One chapter in the guideline covers the management of dementia (Chapter 4). Management of cognitive impairment in primary care setting requires a multi-disciplinary team approach to achieve the goals on improving quality of life, maximising functional performance, and addressing mood and behaviour of the older person. The algorithm for management of cognitive impairment in older people in primary care setting can be found at page 22 of the guideline (Department of Health, 2017b, p.22)

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.

Yes.

a) Alzheimer’s disease

Acetylcholinesterase inhibitor (ACE) therapy such as donepezil, rivastigmine and galantamine are described as drug treatment interventions. As well as the evaluation of the response to the global treatment of behavioural and psychological symptoms of dementia.

Non-pharmacological interventions are indicated: Structured Activities, Behavioural Therapy, Environmental Modifications, Social Contact, Sensory Stimulation and Relaxation.

The active participation of the caregiver is essential for the efficacy of non-pharmacological intervention programmes in patients with dementia.

Among the main comorbidities are depression and the recommendation of the use of antidepressants, preferably sertraline and citalopram.

b) Vascular dementia

Treatment for cardiovascular risk factors is recommended to prevent new events (secondary prevention) rather than to improve cognitive function[1].

The pharmacological treatment of behavioural and psychological symptoms of dementia will be used only in the presence of specific syndromes or that impact the patient’s quality of life or safety.

It is recommended that a multidisciplinary team should be formed for the comprehensive care of the patient. The intervention of personnel trained in geriatrics, psychiatry, neurology, nutrition, social work, physical, occupational and language therapy is suggested, depending on the case and institutional capacity. Rehabilitation strategies adapted to the mental and functional limitations, as well as the remaining cognitive skills of the individual, should be implemented and the needs and goals of patients and caregivers identified. Structured exercise programs, as well as recreational activities, are recommended to maintain functionality and mobility; improve quality of life and self-perception of well-being. However, there is no mention of carer support strategies.

[1] The recommendations are: maintain blood pressure less than 150/90 mmHg (in older adults), with diastolic pressure greater than 60-65 mmHg, adequate glycaemic control, lifestyle interventions, physical exercise, smoking cessation and when appropriate, treatment with platelet antiaggregant, statins and antihypertensive therapy.

Yes.

Yes, see p.145-150 of Emsley et al., (2013) for pharmacological and non-pharmacological treatments.

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