GP and dementia lead Dr Peter Bagshaw provides an update on best practice in management of dementia including latest knowledge on the pharmacological options.
Learning objectives
This module provides an update on current best practice in the management of dementia in primary care, including:
- Understanding of features of dementia beyond memory impairment.
- Pharmacological options for cognitive problems and delaying dementia progression including drugs in development.
- Effective non-pharmacological interventions for delaying dementia progression.
- Frequency and nature of behavioural and psychological problems and their appropriate management.
- Key aspects of end of life care in people with dementia.
Dementia features beyond memory loss
Most people think of dementia as a memory problem, and while loss of short-term memory is a major issue, it is increasingly recognised that non-cognitive features such as apathy, aggression and hallucinations are a core part of the symptomatology. With the lack of insight that comes with the disease, and its effect on carers, this means it can be a uniquely challenging condition to deal with.
As a consequence, the management of dementia can be complex, involving an understanding of possible causes of behavioural difficulties, an ability to work with and support carers, an understanding of issues of capacity and consent, and a knowledge of the local support available.
Although the different subtypes of dementia share many features, it is worth being aware of the specific diagnosis (if known) as this can influence management: Alzheimer’s disease is the commonest, but if the patient has vascular dementia it is particularly important to pay attention to vascular risks, particularly in the early stages. Dementia with Lewy Bodies (DLB) is usually associated with Parkinson’s disease, which can complicate drug intervention, and seems particularly likely to include hallucinations as part of the picture, while the less common Fronto-Temporal Dementia (FTD) often has behaviour change as an early feature, sometimes before memory loss is evident. FTD should be suspected when an elderly patient begins acting out of character, for instance with disinhibition.
Drug therapy is available, but in most cases it makes only a minimal difference to the condition. Non-pharmacological interventions provide the mainstay of help, and nurses are generally the best at providing this in the community.
Dr Peter Bagshaw is a GP and dementia lead at Somerset ICB
To read and complete the full module visit the Nursing in Practice 365 website.
Not a Nursing in Practice 365 subscriber? Register for free or gain access to more CPD content as a Premium member
