Dementia

Description

General measures

Referral

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A52.3/B23.8 + (F02.8)/E03.2-3/E03.8-9/E52/F03

DESCRIPTION

Progressive loss of cognitive function, usually of insidious onset. Initial presentation may be with mild personality or memory changes, before more pronounced deficits become evident.

Common reversible causes of dementia include:

• Metabolic 
  • Hypothyroidism
  • Vitamin B12 deficiency
  • Pellagra 
• Medications and drugs
  • Long-term alcohol abuse 
  • Many medications have CNS side effects
• Infections
  • Neurosyphilis
  • HIV dementia
• Surgical
  • Normal pressure hydrocephalus
• Severe depression (pseudo-dementia) 

GENERAL MEASURES

All patients must be seen by a doctor to confirm the diagnosis.
People with dementia are vulnerable to delirium and worsening confusion.

Manage conditions that may worsen symptoms, including:

• Electrolyte disturbances and dehydration.
• Infections, usually originating from the respiratory or urinary tract.
• Medication toxicity.
• For confirmed diagnosis of mild to moderate dementia the following supportive measure may be taken: 
  - Refer patients to occupational therapy, if available, for assessment of functioning and advice to the family on adaptive measures.
  - Disclose the diagnosis to family members/ primary care giver.
  - Explain that the condition is evolving and future planning is necessary.
  - Advise driving cessation for the patient, if relevant.
  - Discuss home safety risks – e.g. potential for patient to leave stove on while cooking or wander if unattended.
  LoE:IIb⁵
  - Ensure that the patient has a caregiver that can supervise medication taking when the patient is unable to do so themselves.
  - Monitor functional problems and manage as they arise e.g. urinary incontinence.
  - Monitor nutritional status and intervene or refer if necessary.
  - Provide ongoing medical care.
• Initiate a palliative care approach as the patient’s condition deteriorates. (See Medicines used in palliative care).

REFERRAL

• Adults <60 years of age, adolescents and children, where common reversible causes of dementia could not be identified.
• When behavioural and/or psychological symptoms pose a risk to patient or carer.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4_Version 1.0_26 May 2025

Chapter 15: Central Nervous System Conditions_15.2 Dementia