Dementia: Assessment, Management and Support for People Living With Dementia and their Carers
National Institute for Health and Care Excellence. (2018).
London (United Kingdom): National Institute for Health and Care Excellence, 1-419.
This guideline from the National Institute for Health and Care Excellence provides recommendations on diagnosing and managing dementia, including Alzheimer's disease.
National Institute for Health and Care Excellence (United Kingdom)
This guideline was reviewed with the following:
<ul>
<li>National Institute for Health and Care Excellence. (2013). <em>Mental Wellbeing of Older People in Care Homes</em> (Quality Standard 50). Retrieved from <a title="https://www.nice.org.uk/guidance/qs50" href="https://www.nice.org.uk/guidance/qs50" target="_blank" rel="noopener">www.nice.org.uk</a></li>
<li>National Institute for Health and Care Excellence. (2019).<em> Dementia</em> (Quality Standard 184). Retrieved from <a title="https://www.nice.org.uk/guidance/qs184" href="https://www.nice.org.uk/guidance/qs184" target="_blank" rel="noopener">www.nice.org.uk</a></li>
</ul>
Data from this document can be found elsewhere in the Evidence Maps. See the Associated Articles section below for more information.
<div>For individuals with dementia, involving a speech and language therapist should be considered when there are concerns about the person's ability to eat or drink safely.</div>
<div>For individuals with dementia and their family members and/or caregivers (as appropriate), information relevant to their circumstances and stage of their condition should be provided in an accessible format. Oral and written information should be provided at diagnosis explaining: dementia subtype, expected progression, members of the care team, workplace accommodations, and any available local support groups or financial, legal, or advocacy resources. Family members, caregivers, and other communication partners should receive training and education on how to adapt their communication style to support and improve interactions. All information should be tailored to the needs and preferences of the individual with dementia and to their family members/caregivers.</div>
<div>For individuals with dementia, cognitive interventions should be individualized to the person's preferences.</div>
<div>Individuals with mild to moderate dementia should be considered for group reminiscence therapy.</div>
<div>Staff and healthcare professionals working with individuals with dementia should be provided training on the needs of the person and their family members or caregivers, symptoms of dementia, changes to expect as the condition progresses, and how to adapt communication style. Team members should meet to discuss feedback, particular situations, or other needs of the individual with dementia.</div>
<div>When making decisions about care, individuals with dementia should be involved using communication supports (e.g., visual aids, simplified text) as needed. Using structured tools for assessing likes and dislikes, routines, or the individual's personal history may be considered.</div>
<div>Initial assessment for dementia should include taking patient history (e.g., cognitive symptoms and the impact on daily life) from the person with suspected dementia as well as from someone who is familiar with the person (e.g., family member). Patient history may be supplemented with a structured questionnaire instrument (e.g., Informant Questionnaire on Cognitive Decline in the Elderly, Functional Activities Questionnaire). If dementia is still suspected, cognitive testing should be included with other follow-up evaluations using a brief cognitive instrument such as:</div>
<ul>
<li>the 10-point Cognitive Screener (10-CS);</li>
<li>the 6-item Cognitive Impairment Test (6CIT);</li>
<li>the 6-item screener;</li>
<li>the Memory Impairment Screen (MIS);</li>
<li>the Mini-Cog; or</li>
<li>Test Your Memory (TYM).</li>
</ul>
<div>When Alzheimer's disease is suspected, include an assessment of verbal episodic memory.</div>
<div>Cognitive rehabilitation should be considered for individuals with mild to moderate dementia.</div>
<div>Individuals with mild to moderate dementia should be offered group cognitive stimulation intervention.</div>
<div>If cognitive decline from reversible causes (e.g., delirium, depression, medications) has been examined and dementia is still suspected, individuals with suspected dementia should be referred to specialist dementia diagnostic services (e.g., a memory clinic). After diagnosing dementia, individuals should have access to memory services, hospital-based care, or primary care-based multidisciplinary dementia services with flexible access and/or monitoring appointments.</div>
<div>Individuals with dementia should have a healthcare provider responsible for coordinating their care including arranging assessments, providing information about accessing services, involving family members and/or caregivers as appropriate, and developing care and support plans. Services should be made as accessible as possible for each individual with dementia.</div>
<div>Cognitive training should not be offered to individuals with mild to moderate Alzheimer's disease.</div>
