The National Institute for Health and Clinical Excellence ( NICE ) and the Social Care Institute for Excellence ( SCIE ) have issued joint guidance on the treatment and care of people with dementia in health and social care.

The guideline covers the identification, treatment and care of people with dementia and the support that should be provided for carers within primary and secondary healthcare, and social care.

Dementia is a progressive and largely irreversible clinical syndrome that is characterised by a widespread impairment of mental function. As the condition progresses, people with dementia can present carers and social care staff with complex problems including aggressive behaviour, restlessness and wandering, eating problems, incontinence, delusions and hallucinations, and mobility difficulties.
It is estimated that there are 700,000 cases of dementia in the UK and approximately one million people caring for them.

Key recommendations include:

• There should be a coordinated and integrated approach between health and social care to treat and care for people with dementia and their carers.

• The needs of carers should be assessed by health and social care professionals and support should be offered as part of a coordinated care plan.

• Memory assessment services should be the single point of referral for all people with a possible diagnosis of dementia.

• People with dementia should not be excluded from any recommended services because of their diagnosis, age ( whether designated too young or too old ) or coexisting learning disability.

The dementia guideline recommends cognitive stimulation programmes for the treatment of symptoms affecting thinking and memory ( cognitive symptoms ) in all types of mild and moderate dementia.

The guideline incorporates the Institute's recommendation that Donepezil ( Aricept ), Galantamine ( Reminyl ) and Rivastigmine ( Exelon ) should only be prescribed for people with moderate Alzheimer's disease when managing these symptoms.

It also contains supplementary advice for clinicians on how to accurately diagnose which stage of Alzheimer's disease an individual has reached, for example, if they have a learning disability or if the patient has language difficulties because they have had a stroke.

The guideline goes on to set out a range of recommendations on pharmacological and non-pharmacological treatments for symptoms affecting mood and behaviour ( non-cognitive symptoms ).
It recommends that Donepezil, Galantamine and Rivastigmine may be offered to a small number of patients with dementia with Lewy bodies if these symptoms are causing severe distress, and a small number of patients with Alzheimer’s disease if these symptoms are causing significant distress and other treatments have not worked or are not suitable. Some patients with mild Alzheimer’s disease will display these symptoms.

Source: NICE, 2006


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