NICE Updates Dementia Diagnosis and Care Guideline

Nicky Broyd

June 22, 2018

The National Institute for Health and Care Excellence (NICE) has, for the first time in over 10 years, updated its guideline on diagnosis, treatment, and support for people with dementia in England.

NICE says there are more than 850,000 people in the UK who have been diagnosed with dementia and the number is expected to double in the next 30 years.

The NICE recommendations follow recently published dementia care guidance from the Department of Health and Social Care.

Dementia Diagnosis

The initial primary care assessment will involve taking a medical history to include cognitive, behavioural and psychological symptoms, and how these affect daily life. Information should come from the person suspected of having dementia and, if possible, a family member or other person who knows them well.

The next steps are:

  • A physical examination

  • Blood and urine tests to rule out any reversible causes of cognitive decline

  • Validated cognitive tests, although a normal score should not always exclude a diagnosis

The person should be referred to a specialist diagnostic unit if reversible causes of cognitive decline have been ruled out and dementia is still suspected.

Doctors are reminded that some commonly prescribed medications may be associated with cognitive impairment, and that they should consider alternatives where appropriate.

If other symptoms are unclear, a specialist CT scan or analysis of cerebrospinal fluid is now recommended to assist in the diagnosis of Alzheimer's disease. CSF should be checked for proteins associated with the condition - either total tau, or total tau and phosphorylated-tau 181, and either amyloid beta 1–42 or amyloid beta 1–42 and amyloid beta 1–40.

Commenting on the new guideline, Dr Matthew Norton, director of policy and strategy at Alzheimer's Research UK, said: "In recent years research has shown CSF tests can be a valuable tool for the detection of Alzheimer's and the inclusion of this approach could help provide an accurate diagnosis for people with Alzheimer's disease where a diagnosis is particularly uncertain. We still need more reliable ways of detecting diseases like Alzheimer's, which is why it's crucial to continue research to develop better diagnostic tools."

The new guideline also urges health professionals to make people who have dementia aware of participation opportunities in current research studies.

Dr Norton said: "While a diagnosis of dementia can leave people feeling powerless, research represents a tangible way those individuals can regain some control and take action.

"Unfortunately, people with dementia are not always made aware of opportunities to be involved in research studies like those offered through Join Dementia Research. Although this is a key goal set out in the government's Challenge on Dementia 2020, we must do more to increase awareness about opportunities for people to get involved in dementia research."

'Person-Centred Care'

The guideline stresses the importance of involving patients, along with their families, and carers, in decisions about their care and to listening to their views.

Information should also be given about the disease type and prognosis in a way that can be understood, including how the diagnosis may affect driving, advance care planning, and access to local support services.

People diagnosed with dementia should also be allocated a named health professional or social care professional to co-ordinate care. Individual care plans should also be put in place and reviewed at least annually due to the progressive nature of the disease.

When considering admission to hospital, the benefits to the patient should be assessed against the potential worsening of symptoms associated with being placed in an unfamiliar environment.

Commenting on the guidance, Director of Policy, Campaigns and Partnerships at Alzheimer's Society, Sally Copley said: "With one person developing dementia every 3 minutes in the UK, it is vital we prioritise dementia care. This is the first update to the NICE guideline in 10 years, so it's encouraging to see the steps it's taking to ensure the needs and rights of people with dementia are met."
 

Treating Dementia

The guideline promotes therapies tailored to individual needs in certain cases, including cognitive stimulation therapy, group reminiscence therapy, cognitive rehabilitation, or occupational therapy.

Acupuncture, ginseng, vitamin E supplements, or herbal formulations are not recommended.

Non-invasive brain stimulation is not recommended for mild to moderate Alzheimer's disease unless as part of a clinical trial.

Management of Alzheimer's disease using drugs is already covered by various NICE technology appraisals.

Use of diabetes medication, anti-hypertensives, statins, or NSAIDs specifically to slow the progress of the disease is not recommended unless as part of a randomised controlled trial.

Dementia Training

The guideline recommends specific dementia training and tailored support for carers looking after people with dementia.

Professor Gillian Leng, NICE deputy chief executive, writes that: "The new NICE guideline highlights the need to properly train staff and says that carers should be helped to improve support for people living with dementia.

"The recommendations focus on person-centred support, placing a particular emphasis on involving people with dementia in every decision about the care they receive."

Sally Copley commented that "the guideline is just a starting point. What we need now is support to implement these recommendations. Take training as an example - a third of homecare workers currently have no dementia training, resulting in inadequate care for many people with dementia. The guideline alone can't change this, we'll need to see significant investment to improve care quality, when the Government announces its plans for social care reform in the autumn."

Dementia: assessment, management and support for people living with dementia and their carers. The National Institute for Health and Care Excellence (NICE). Guideline NG97 published June 2018. Guideline.

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