How to Manage Dementia in General Practice by Nicholas Clarke
By Nicholas Clarke
This useful consultant basically exhibits each one level within the administration of a sufferer with dementia. It covers the complicated matters surrounding dementia comparable to spouses and households, entry to acceptable care, criminal and moral issues, making plans for the longer term and "living good" and contains the choice making approach on starting up remedy and suggestions on how top to entry the on hand services.
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Extra info for How to Manage Dementia in General Practice
Its 20 mg capsule preparation as Yentreve (Lilly) offers GPs the possibility of off-licence low-dose introduction before proceeding on to an antidepressant dose of 30 mg and then to 60 mg as Cymbalta (Lilly). A third dual-action antidepressant which is effective in our experience is venlafaxine in delayed-release formulation. This drug needs to be used with caution in cases of heart disease and hypertension and requires ECG and blood pressure monitoring. Tricyclic antidepressants should be avoided in this age group because of their anticholinergic effects.
Dementia and physical disease Dementia and diabetes GPs will know that the ideal care in diabetes involves joint management with a patient who is often highly informed and understands the importance of diet and self-monitoring, the types of insulin formulation and the need to keep appointments with specialists such as ophthalmologists. In patients with dementia GPs should prepare themselves to eventually be at the other end of the care spectrum in diabetes. By this we mean their main aim will be to avoid hypoglycaemia and the worst excesses of high blood sugars, rather than focus on prevention of long-term complications such as weight gain, retinopathy and renal disease.
There is a number of ways of differentiating depression from dementia and one clinical shortcut is to ask the patient the full address of the surgery or their residence or care home and the date including day, month and year. The older patient with depression but intact cognition will give clear correct answers. In contrast a patient with early dementia is likely to make errors as Complex pictures of dementia 35 part of an expansive reply and will give the name of the town they grew up in rather than their actual whereabouts.