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Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK)

Version: 2007

THERAPEUTIC INTERVENTIONS FOR PEOPLE WITH DEMENTIA – COGNITIVE SYMPTOMS AND MAINTENANCE OF FUNCTIONING

There are a number of possible ways to group and categorise interventions in dementia care, for example, by the type of treatment approach used. In this and the following chapter, the main grouping is by the therapeutic goal, with three major domains highlighted: the maintenance of function, including cognitive functions, the management of behaviours that challenge and the reduction of comorbid emotional disorders. Each of these three areas has the aim of improving the quality of life and well-being of the person with dementia, which may in turn impact on the well-being of those providing care. In this chapter, we look at the evidence for the effectiveness of interventions designed to enhance and increase functioning; in the following chapter, the aim of therapy is to reduce depression or agitation or to modify other distressing symptoms of dementia – although potentially this may also be achieved by improving function in other areas.

THERAPEUTIC INTERVENTIONS FOR PEOPLE WITH DEMENTIA – NON-COGNITIVE SYMPTOMS AND BEHAVIOUR THAT CHALLENGES

Although it is the cognitive features of dementia that are its defining characteristic, other aspects contribute in large measure to the difficulties experienced, by both the person with dementia and the people that support him or her. Often these non-cognitive symptoms are described as neuropsychiatric symptoms or ‘behavioural and psychological symptoms of dementia’ (BPSD), terms that include delusions, hallucinations, depression, anxiety, apathy and a range of behaviours, such as aggression, wandering, disinhibition and agitation. It is suggested that these behaviours may occur in up to 90% of people with AD (Robert et al., 2005). Prevalence rates for features such as anxiety, apathy and depression are consistently high.

EXECUTIVE SUMMARY

People with dementia should not be excluded from any services because of their diagnosis, age (whether designated too young or too old) or coexisting learning disabilities.

DEMENTIA

This guideline is concerned with the identification and treatment of, and care for, dementia as defined in the 10th edition of the International Classification of Diseases (ICD-10) (World Health Organization, 1992). Care for people with dementia is provided by both health and social care organisations, each bringing its own particular perspectives on both the nature of the dementia and, more particularly, our response to people with dementia. As a result, this guideline has been jointly developed for the Social Care Institute for Excellence (SCIE) and the National Institute for Health and Clinical Excellence (NICE), and we have drawn on the combined knowledge and evidence base of both social and clinical perspectives within the area of dementia care. This has presented challenges for guideline development in analysing and synthesising the two different approaches to ‘evidence’ and the sheer volume of literature needing appraisal, and the need to produce ‘joined up’ practice guidelines to address the sometimes contrasting perspectives in health and social care approaches to dementia care.

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