GP assessment and management
A diagnosis of dementia should be made only after a comprehensive assessment, which includes:
- history taking from the patient and a person who knows the patient well, if possible
- cognitive and mental state examination with a validated instrument
- physical examination
- a review of medication to simply medication schedule and assess the effect on cognitive functioning
- consideration of other causes (including delirium or depression)
The diagnostic pathway outlines five recommended consultations with guiding information to assist the GP and PN role in responding to concerns of cognitive change. The pathway also includes three decision points that are designed to further assist in assessment and management of dementia.
Consultation 1: Initial consultation
Decision Point One
Consultation 2: Baseline information collection
Consultation 3: Review of baseline information and carer information
Decision Point Two
Consultation 4: Carer consultation
Consultation 5: Detailed assessment
Decision Point Three
MBS Item numbers and Dementia assesssment and care
General Practice / Practice nurse-led investigations in rural settings including ordering of relevant tests and referring to specialist as indicated with supporting information from investigation may support better coordinated and timely diagnosis when there is limited access to medical specialists.[1]
Information and referral post-diagnosis to appropriate support services is essential to inform planning, help with acceptance of diagnosis and ensure carer needs are addressed
1. KPMG Dementia services pathways - an essential guide to effective service planning 2011 pg. 20