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Dementia

What is dementia?

Dementia is a disorder that affects how the brain works. There are different types of dementia; the most common are:

  • Alzheimer's disease
  • vascular dementia
  • dementia with Lewy bodies
  • frontotemporal dementia.

Dementia is more likely to affect older people, but younger people can also develop the condition.

What are the main symptoms?

Symptoms of dementia vary from person to person, but can include:

  • loss of memory
  • difficulty thinking things through and understanding
  • problems with language (reading and writing)
  • confusion and agitation
  • hallucinations and delusions
  • difficulty controlling movements of the body.

Symptoms of dementia usually get worse over time and can become very severe, so that it is difficult for the person to do many daily activities or to care for him or herself.

How many people are affected?

It is estimated that 700,000 people are living with dementia in the UK. A further 1 million people care for someone with the condition.

What does NICE recommend?

NICE and the Social Care Institute for Excellence (SCIE) have jointly published a number of recommendations on how to identify, treat and care for people with the condition. They also include advice on the support that their carers should receive.
Some of the key recommendations in the clinical guideline are:

  1. There should be a coordinated and integrated approach between health and social care to treat and care for people with dementia and their carers.
  2. The needs of carers should be assessed by health and social care professionals and support should be offered as part of a coordinated care plan.
  3. Memory assessment services should be the single point of referral for all people with a possible diagnosis of dementia.
  4. People with dementia should not be excluded from any recommended services because of their diagnosis, age (whether designated too young or too old) or coexisting learning disability.

I've heard a lot in the media about the Institute's guidance on drugs for Alzheimer's disease. What does the dementia guideline recommend about the use of these drugs?

The dementia guideline recommends cognitive stimulation programmes for the treatment of symptoms affecting thinking and memory (cognitive symptoms) in all types of mild and moderate dementia. Cognitive stimulation programmes are a kind of treatment that involves doing activities that require some thought and problem solving.

The guideline incorporates the Institute's recommendation that donepezil, galantamine and rivastigmine should only be prescribed for people with moderate Alzheimer's disease when managing these symptoms. It also contains supplementary advice for clinicians on how to accurately diagnose which stage of Alzheimer's disease an individual has reached, for example, if they have a learning disability or if the patient has language difficulties because they have had a stroke.

The guideline goes on to set out a range of recommendations on drugs and other treatments for symptoms affecting mood and behaviour (non-cognitive symptoms). The guideline recommends that donepezil, galantamine and rivastigmine may be offered to a small number of patients with dementia with Lewy bodies if these symptoms are causing severe distress, and a small number of patients with Alzheimer's disease if these symptoms are causing significant distress and other treatments have not worked or are not suitable. Some patients with mild Alzheimer's disease will display these symptoms.

How was the guidance on drugs for Alzheimer's disease developed?

NICE follows a standard process for developing technology appraisal guidance on the use of drugs.
Read about how we develop technology appraisals.
Read the technology appraisal guidance.

How was the clinical guideline on dementia developed?

NICE follows a standard process for developing clinical guidelines.
Read about how we develop clinical guidelines.
Read the clinical guideline.

When NICE publish a technology appraisal and a clinical guideline covering aspects of the same clinical question, the appraisal findings are normally incorporated within the broader guideline.

How will the recommendations affect patients and carers?

NHS organisations have to take into account nationally agreed guidance, including NICE technology appraisals and clinical guidelines, when planning and delivering treatment and care. The recommendations are based on the most up-to-date clinical evidence. That means anyone living with dementia - and their carers - wherever they live in England and Wales, should receive the best support available, based on the best available evidence.

How will the recommendations affect healthcare professionals?

The dementia guideline incorporates the Institute's guidance on the use of drugs for people with Alzheimer's disease, and it also sets wider standards for the care of people with all types of dementia which healthcare professionals and commissioners alike in the NHS are expected to implement.

How will the recommendations affect social care professionals?

The Social Care Institute for Excellence (SCIE) was launched in October 2001 as part of the Government's drive to improve social care. Its role is to promote and advance knowledge about good practice in social care across England, Wales and Northern Ireland. More information about SCIE.

The joint recommendations from NICE and SCIE will ensure that NHS and social care professionals follow the same guidelines on caring for people with dementia. For the first time, healthcare professionals working within the NHS will be following the same guidelines as social workers and care workers in nursing homes.

This page was last updated: 11 May 2011

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.