Guidelines for preventive activities in general practice

The Red Book
5.5 Dementia
☰ Table of contents

Age range chart

0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80

With people aged >65 years, clinicians should be alert to the symptoms and signs of dementia. These may be detected opportunistically and assessed using questions addressed to the person and/or their carer (C). Depression and dementia may co-exist. When a person has dementia, adequate support is required for the person, carer and family. Counselling and education are important. Management priorities will vary from patient to patient, but there may be a need to consider medical management of dementia, behaviour and comorbidity, legal and financial planning, current work situation, driving, and advance care planning.59

Table 5.5.1. Dementia: Identifying risks

Who is at risk?

What should be done?

How often?

Average risk

Those without symptoms 60, 61

No evidence of benefit from screening (II, C)


Moderate risk62–64

  • Those with symptoms (refer to Table 5.5.2)
  • A family history of Alzheimer’s disease
  • People with history of repeated head trauma 65
  • People with Down syndrome
  • Those with elevated cardiovascular risk (eg heart disease, stroke, hypertension, obesity, diabetes, elevated homocysteine, elevated cholesterol, smoking, sedentary lifestyle)66–69
  • Those with depression or a history of depression
  • People with low levels of education
  • Aboriginal and Torres Strait Islander peoples 70–74 (Note that culturally safe practices should be adopted with this community)

Case finding and early intervention (III, C)


Table 5.5.2. Dementia: Preventive interventions



Case finding and confirmation

  • Ask ‘How is your memory?’ and obtain information about dementia and other cognitive problems from others who know the person (eg repeating questions, forgetting conversations, double buying, unpaid bills, social withdrawal) 75–77
  • Other symptoms may include a decline in thinking, planning and organising, and reduced emotional control or change in social behaviour affecting daily activities. Not everyone with dementia has memory problems as an initial symptom (C). Other clues are missed appointments (receptionist often knows), change in compliance with medications, and observable deterioration in grooming or dressing. Falls may also be an indication of cognitive impairment
  • Over several consultations, obtain the history from the person and family/carer, and perform a comprehensive physical examination. Undertake cognitive assessment using: A suite of recommended rating tools is available here
  • Assess functional status.80,81 The Instrumental activities of daily living assessment tool may be used. All screening instruments used to assess dementia in general practice have high rates of overdiagnosis (false positives) and underdiagnosis (false negatives), so the full clinical presentation needs to be taken into account. Reassessment after 6–12 months may be helpful

Assessment should include relevant blood tests and imaging to a exclude space-occupying lesion or other brain disorder 

Relevant tests are recommended in the Clinical practice guidelines for dementia in Australia.

Early intervention and prevention

Evidence is growing that attention to cardiovascular disease (CVD) risk factors may improve cognitive function and/or reduce dementia risk. There is sufficient evidence now for clinicians to recommend the following strategies for early intervention and prevention of dementia:68,69, 82–87, 88

  • increased physical activity (eg 150 minutes per week of moderate-intensity walking or equivalent)
  • social engagement (increased number of social activities per week)89, 90
  • cognitive training and rehabilitation 91, 92
  • diet – the Mediterranean and the Dietary Approaches to Stop Hypertension (DASH) diets have been shown to be protective against cognitive decline 67
  • smoking cessation 66, 68
  • management of vascular risk factors (refer to Chapter 8. Prevention of vascular and metabolic disease
  • use of the risk assessment tool developed by the Collaborative Research Centre, which is based on dementia prevention, and takes about 15 minutes to fill out and provides a good overview for all the possible risks for dementia, for discussion with the GP is available here

Refer to Chapter 7. Prevention of chronic diseaseChapter 8. Prevention of vascular and metabolic disease, and Chapter 10. Psychosocial

CVD, cardiovascular disease; DASH, Dietary Aproaches to Stop Hypertension; KICA, Kimberley Indigenous Cognitive Assessment; MMSE, Mini-Mental State Examination; SMMSE, Standardised Mini-Mental State Examination


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