Primary Care - Dementia Pathway for over 65yrs
Under 65yrs please refer direct to Memory Service using
Memory Service Referral Form
Mild/moderate presentation
GP to perform cognitive Screen
(6CIT) + IQ Code + bloods
Severe/advanced presentation
Carer to complete parts of
DiADeM, or DeAR GP and send to
GP. GP to complete the DiADeM
Investigate and treat abnormal
bloods/acute illness then repeat
6CIT
Mild Cognitive Impairment
6CIT 8-9
& IQCODE < 3.5
For annual review
Signpost pt to OneYou
Investigate and treat abnormal
bloods/acute illness then repeat
6CIT
Dementia Suspected
Positive for dementia
Fulfils DiADeM criteria
6CIT<10 & IQCODE>3.5
or 6CIT 10+
Refer via Memory Service
Referral form
Signpost to Next Steps
GP diagnoses and
codes: unspecified
dementia (52448006)
Secondary Care
Pathway
Person receives
diagnosis and
treatment plan
If required: Advice and
Guidance from Secondary Care
(LPFT)
LPFT.MAMSadvice@nhs.net
GP to consider memantine. Initially 5mg OD then increase in steps
of 5mg every week. Usual maintenance dose 20mg OD. R/v after 1
month. Dose adjust in renal impairment.
Post diagnostic Support
- For further info see Lincolnshire Frailty website or
additional information sheet
- Cognitive Stimulation Therapy (mild/mod sx only)
- Dementia Support Service
- Join Dementia Research
For URGENT support with
patients, please contact the
locality CMHT Teams:
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Post diagnostic Administration
Annual QOF Review
Advanced care planning including admission avoidance plans
Consider ReSPECT/EPaCCS
Consider adding to the Palliative Care Register (SPICT tool)
Frailty support if indicated (Edmonton Frailty Scale score)
Update Carer Register & signpost carers to the Lincolnshire
Carers Service
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Boston
01205 445750
Grantham and Sleaford
01476 464838
Lincoln and Gainsborough
01522 508332
Louth
01507 608319
Skegness
01754 800200 – option 3
Spalding
01775 652300
Stamford
01780 757142
Presents with Behavioural and Psychological
Symptoms of Dementia (BPSD)
Non-Pharmacological Interventions – STEP 1
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-
Structured assessment of patient to explore distress/symptoms
e.g. ABC
Identify and quantify the symptoms using Neuropsychiatric
Inventory NPI/NPI Care HomeNPI Care Home
Address clinical and environmental causes
o Pain, delirium, dehydration, review medication for SEs,
constipation, check bloods/MSU etc.
o Noise, boredom, temperature
Offer psychosocial and environmental interventions first
Pharmacological Interventions – STEP 2
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Only after step 1 has not resolved the distress
Therapeutic trial of paracetamol
Consider trial of memantine
4-6/52 trial with SSRI or antidepressant may help with
restlessness/agitation (citalopram (max dose 20mg or 10mg if
already on drugs which may prolong QTc) or sertraline; or
mirtazapine (max dose 15mg OD if sedation is needed)
If antipsychotic is indicated risperidone is the only licenced
medication. At point of prescribing either:
o Consider advice or guidance from LPFT or
o Refer to secondary care
If BPSD persists refer to Memory Service –
Refer via Dementia referral form section 6
(LPFT Memory Service Referral Form)