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. 2011 Nov 15;8(11):e1001122. doi: 10.1371/journal.pmed.1001122

Table 5. Abridged recommendations for dementia (DEM 1–10).

Role of acetylcholinesterase inhibitors and memantine DEM 1 & DEM 2. Acetylcholinesterase inhibitors or memantine should not be considered routinely for people with dementia in non-specialist health settings in LAMIC. They may be considered where adequate support and supervision by specialists is available. Consideration should be given to adherence and monitoring of adverse effects, which generally requires the availability of a carer.
Role of medicines including antipsychotics for behavioural and psychological symptoms of dementia DEM 3. Thioridazine, chlorpromazine, or trazodone should not be used for the treatment of behavioural and psychological symptoms of dementia.Haloperidol and atypical antipsychotics should not be used as first-line management. Where there is clear and imminent risk of harm with severe and distressing symptoms, their short-term use may be considered, preferably in consultation with specialist.
Role of antidepressants DEM 4. In people with dementia with moderate or severe depression, use of selective serotonin reuptake inhibitors may be considered. In case of non-response after at least 3 weeks, they should preferably be referred to a mental health specialist for further assessment and management.
Cognitive and psychosocial interventions DEM 5. Cognitive interventions applying principles of reality orientation, cognitive stimulation, and/or reminiscence therapy may be considered in the care of people with dementia. Health care providers should be trained for delivering these interventions and family members should be involved in delivery of these interventions.
Diagnosis of dementia DEM 6. Non-specialist health care providers should seek to identify possible cases of dementia in the primary health care setting and in the community after appropriate training and awareness raising. Brief informant assessment and cognitive tests should be used to assist in confirming these cases. For a formal dementia diagnosis, a more detailed history, medical review, and mental state examination should be carried out to exclude other common causes of cognitive impairment and decline.DEM 7. People with dementia and their family members should be told of the diagnosis subject to their wishes in this regard, keeping in mind cultural sensitivities and employing some preparatory work to determine their preferences. It should be accompanied with relevant information appropriate to culture and understanding of people, and with a commitment of ongoing support and care that can be provided by health and other services.
Role of a medical review DEM 8. People with dementia should receive an initial and a regular medical review (at least every 6 months) and appropriate care.
Interventions for carers of people with dementia DEM 9. Psychoeducational interventions should be offered to family and other informal carers of people with dementia at the time when diagnosis is made. Training of carers involving active carer participation (e.g., role playing of behavioural problem management) may be indicated later in the course of illness for carers who are coping with behavioural symptoms in people with dementia. Carer psychological strain should be addressed with support, counselling, and/or cognitive behaviour interventions. Depression in carers should be managed according to the recommendations for depression.DEM 10. Where feasible, home-based respite care may be encouraged for carers of people with dementia.