Dementia

Please click on the link below to access the most up-to-date version of this guideline. The content on this page is currently being updated to align with the latest publication. Always check the version number at the bottom of the screen to confirm which version you are using.

Click here to access the Adult Hospital Level Chapter 14: Neurological Disorders with Supporting NEMLC Report-2020-4-Review-Version-3.0-22-November-2025

---

Description

General measures

Medicine treatment

---

E51.2/E52/E63.9/F00.0-2/F00.9/F01.0-3/F01.8-9/F03

DESCRIPTION

Progressive loss of cognitive function, usually of insidious onset. Initial presentation may be with mild personality or memory changes, before more pronounced defects become evident. Investigate patients for potentially reversible causes:

• Metabolic
  • Hypothyroidism
  • Vitamin B12 deficiency
  • Pellagra
  • Thiamine deficiency (Wernicke's syndrome)
• Medications and drugs
  • Alcohol abuse
  • Many medications with CNS side effects
• Infections
  • Syphilis
  • HIV dementia
• Surgical
  • Chronic subdural haematoma
  • Normal pressure hydrocephalus
• Severe depression (may mimic dementia)

Conditions which may worsen already existing dementia include:

• electrolyte disturbances and dehydration.
• infections.
• medication toxicity.

GENERAL MEASURES

• Appropriate care and support, according to the level of impairment.
• Ambulatory care is preferred to hospitalisation, if feasible.
• Family counselling and support.
• Use a palliative care approach: involve a multidisciplinary care team early and plan for advanced dementia care.

MEDICINE TREATMENT

Management is mainly symptomatic.

To control restless patients:

• Haloperidol, oral, 0.75–1.5 mg 8 hourly with a higher dose at night, if required.

---

Note

- There is uncertainty of benefit versus harm of long-term use of antipsychotics in dementia, but antipsychotics may be of benefit in severe behavioural and psychological symptoms.
- Inform the family of a possible elevated risk of mortality with prolonged use of antipsychotics.
- If there is no improvement, stop the antipsychotic.
- Initiate treatment at a low dose and titrate to the lowest effective dose for the shortest possible time. Reassess the person at least every 6 weeks, to check whether they still need medication.

LoE:IIIa^xix 

---

For pellagra:

• Nicotinamide, oral, 100 mg 8 hourly.

Wernicke's syndrome: E51.2 + (F02.8*)

• Thiamine, IM, 500 mg immediately and daily for 3 to 5 days.
  • Follow with thiamine, oral, 100 mg 8 hourly.

---

CAUTION

Thiamine should preferably be administered prior to intravenous glucose to prevent permanent neurological damage. Do not delay the dextrose administration in a hypoglycaemic patient.

---

Prophylaxis in patients at risk (alcoholism, malnutrition): Z29.2

• Thiamine, IM, 200 mg daily or oral, 100 mg 8 hourly for 14 days.

LoE:IIb^xx

Treat other commonly associated nutritional deficiencies:

• If confirmed Vitamin B12 deficiency, manage as Anaemia, megaloblastic.

Click here to access the pdf.

---

Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-4_Version 2.0_6 June 2025

Chapter 14 Neurological Disorders_14.2 Dementia