Table 1 Recommendations of the IRIS trial

Detection and diagnosis

 Conduct a cognitive assessment using the Mini Mental State Examination (MMSE) in individuals with suspected cognitive impairment.

SIGN guideline (grade B recommendation*) [3].

 Assess for co-morbid depression using a validated tool.

SIGN guideline (grade B recommendation*) [3]. We include the following as validated scales: Geriatric Depression Scale (GDS), Hamilton Rating Scale for Depression, and Even Briefer Assessment Scale for Depression.

 Refer to Cognitive, Dementia and Memory Service (CDAMS) or specialist for access to dementia-modifying medications.

Local adaptation of SIGN guideline (grade B recommendation*) [3]. Guideline makes recommendations about specific pharmacological interventions (e.g., use of cholinesterase inhibitors). Access to dementia-modifying medication is via specialist referral in Australia.

 Refer for head/brain computed tomography (CT) scan.

SIGN guideline (grade C recommendation*) [3]. Guideline recommends structural imaging. We focus only on referral for CT scan since GPs in Australia cannot refer for a MediCare rebatable magnetic resonance imaging.

 Review current medication (prescription and over the counter) that may cause cognitive impairment.

Not a recommendation of the SIGN guideline. Considered best practice by the IRIS clinical investigators^†.

 Refer for pathology testing.

SIGN guideline (good practice point^‡) [3]. Supported by other guidelines and considered best practice by the IRIS clinical investigators^†.

Management

 Disclose or reinforce a diagnosis of dementia.

Not a recommendation of the SIGN guideline [3]. The SIGN guideline recommends that healthcare professionals should be aware that many people with dementia can understand their diagnosis, receive information and be involved in decision-making (grade C recommendation); that some people with dementia may not wish to know their diagnosis (grade C recommendation); and that in some situations, disclosure of a diagnosis of dementia may be inappropriate (grade D recommendation). Supported by other guidelines and considered best practice by the IRIS clinical investigators^†.