health and Care Excellence

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.