Diagnosis and Management of the Patient with Suspected Dementia in Primary Care

Abstract

Dementia is a complex progressive syndrome characterised by impairment of cognition (including memory, language, visuospatial skills and executive function), changes in personality and diminished activities of daily living. The impact of dementia is enormous and poses a huge challenge to patients, their carers, society at large and health systems around the world, in terms of the direct cost of medical care, social care and unpaid care provided by family members and others. In this review, we combine evidence and clinical opinion, using guidelines and reviews from 2006, 2009 and 2010 to present a practical guide for primary care physicians to the diagnosis, treatment and ongoing care of patients with suspected or diagnosed dementia. This review summarises the epidemiology of dementia syndrome, and offers detailed evidence-based advice on recognition of dementia (including subtyping) and responses to it and its associated symptoms. The roles of neuroimaging and biomarkers are discussed, as are both non-pharmacological and pharmacological therapies.

Dementia Approach and Follow-up in Primary Care

“…Dementia 2(3),[37][38][39][40][41][42][43][44] m 3 40 planned as well as those related with patient safety so as to prolong their independence. It also enables caregiver burden to be reduced by conveying information about the disease, support groups and monitoring as provided by appropriate services in order to delay the patient's institutionalization (Dodd, Cheston & Ivanecka, 2015;Holzer et al, 2013;Pinho, 2008). Generally speaking, the public perception of dementia is that most people are institutionalized in short-term or long-term care units.…”

“…The medical-related obstacles include the difficulty in differentiating changes inherent to memory loss brought about by the normal aging process and the early stages of dementia, pessimism about treatment and prognosis, lack of skills in recognizing dementia, as well as the belief that diagnosis of this condition should be conducted by specialists. As for the health system, it is worth mentioning the lack of time and resources in PHC to address this issue (Dodd et al, 2015;Holzer et al, 2013;Pinho, 2008). …”

“…Alzheimer's disease is the most common type and is present in approximately 60 to 80% of cases. This is followed by vascular dementia, dementia with Lewy bodies and frontotemporal dementia (Alves & Caetano, 2010;Holzer et al, 2013;Larson, 2016;Pinho, 2008). Some studies reveal that an overlap of pathologies is more common than previously thought, particularly with an overlap of Alzheimer's disease with vascular dementia and dementia with Lewy bodies, while the frontotemporal dementia tends to be erroneously misdiagnosed as Alzheimer's disease (Holzer et al, 2013).…”

“…This is followed by vascular dementia, dementia with Lewy bodies and frontotemporal dementia (Alves & Caetano, 2010;Holzer et al, 2013;Larson, 2016;Pinho, 2008). Some studies reveal that an overlap of pathologies is more common than previously thought, particularly with an overlap of Alzheimer's disease with vascular dementia and dementia with Lewy bodies, while the frontotemporal dementia tends to be erroneously misdiagnosed as Alzheimer's disease (Holzer et al, 2013). It should be noted that in the study by Rodrigues et al (2006) to estimate the prevalence of dementia cases diagnosed in PHC, there was a higher percentage of vascular dementias in Portugal compared to other European countries.…”

“…It is a complex, chronic and progressive disorder characterized by cognitive impairment which involves one or more functions (learning, memory, language, visuospatial skills and executive function), personality changes and decreased overall operation (Boustani, Schubert & Sennour, 2007;Holzer, Warner & Iliffe, 2013;Larson, 2016). In Portugal, like other European countries, there is a growing aging population.…”