According to the guideline, dementia is a progressive and mostly irreversible cognitive decline that causes functional impairment in daily activities. There are four major subtypes of dementia, which are Alzheimer’s disease (AD), vascular dementia (VaD), mixed dementia, and other subtypes such as dementia with Lewy bodies (DLB), frontotemporal dementia (FTD) and Parkinson’s disease dementia (PDD) (Department of Health, 2017b). One chapter in the guideline covers the diagnosis of dementia (Chapter 3). The assessment of cognitive impairment in primary care setting should include history, physical examination, cognitive screening test, appropriate investigations, and review of medications which may adversely affect the cognitive functions of the elderly people (Department of Health, 2017b). An algorithm for the assessment of cognitive impairment in older people in primary care setting can be found on page 13 of the guideline (Department of Health, 2017b, p.13).

References:

Department of Health. (2017b). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment. Retrieved from https://www.fhb.gov.hk/pho/rfs/english/pdf_viewer.html?file=download215&title=string258&titletext=string189&htmltext=string189&resources=07_Module_on_Cognitive_Impairment

Yes.

a) Alzheimer’s disease

Various actions are recommended to improve the accuracy of the diagnosis, such as the following:

1. Obtain a medical and family history of the individual, including a neuropsychiatric history and a history of changes in cognition and behaviour.
2. Review of medications used that could affect cognition
3. Ask family members and others close to you individually for changes in thinking or behaviour.
4. Cognitive tests, neurological exam, and physical tests.
5. Serological and neuroimaging tests (primarily to rule out other causes).

b) Vascular dementia

Patients at high risk for vascular cognitive impairment should be considered those who present the following risk factors: hypertension, age over 65, hyperlipidemia, diabetes mellitus, clinical evidence of cerebral vascular event, findings in neurodiagnostic images of cerebral vascular event and/or leukoencephalopathy, damage to other target organs (eye, kidney, heart), and patients with cognitive or functional changes that are clinically evident or reported during the completion of the clinical history.

General examinations are recommended in patients with suspected dementia, to exclude potentially reversible causes of dementia and for screening for comorbidities. As well as neuroimaging studies for the detection of vascular components.

It is recommended to differentiate between vascular dementia, Alzheimer’s disease or the co-existence of the two entities, using the Hachinski ischemia scale, in order to better identify treatment and prevention.

Yes.

Yes, see p.143 of Emsley et al., (2013).

References:

Emsley, R., & Seedat, S. (2013). The South African Society of Psychiatrists (SASOP) treatment guidelines for psychiatric disorders. South African Journal of Psychiatry, 19(3), 127–196. https://doi.org/10.4102/sajpsychiatry.v19i3.942