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Simple tips on referring for Alzheimer's

Dr Neil Brownlee on why referral to the different support agencies is essential

atients first presenting with Alzheimer's dementia frequently look rather lost and are surrounded by a team of emotionally exhausted relatives.

It is very important to lead the consultation, and this means having a set package of assessment and care strategies.

Alzheimer's must be suspected in any adult with any enduring, acquired deficit of memory and cognition. A mini-mental state examination should be readily to hand.

There is a huge support network for patients and carers involving primary care, secondary care, voluntary groups and charities. Referral to different agencies is therefore essential.

Consultant referral

Acetylcholinesterase inhibiting drugs are used in the treatment of Alzheimer's disease. The evidence to support their use relates to their cognitive enhancement.

NICE has recommended Alzheimer's should be diagnosed in a specialist clinic which should also assess cognitive, global and behavioural function, activities of daily living and the likelihood of compliance with treatment.

Full bloods (including FBC, ESR, U&Es, LFTs, TFTs, glucose, B12, folate and syphillis serology) should be performed and the results forwarded to the mental health team for the elderly.

The Alzheimer's Disease Society

This organisation gives excellent support and advice to carers (address and phone left). Its website is superb.

It explains in lay terms the symptoms and signs of Alzheimer's and has a very appropriate FAQs section. It details all regional branches and gives the phone numbers of 'carer's contacts' (trained volunteers who give advice to carers over the phone). It also explains 'enduring power of attorney' and council tax exemption.

Social services, district nurses and solicitors

Refer to social services for advice on day centres, benefits, respite care and possible future residential care. You should also discuss the case with the district nurses. Initially they need only be aware of the problem but may become actively involved in supporting the patient and family as the disease progresses.

Suggest to the family and the patient they contact a solicitor during the early stages of declining mental function to arrange an enduring power of attorney.

This is the means by which an individual can appoint somebody they trust (the attorney) to act for them should they become mentally incapable.

Responsibilities of the attorney include organising financial affairs, which may become particularly important when arranging future residential care.

In summary, Alzheimer's is a distressing and exhausting illness.

As family doctors we can offer clinical care and point the way to a large resource of practical information that will be of great benefit to the patient and their carers.

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