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Table 1 Diagnosis and management recommendations investigated

From: Understanding diagnosis and management of dementia and guideline implementation in general practice: a qualitative study using the theoretical domains framework

Recommendation Details and source
Conduct a formal cognitive assessment using a validated scale (e.g., MMSE) in individuals with suspected cognitive impairment. SIGN guideline recommends the MMSE should be used for cognitive testing of individuals with suspected cognitive impairment (Grade B recommendation).
Assess for co-morbid depression using a validated tool (e.g., Geriatric Depression Scale or others). SIGN guideline recommends considering the presence of co-morbid depression as part of the assessment for suspected dementia (Grade B recommendation). Evidence underpinning the guideline advocates use of validated tools for assessing depression (e.g., Geriatric Depression Scale).
Refer for pathology testing. This is a SIGN guideline good practice point. Supported by other guidelines and considered best practice by the IRIS clinical investigators to facilitate exclusion of potentially reversible causes of dementia.*
Refer for head/brain computed tomography (CT) scan. SIGN guideline recommends structural imaging should form part of the diagnostic work up of patients with suspected dementia (Grade C recommendation). We focus only on referral for CT scan since GPs in Australia cannot refer for a Medicare rebatable magnetic resonance imaging (MRI).
Review current medication (prescription and over the counter) that may cause cognitive impairment. Not a recommendation of the SIGN guideline. Supported by other guidelines and considered best practice by the IRIS clinical investigators to eliminate possible other causes of dementia-like symptoms.*
Disclose or reinforce a diagnosis of dementia. Not a recommendation of the SIGN guideline. 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.*
Refer to specialist (including via Cognitive, Dementia and Memory Service [CDAMS]) for access to dementia-modifying medications. SIGN guideline makes recommendations about specific pharmacological interventions (e.g., use of cholinesterase inhibitors) (Grade B recommendations). Access to dementia-modifying medication is via specialist referral in Australia.
Provide information on, or refer for, recreational activities. SIGN guideline recommends that recreational activities should be encouraged to enhance the quality of life and well-being of people with dementia (Grade B recommendation). Recreational activities may include current or previous interests or the introduction of new recreational activities. Alzheimer’s Australia offer education and training and facilitate support groups for people with dementia and their carers.
Provide information on, or refer for, activities to promote cognitive stimulation. SIGN guideline recommends that cognitive stimulation should be offered to people with dementia (Grade B recommendation). Cognitive stimulation may occur through participation in recreational activities, via support from a carer or through formal cognitive stimulation activities. Alzheimer’s Australia offer education and training and facilitate support groups for people with dementia and their carers.
Provide, or refer for, caregiver training. SIGN guideline recommends that caregivers should receive training on interventions that are effective for people with dementia (Grade B recommendation). Alzheimer’s Australia offer education and training and facilitate support groups for people with dementia and their carers.
Give advice re. respite care. Not a recommendation of the SIGN guideline. Supported by other guidelines and considered best practice by the IRIS clinical investigators.*
Promote awareness of changing driving capacity as disease progresses. Not a recommendation of the SIGN guideline. Supported by other guidelines and considered best practice by the IRIS clinical investigators.*
Discussion of legal issues. Not a recommendation of the SIGN guideline. Supported by other guidelines and considered best practice by the IRIS clinical investigators.*
  1. *Recommendations considered best practice by the IRIS clinical investigators, arrived at through discussion and consensus.