A holistic approach
CPD activity
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Dementia management should involve a holistic approach that considers both pharmacological and non-pharmacological interventions.
Non-pharmacological
The non-pharmacological management of dementia should include:
- Social support
- Assistance with daily activities
- Information and education
- Carer support
- Community dementia teams
- Home nursing
- Community services.
The National Institute for Health and Care Excellence (NICE) recommends that people with mild to moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation programme.
Pharmacological
Pharmacological treatment options for Alzheimer's disease (AD) are symptom-treating. These fall into two categories:
- Acetylcholinesterase (AChE) inhibitors, e.g. donepezil
- N-methyl D-aspartate (NMDA) receptor antagonists, e.g. memantine.
NICE recommends the following guidance for AD:
- Donepezil, galantamine and rivastigmine are recommended as options for managing mild to moderate AD
- The least expensive AChE inhibitor should be prescribed first. An alternative can be tried taking into account adverse event profile, adherence, medical co-morbidity, potential drug interactions and dosing profiles
- Memantine is recommended as an option for patients with severe AD or those with moderate AD who cannot take AChE inhibitors.
A specialist should initiate treatment and it should continue for as long as it has a worthwhile effect. Patients should be assessed regularly unless there are locally-agreed protocols for shared care.