Investigation, diagnosis and treatment of dementia will increasingly be part of a GPs role as the number of new cases in Australia is forecast to reach 175,000 per year by 2050.

In the latest edition of Australian Prescriber, Dr Alisa Crouch, registrar in Geriatric medicine at Brisbane’s Princess Alexandra Hospital, discusses differential diagnosis of dementia and the place of non-drug and drug therapy within treatment plans.

The article summarises the available evidence for efficacy of non-drug and drug therapy – including cholinesterase inhibitors and memantine – and discusses when to stop drug treatment.

“Dementia is a progressive disease. Drug treatment at best only slows the decline in cognitive function,” Dr Crouch writes. “Timing of cessation of drug therapy for dementia is controversial, but should be considered if the patient is completely dependent in their care needs.”

“Cessation should be discussed with the patient’s family, particularly as they may notice some deterioration in the patient’s functional abilities.”

“Psychosocial interventions for carers are more effective if the patient is involved. [Non-drug] interventions can help to reduce the psychological burden and can reduce the need for institutional care,” Dr Crouch says.

GPs are the first point of contact in 93% of cases, making identification and treatment of alternative causes of cognitive impairment an important skill. Clinical features of alternative causes of cognitive impairment are listed.

The article also lists subtypes and features of dementia.

Dr Crouch concludes that while there is no cure for most types of dementia, if the diagnosis includes information about the subtype it allows a patient and their family to develop the most appropriate, individualised treatment plan.

“Early education and planning for future events can assist both the patient and their support network,” she says.

Carers and families may benefit from support materials from Alzheimer's Australia, which are available from www.alzheimers.org.au or 1800 100 500.

For a fully copy of the article visit www.australianprescriber.com.

ENDS

Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published by National Prescribing Service Limited (NPS), an independent, non-profit organisation for Quality Use of Medicines funded by the Australian Government Department of Health and Ageing.