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Research shows importance of primary care in diagnosis and management of dementia


Morgan Liotta


6/09/2018 10:47:47 AM

With the average Australian patient growing older by the day, general practice is moving further into the spotlight of assisting with neurological conditions.

The rising tide of an ageing Australia is also lifting the prevalence of dementia.
The rising tide of an ageing Australia is also lifting the prevalence of dementia.

The latest issue of Australian Journal of General Practice (AJGP) focuses on diagnosis and management of neurological conditions in general practice, including the role GPs can play in assessing patients for cognitive impairment.
 
Professor Dimity Pond, author of ‘Office-based assessment of cognitive impairment’ in the September issue of AJGP, is the Head of the Discipline of General Practice at the University of Newcastle. Her research suggests that an increased worldwide prevalence of dementia means there is a need for changes in treatment beyond the traditional specialist referral pathway.
 
‘Dementia is an increasingly prevalent condition, currently affecting over 400,000 Australians, and this is expected to rise to over one million by 2056,’ Professor Pond said.
 
‘As the number of people developing dementia increases, specialist referrals are becoming less feasible, economically and logistically.’
 
Professor Pond believes GPs are essential in screening and management of dementia, incorporated in their role of disease management and ongoing care for patients.
 
‘GPs are on the frontline of healthcare presentations and will therefore play an increasingly important role in dementia identification and management,’ she said.
 
Professor Pond has found an office-based assessment of cognitive impairment in the general practice setting can help to identify or exclude dementia from other common causes of impairment.
 
She recommends assessment using the ‘three Ds’  – delirium, depression and drug [medication] effects – to distinguish dementia from other common causes of cognitive impairment, in order to accurately identify those patients at moderate risk of dementia.
 
The presence of one or more of the following factors places a person at moderate risk of dementia and warrants case-finding for cognitive impairment:

  • Symptoms of dementia
  • Increasing age (risk increases with age)
  • Family history of Alzheimer’s disease
  • History of repeated head trauma
  • Down syndrome
  • Elevated cardiovascular risk (eg heart disease, stroke, hypertension, obesity, diabetes, elevated homocysteine, elevated cholesterol, smoking, sedentary lifestyle)
  • Depression or a history of depression
  • Low levels of education
  • Identifying as an Aboriginal or Torres Strait Islander person
  • Hearing impairment
Professor Pond emphasises that the right assessment allows GPs to adapt patients’ specific healthcare needs to assist with the ongoing management of complex and long-term conditions, like dementia.
 
‘For day-to-day management of dementia, GPs can tailor management of comorbidities, with the assistance of a care plan and a practice nurse,’ she said.
 
Resources
September is Dementia Awareness Month, and the RACGP has a number of resources available to assist GPs with assessment and management of dementia:



AJGP cognitive impairment dementia Dementia Awareness Month





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