The content herein is provided for information purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.
Copyright 2025 Omniamed Communications Ltd®. Any distribution or duplication of the information contained herein is strictly prohibited. Omniamed Communications Ltd® receives funding from advertising but maintains editorial independence. Practice Nurse stores small data files on your computer called cookies so that we can recognise you and provide you with the best service. If you do not want to receive cookies please do not use Practice Nurse.

Practice Nurse has been the leading journal for nurses in general practice for more than 30

 years. It is one of the only nursing journals to focus solely on the needs of the practice nursing team, from new starters to advanced practitioners and nurse prescribers.

This site is intended for healthcare professionals

You can only view a limited number of pages without an account

Unlimited access to more than 30,000 pages of clinical information

Ability to add personal annotations to pages

Sign in

Sign in to view more pages

Practice Nurse

Dementia: Diagnosis and management in primary care

Home

Modules

Dementia is a progressive deterioration in mental function, which is severe enough to interfere with activities of daily living (ADLs). In the UK it is estimated that around 850,000 people are living with dementia, and predicted that this figure will rise to over 1 million by 2025. The most common form of dementia is Alzheimer’s disease. Making the diagnosis of dementia can be difficult as symptoms vary between patients. In addition onset can be slow and non-specific, but for patients and their families or carers to receive the support they need, timely diagnosis is vital.

On completion of this module you will be better able to:

Ensure that primary healthcare is coordinated with secondary healthcare and social care in the management of people with dementia

Ensure symptoms, behavioural problems, and physical disabilities are addressed in partnership with the person and their family/carers

Ensure the appropriate use and monitoring of drug treatments

Avoid the use of antipsychotic drugs for the control of behaviour, if possible

Provide effective psychosocial support for the person's family or carers from the time dementia is first suspected

Ensure effective end-of-life care is provided

Improving diagnosis of dementia – the role of the practice nurse

Pain in dementia: a multi-modal approach to assessment and management 

This resource is provided at an advanced level. Read the article and answer the self-assessment questions, and reflect on what you have learned. Complete the resource to obtain a certificate to include in your revalidation portfolio. You should record the time spent on this resource in your CPD log.

Impairment of which of the following is not a criterion for a diagnosis of dementia?

Impairment in mental function due to dementia is more severe than that expected with normal ageing. For a diagnosis of dementia to be made, the person must have impairment in at least two cognitive domains (memory, language, behaviour, and visuospatial or executive function) leading to significant functional decline (enough to affect ADLs) that cannot be explained by another disorder or adverse effects of medication.

Question 1

Early-onset dementia is disease that develops in patients under the age 65 years. Mild cognitive impairment is cognitive impairment that does not fulfil the diagnostic criteria for dementia, for example, because only one cognitive domain is affected, or deficits do not significantly affect ADLs. Prevalence of dementia increases with advancing age, and only 5% of patients living with dementia developed the condition before the age of 65, compared with a population prevalence of 11.1% in patients aged 80-84 years.

Question 2

Symptoms of dementia are variable, may be slow in onset and non-specific but may include evidence of cognitive impairment such as difficulty learning new information, remembering recent events or people’s names, language difficulties – receptive or expressive dysphagia – or impairment of executive function such as planning or problem-solving. Behavioural and psychological symptoms may include sleep disturbance or insomnia, withdrawal or apathy, or agitation and agression.

Question 3

Which of the following statements is NOT characteristic of dementia with Lewy bodies?

Symptoms related specifically to dementia with Lewy bodies include repeated falls, syncope or transient loss of consciousness, severe sensitivity to antipsychotics, delusions, and hallucinations. Memory impairment may not be apparent in early stages. Parkinsonian motor features, such as shuffling gait, rigidity, slow movement (bradykinesia), and loss of spontaneous movement and autonomic dysfunction such as postural hypotension, difficulty in swallowing, and incontinence or constipation may also be present.

Question 4

Which of the following statements is true of patients with mild cognitive impairment and possible driving impairment?

The DVLA states that for dementia and/or any organic syndrome affecting cognitive functioning Group 1 (car and motorcycle) license holders may be able to drive but must notify the DVLA. The decision on licensing is usually based on medical reports. Poor short-term memory, disorientation, and lack of insight and judgement almost certainly mean they are not fit to drive. The variable presentation and rate of progression is acknowledged. Disorders of attention will also cause impairment. In early dementia, when sufficient skills are retained and progression is slow, a licence may be issued subject to annual review. A formal driving assessment may be necessary. Group 2 (bus and lorry) license holders must not drive and must notify the DVLA. Licensing will be refused or revoked.

Question 5

Asif is a 67 year old retired librarian. He attends your surgery with his wife. Asif seems irritable and tells you that he is quite well, but his wife thinks that his memory is poor and has been getting worse over the past six months. Asif has a history of high blood pressure and is on an ACE inhibitor and a statin. His BMI is 35kg/m

 useful as part of the next steps in the consultation with Asif?

Formally assessing this patient’s cognitive ability and memory would be appropriate, but may be challenging as he is already irritated at his wife’s suggestion that his memory is poor. Examining for neurological or other conditions, and performing a range of blood tests, may help to identify potentially treatable or reversible causes of memory loss. Performing a chest X-ray would only be appropriate if clinically indicated, e.g. if the patient has a persistent cough, haemoptysis or breathlessness.

Question 6

Asif comes back to see you on his own a week later. He admits that he has found things 'difficult' recently. He got lost driving to his son's new house, although he had been there twice previously. He also admitted to writing down to do lists more and more often. He has also recently bought two pairs of reading glasses to replace ones that he has lost. He is worried that he has dementia, which he says 'runs in the family'. His uncle and his grandmother had dementia. You undertake a formal cognitive assessment and general physical examination. It becomes clear that Asif may have a degree of cognitive impairment but no obvious cause from examination. You arrange for baseline blood tests and MSU and ask him to return the following week to discuss the results. Asif comes back to discuss the results of his investigations, which are all normal. Which of the following should form part of your management plan for Asif?

You may wish to consider that in the absence of any reason to the contrary you can refer Asif to the local memory clinic for assessment. The DVLA should be informed if a person has possible cognitive deficit. Asif is overweight with a BMI of 35kg/m

. Losing weight is therefore advisable, as obesity is a modifiable risk factor for cognitive impairment

Question 7

Asif and his wife come back to see you after his assessment at the memory clinic. They tell you that Asif has been diagnosed with early Alzheimer's disease. He is still taking his ACE inhibitor and his statin but is on no other medication. They want you to prescribe a medication to improve Asif's memory and something for his problems with mild insomnia. Which of the following would be appropriate as part of Asif’s follow-up management.

None of the pharmacological interventions above would usually be offered to a patient with mild cognitive impairment, but if they were initiated, it would be on the advice of a specialist.

Dementia: Diagnosis and management in primary care

Related modules

title

title

title

title

title

title