1. AD Alz / FTD / cerebral ADom arteriopathy with subcortical infarcts / Leucoencephalopathy (CADASIL), Hungtington's
2. MMSE, GPCOG (GP assessment of cog), 6-CIT (6 item cog imp testing), 7-min screen
3. For LD use these instead of MMSE: CAMCOG, CAMDEX, DMR, DSDS
4. Risk factors
   1. General population screening
   2. Middle aged older - review and Rx CVS risks
5. Genetic counselling
   1. Offer to those who are thgt to have genetic cause AND to unaffected relatives
   2. Clinical genotyping if genetic cause is not suspected.
6. Prevention
   1. Statins, Vit E, HRT, NSAIDs
   2. review and Rx vascular and other risks
7. Early identification
   1. In 1 care: refer people with s/s of MCI to memory assessment services- offer f/u if s/s
   2. INCREASED RISK IN LD
   3. HIGH RISK GPS: stroke, neuro- Parkinson's
8. Diagnosis & Assessment
   1. 1. comprehensive history, ask them if they want to know, neuropsych testing, comorbidity
   2. 2 COG: attention and conc, praxia, orientation, memory, language, exe fn
   3. 3. bloods, msu, xray, ecg
   4. syphilis and HIV serrology ; CSF exam
   5. LD
      1. ASSESSMENT OF MOTOR AND PROCESS SKILLS (AMPD) to help develop care plan
      2. DEMENTIA QUESTIONNAIRE FOR MENTALLY RETARTED PERSONS (DMR) AND DALTON'S BRIEF PRAXIS TEST (BPT) for monitoring change in Fn
9. Subtype diagnosis
   1. 1. ALZHEIMER'S : NISCDS / ADRDA CRITERIA (or ICD, DSM)
   2. 2. VASCULAR : NINDS-AIREN CRITERIA , OR ICD / DSM
   3. 3. DLB : International consensus criteria for DLB
   4. 4. FTD: Lund-Manchester criteria, NINDS criteria
   5. 5. CJD: CSF exam
   6. * EEG: NOT ROUTINE (Consider in delirium, FTD or CJD, asso seizure disorder)
   7. biopsy ONLY if potentially reversible cause is suspected that can't be diagnosed in any other way
10. Imaging
    1. *Prefer MRI to assist with early diagnosis and detect subcortical vascular changes
    2. HMPAO OR SPECT : TO d/d ALZ / Vascular / FTD (NB: SPECT NOT USEFUL IN DOWN'S), Alt : FDG PET
    3. FP-CIT SPECT TO CONFIRM SUSPECTED DLB
11. Treatment (ALZ)
    1. MMSE=10-20 ONLY
       1. Mod dementia --> DONEPEZIL , GALANTAMINE, RIVASTIGMINE
       2. REVIEW 6 monthly
       3. Continue if score >10 and global, Fn, and behav condition indicates worthwhile effect
       4. Memantine (except well designed studies)
    2. DON'T RELY ON MMSE FOR
       1. MMSE >20 but mod dementia acc to Fn, personal, social disability
       2. MMSE < 10 but low premorbid attainment or linguistic problems (clinically mod.)
       3. Not fluent in language of MMSE
       4. LD
    3. NB: DO NOT use ACE inhibitor / Memantine for COG DECLINE IN VASCULAR DEMENTIA & ACE inhibitors IN MCI
12. Non-cog S/S and Behaviour that challenges
    1. NOn-cog s/s
       1. hallu, delum anxiety, marked agitation, asso aggressive behav
    2. Behav that challenges
       1. aggrn, agitation, wandering, hoarding, sexual disinhibition, apathy, disruptive vocal activity e.g shouting.
    3. Non pharmac Management
       1. Id factors that influence- physical illness, ADR, env, etc.
       2. OPTIONS
          1. AROMATHERAPY
          2. MULTISENSORY STIMULATION
          3. THERAPUTIC USE OF MUSIC AND DANCING
          4. ANIMAL ASSISTED THERAPY
          5. MASSAGE
    4. Rx
       1. ANTIPSYCHOTICS
          1. ONLY for severe s/s
          2. DLB (risk of severe ADR), ALZ, VASCULAR, MIXED --> CVS EVENTS AND DEATH
       2. ACE I
          1. DLB OR ALZ (where you can't use above)
          2. VASCULAR DEMENTIA (except in clinical trials)
       3. IM Rx
          1. LORAZEPAM, HALO, OLANZ (use singly if possible)
          2. Rapid Tranq: HALO + LORAZ
          3. DIAZEPAM / CPZ