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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.

PREVENTION, EARLY IDENTIFICATION, ASSESSMENT AND DIAGNOSIS OF DEMENTIA

Prevention of dementia syndromes would have a huge impact on large numbers of individuals and on society as a whole. Primary prevention, to avert early pathological changes, or secondary prevention, to delay pathological processes, are strategies that seem worthwhile pursuing. To do this, we must understand the factors that increase the risk of developing dementia and those that appear to be protective. Earlier identification of dementia may allow secondary prevention interventions, as well as early mobilisation of support and resources. To achieve earlier identification, we need to understand the ways in which cognitive function in dementia syndromes diverges from normal ageing processes. Diagnosis of dementia and its subtypes is often a complex process in which practitioners need to consider personal and informant histories, cognitive function testing and exclusion of other organic and psychological disorders. The importance of structural and functional neuroimaging is debated, as are the respective roles of primary- and secondary-care specialists in the diagnostic process. This step-wise process of reaching a diagnosis of dementia may involve assessment by a number of different professionals over a period of time. The process may raise difficult questions about how to discuss the possible or actual diagnosis, with whom and when. The experience of this assessment process may influence the way in which the person with dementia and his or her family or other carers assimilate and accommodate themselves to the diagnosis, and professional skills in managing the assessment process are therefore of great importance.

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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