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dementia diagnosis and too much stimuli

It is important to establish a diagnosis following a comprehensive assessment in all people with dementia, whatever the type. An assessment should lead to greater understanding of what the individual and their family may need or benefit from, and should assess skills and abilities and not purely determine loss of skills or level of disability. The process of diagnosing dementia

and determining what type a person is experiencing is complex. It is necessary to establish a comprehensive family and medical history, along with changes in behaviour and health generally, both recently and over time. The symptoms and features of dementia may be exacerbated by underlying treatable medical conditions,such as:

• urinary tract and respiratory infections

• depression

• constipation

• thyroid or vitamin deficiencies.

It is beneficial to gather information from the individual and family members, and consent should be obtained from the person being assessed whenever possible. Time should be taken to explain things to the person with dementia, and information should be given in written and verbal forms.

A whole array of tests may be used, including:

• blood tests

• X-rays

• cognitive tests

• computerised tomography (CT) scans

• Magnetic resonance imaging (MRI) scans, which produce images of the brain showing the extent of any changes to the brain.

People with dementia are sometimes excluded from the process of diagnosis for fear that they will not cope and may become depressed or suicidal, although this is less usual than it used to be. Information and support are essential for the person receiving the diagnosis and the family. Many NHS Trusts have specialist memory clinics, which are specialist services providing assessment, diagnosis, treatment and support to people with dementia and their families.

The scenario below provides an example of one couple’s experience of receiving the diagnosis.

Early diagnosis may result in effective treatment to prevent or slow further deterioration in some types of dementia. It will also allow people to make informed choices about their future treatment and to be involved in any decision-making process. A comprehensive assessment will enable an informed diagnosis to be made, which is vital, because, as mentioned above, certain drugs that may be effective in treating symptoms in some types of dementia for some people may in fact make things worse for a person with another type of dementia. Drugs currently licensed for use in the treatment of Alzheimer’s disease are:

• Aricept (donepezil hydrochloride; Eisai Pharmaceuticals, Teaneck, New Jersey)

• Exelon (rivastigmine; Novartis Pharmaceuticals, Basel, Switzerland)

• Ebixa (memantine; H Lundbeck A/S, Copenhagen, Denmark)

• Reminyl (galantamine; Shire Pharmaceuticals Group, Chineham, Hants., UK).

Only consultant physicians can prescribe these drugs, but GPs can write repeat prescriptions. There is currently no course of treatment to slow down the progression of fronto-temporal lobe dementia. Some drugs used in the treatment of people experiencing psychotic symptoms, such as hallucinations, may result in severe complications or even death in someone with Lewy body dementia, which reinforces the need for comprehensive assessment and diagnosis before prescribing medication for people with dementia. A clearer diagnosis also

means that the person with dementia and their carers will have an opportunity to access appropriate information on the condition, its likely progress and what can be done to manage the changes.

The use of drugs to control behaviour is not considered to be good practice unless all other avenues have been explored. This includes assessing physical needs, communication difficulties, distress and the person’s need for time and understanding.

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