Dementia in General Practice

General Practitioners are often the first healthcare professionals to be consulted when dementia is suspected by the person and/or their families. Irish GPs have reported difficulty differentiating normal ageing from symptoms of dementia, citing a lack of confidence and concerns about the impact of the diagnosis on the patient.

'Dementia: Diagnosis and Management of in General Practice' (Tony Foley, Aisling Jennings and Greg Swanwick) was published in April 2019 by the ICGP Quality in Practice Committee, It is a revised version of a 2014 document.

Its aim is to provide a comprehensive overview for GPs and primary health care professionals in all aspects of the diagnosis and management of dementia. 

The GP Dementia Review

The quality of care provided to patients with dementia can be improved by focusing on the following 6 key areas at this regular review. This applies both to patients in the community and nursing home residents.

1. Medication Review

  • Is the patient on an antipsychotic? Is it necessary? Is it monitored? Can it be reduced or withdrawn?
  • Is the patient on a medication such as an anticholinergic that could worsen cognition? 
  • Is the patient on an acetylcholinesterase inhibitor (e.g Donepezil)? If yes, is the dose therapeutic? Are there any side effects?
  • Does the patient have adequate pain relief?
  • Is the patient experiencing any medication side effects?

Visit our page on post diagnosis information for further detail on medication management in dementia.

2. Mental Health

  • Is there evidence of depression? Depression is often difficult to detect in people with dementia. If uncertain consider using a depression screening tool such as:
    • The Geriatric Depression Scale - this is a relatively short 15-item questionnaire and has been vailidated for use in mild dementia, however, is not as suitable in more advanced dementia as the patient may lack the ability to comprehend the questions. (PDF below)
    • The Cornell Scale for Depression in Dementia - this tool is dementia specific but can take up to 20 mins to perform (PDF below)

3. Physical Factors

  • Hearing, vision, nutrition, bowel, bladder
  • Advise dental review

4. Risk Assessment

  • Inadvertent self-harm e.g kitchen accidents, medication mistakes
  • Deliberate self-harm
  • Risk to others e.g. driving, aggression
  • Evidence of elder abuse

5. Assessment of Carers Needs

  • Consider caregiver burden: Does the carer regularly get time to themselves? Do they have adequate support? Are they themselves feeling down/anxious/irritable? 
  • Consider using a scale to formally measure caregiver burden, however, these are often quite lengthy. (See PDF below)
  • If appropriate consider directing carers to online resources designed to support carers:

6. Social Supports Review

  • Are there social supports in place? Does the carer, or person with dementia, access any support groups, go to Alzheimer cafes, avail of day care or respite services?