Knut Engedal1. 1. Nasjonalt kompetansesenter for aldersdemens, Ullevål universitetssykehus, 0407 Oslo. knut.engedal@nordemens.no
Abstract
BACKGROUND: About 75% of nursing homes patients in Norway suffer from dementia, though only half of them have a dementia diagnosis. No consensus exists on how or when to do an assessment for dementia in the nursing home. MATERIAL AND METHODS: The paper is based on a search on Medline and personal experience in the field. RESULTS AND INTERPRETATION: Dementia assessment in nursing homes should be done in a co-operation between a physician, a nurse and an occupational therapist. The physician should carry out a Mini-Mental State Examination and a clock test, a physical and mental examination, an assessment of depressive symptomatology, and see to it that the thyroid function is measured. A CT scan of the brain should be done in cases with short duration of dementia symptomatology. A nurse and an occupational therapist should interview a family member and assess the patient's functioning by means of the Informant questionnaire on cognitive decline in the elderly and the Clinical dementia rating scale, or a similar assessment tool. Memantine could be a treatment for some patients with moderate to severe degrees of dementia, while acetylcholinesterase inhibitors could be useful for some patients with mild to moderate degrees of dementia of the Alzheimer type. Anti-dementia drug therapy must be individualised.
BACKGROUND: About 75% of nursing homes patients in Norway suffer from dementia, though only half of them have a dementia diagnosis. No consensus exists on how or when to do an assessment for dementia in the nursing home. MATERIAL AND METHODS: The paper is based on a search on Medline and personal experience in the field. RESULTS AND INTERPRETATION:Dementia assessment in nursing homes should be done in a co-operation between a physician, a nurse and an occupational therapist. The physician should carry out a Mini-Mental State Examination and a clock test, a physical and mental examination, an assessment of depressive symptomatology, and see to it that the thyroid function is measured. A CT scan of the brain should be done in cases with short duration of dementia symptomatology. A nurse and an occupational therapist should interview a family member and assess the patient's functioning by means of the Informant questionnaire on cognitive decline in the elderly and the Clinical dementia rating scale, or a similar assessment tool. Memantine could be a treatment for some patients with moderate to severe degrees of dementia, while acetylcholinesterase inhibitors could be useful for some patients with mild to moderate degrees of dementia of the Alzheimer type. Anti-dementia drug therapy must be individualised.