Alzheimer’s

Vascular Dementia

Lewy Body Dementia

Dementia is a clinical syndrome of progressive cognitive impairment that affects daily function and independence. It is thought to affect over 900,000 people in the UK and accounts for a large amount of health and social care spending. The most common cause of dementia in the UK is Alzheimer's disease, followed by vascular dementia and Lewy body dementia. These conditions may coexist.

Features

• diagnosis can be difficult and is often delayed
• assessment tools recommended by NICE for the non-specialist setting include: 10-point cognitive screener (10-CS), 6-Item cognitive impairment test (6CIT)
• assessment tools not recommended by NICE for the non-specialist setting include the abbreviated mental test score (AMTS), general practitioner assessment of cognition (GPCOG) and the mini-mental state examination (MMSE). However, these have been widely used historically. An MMSE score of 24 or less out of 30 suggests dementia

Management

• in primary care, a blood screen is usually sent to exclude reversible causes (e.g. Hypothyroidism). NICE recommend the following tests: FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels
• in secondary care, neuroimaging is performed* to exclude other reversible conditions (e.g. subdural haematoma, normal pressure hydrocephalus) and to help provide information on aetiology, guiding prognosis and management
  • according to the 2018 NICE guidelines, structural imaging should be offered to help exclude reversible causes of cognitive decline and to assist with subtype diagnosis unless dementia is well established and the subtype is clear
• patients are now commonly referred to memory clinics, which are often led by old-age psychiatrists or geriatricians