Dementia
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Unit 609
March 2024
The purpose of this activity is to provide you with an understanding of the initial assessment and diagnostic framework of mild cognitive impairment and dementia in primary care.
Dementia describes a group of conditions that cause global brain degeneration. Its main impact is on memory, cognition, personality and behaviour and mobility. Alzheimer’s disease and vascular disease (mixed dementia) are the most common forms of dementia. Dementia is not a normal part of ageing, despite age being the biggest risk factor.
Dementia affects approximately 400,000 people in Australia, but prevalence is likely to increase to 800,000 people by 2050. It is the leading cause of disability in older adults in Australia; it is also the leading cause of death for women in Australia and second-leading cause of all-cause mortality.
There are several modifiable risk factors. Alzheimer’s Disease International ran a campaign in 2023 with the slogan ‘Never too early, never too late’ to institute risk reduction measures. A diagnosis is more often delayed in some populations than others; Aboriginal and Torres Strait Islander peoples and people under the age of 65 years are two examples.
Aboriginal and Torres Strait Islander peoples also have an increased rate of dementia, 3–5 times higher than the overall rate in Australia, often presenting in younger populations. In this population, case finding or cognitive assessment should begin from the age of 50 years.
Objective dementia assessment requires the use of cognitive assessment tools and these should be selected based on the individual you are assessing, including the population they are a part of.
There is stigma affecting people living with dementia and dementia can make it more challenging to manage other chronic diseases. A multidisciplinary team approach can improve the care and support offered to people living with dementia in primary care.
Janet, aged 76 years, presents for preparation of her chronic condition care plan (General Practitioner Management Plan and Team Care Arrangements, Medicare Benefits Schedule Items 721 and 723, respectively), as she developed overt diabetes about 12 months ago. She lives with her husband, aged 82 years, who has multiple physical illnesses. She was recently diagnosed, at the memory clinic, with early dementia and started on donepezil, in addition to her usual metformin 500 mg twice a day. These are her only medications. In response to prompting from the memory clinic, she has relinquished her driver’s licence. She is receiving a Level 2 package from My Aged Care, which currently gives her some assistance with cleaning the house each week. She forgot her last two appointments and it is at least six months since you have seen her.
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Each unit of check comprises approximately five clinical cases, and the choice of cases will cover the broad spectrum of the unit’s topic. Each unit will be led by a GP with an interest and capability in the topic, and they will scope the five different cases for that unit in collaboration with the check team.