A diagnosis of dementia is confirmed in a specialist setting, where any pharmacological treatment is also discussed and initiated.
Each HSCP arranges its own services: referrals are generally to Older People’s Mental Health teams, for those over 65, or memory assessment centres. HSCPs also offer a variety of urgent and supportive services for those with a diagnosis of dementia, particularly for those in care homes, who are distressed or where there are behavioural difficulties.
Donepezil, galantamine, rivastigmine and memantine prescribing are no longer covered by Shared Care Agreements (SCAs). However, the principles of the SCAs have been retained, namely that specialists will initiate prescribing, titrate doses, assess efficacy and tolerability, and undertake initial monitoring. Further details are available on the East Region Formulary Alzheimer’s disease page.
Initial assessment
Please ensure that an appropriate physical examination and investigation have been undertaken, where organic disease is suspected. Where appropriate, the GP should assess for delirium – Delirium (nhslothian.scot) – which is more common in those with dementia.
Please also check the following – there is a dementia order set for these on GPOC/ICE:
- FBC
- B12*
- folate*
- C&Es
- TFTs*
- LFTs
- Calcium/albumin
- random glucose.
*TFT, Vitamin B12 and folate do not need to be repeated if done within 6 months prior to referral.
Rating scales or an MMSE help with initial assessment. A specialist team will complete an ACE III (or alternative) in clinic for a more comprehensive assessment of cognition.
It is useful to include details of:
- family, current social circumstance and of others involved in the person’s care.
- a name and number of a carer and an indication if the patient has agreed to contact with carer
- whether the patient can come to clinic (preferable) or if a home visit is necessary
Please see individual HSCP services for details of referral pathways – Older Peoples Mental Health (nhslothian.scot)
C.M & A.B 25-04-24
Alzheimer Scotland and Dogs for Good
Alzheimer Scotland and Dogs for Good are matching people living with dementia with a specially trained dog to support them in the early stages of dementia. The dog companion can be trained, similar to dogs for the blind and deaf, to help those who need support by prompting them in their daily lives for example, eating, taking their medication, sleeping and of course, dogs make a wonderful companion, enabling people to get out for some exercise and fresh air and to meet with others, so combatting loneliness.
If you’d like to know more: www.alzscot.org/living-with-dementia/getting-support/dementia-dog
