Interventions for Alzheimer disease and other dementias

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Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation among the communities on memory loss including prevention measures	Mental exercise Engagement in intellectual activities Regular social interactions Healthy life style	Recognition of dementia symptoms	Referral to a health facility for further management	Home based physical exercise	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families
Primary Care
Regular patient education on staying active, identification of symptoms of dementia early	Guidance and counselling on mental exercise including engagement in intellectual activities	History Physical examination Mental status examination Neurologic assessment	Psychosocial therapy –including behavioural therapy Referral to a health facility for further management	Cognitive training and rehabilitation	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families
Referral Facility: General
Regular patient education on staying active, identification of symptoms of dementia early	Guidance and counselling on mental exercise including engagement in intellectual activities.	History Physical examination Mental status examination Neurologic assessment Complete blood count (CBC) Metabolic panel (CMP) Thyroid function tests	Cholinesterase inhibitors Psychosocial therapy Behavioural therapy Cognitive stimulation	Cognitive training and rehabilitation	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families
Referral Facility: Specialist
Regular patient education on staying active, identification of symptoms of dementia early	Guidance and counselling on mental exercise including engagement in intellectual activities	History Physical examination Mental status examination Neurologic assessment Complete blood count (CBC) Basic metabolic panel Thyroid function tests Vitamin B12 level Computed tomography (CT) Positron emission tomography (PET) scan Magnetic	Cholinesterase inhibitors and memantine Psychosocial therapy – including behavioural therapy Psychoeducation	Cognitive training and rehabilitation	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation among the communities on memory loss including prevention measures	Guidance to the elderly persons on mental exercise including engagement in intellectual activities (reading, playing board games, completing crossword puzzles, playing musical instruments, Encourage the elderly persons to participate in regular social interaction Guidance on modifiable risk factors (healthy diet, physical exercise /physical activities, cessation of tobacco smoking and avoidance of secondary smoke, stopping alcohol, prevention of head injuries, sleep patterns)		Recognition of the symptoms of dementia including difficulty in remembering recent events, problems with language, disorientation (including easily getting lost), mood swings, loss of motivation, not managing self-care, and behavioural issues. Monitoring of any indications that Alzheimer’s is getting worse including swallowing difficulties, oral and dental disease, hygiene problems, skin, or eye infections. Referral of an elderly person with Alzheimer’s to a health facility for further management
Primary Care
	Guidance to the elderly persons on mental exercise including engagement in intellectual activities (reading, playing board games, completing crossword puzzles, playing musical instruments, Encourage the elderly persons to participate in regular social interaction Guidance on modifiable risk factors (healthy diet, physical exercise /physical activities, cessation of tobacco smoking and avoidance of secondary smoke, stopping alcohol, prevention of head injuries, sleep patterns)		History and physical examination for dementia (including Alzheimer disease) Clinical examination including behavioural observations (including mini mental status exam) Psychosocial therapy –including behavioural therapy Monitoring of any indications that Alzheimer’s is getting worse including swallowing difficulties, oral and dental disease, hygiene problems, skin, or eye infections. Referral of an elderly person with Alzheimer’s to a health facility for further management
Referral Facility: General
			History and physical examination for dementia (including Alzheimer disease) Clinical Examinations including behavioural observations. Assessments of intellectual functioning including memory testing/cognitive testing Drug management including cholinesterase inhibitors Psychosocial therapy – including behavioural therapy Monitoring of any indications that Alzheimer’s is getting worse including swallowing difficulties, oral and dental disease, hygiene problems, skin, or eye infections. Relieving discomfort especially in the later stages of the disease Investigations, blood tests to rule out other possible diagnosis such as thyroid disorders; vitamin deficiencies Medical imaging (CT scan, MRI, PET Scan) Relieving discomfort especially in the later stages of the disease Blood tests to rule out other possible diagnosis such as thyroid disorders; vitamin deficiencies Referral of an elderly person with Alzheimer’s to a health facility for further management		Psychoeducation and psychosocial support (including for patient’s carers)
Referral Facility: Specialist
			History and physical examination for dementia (including Alzheimer disease) Clinical Examinations including behavioural observations. Assessments of intellectual functioning including memory testing/cognitive testing Drug management including cholinesterase inhibitors Psychosocial therapy – including behavioural therapy Monitoring of any indications that Alzheimer’s is getting worse including swallowing difficulties, oral and dental disease, hygiene problems, skin, or eye infections. Relieving discomfort especially in the later stages of the disease Investigations, blood tests to rule out other possible diagnosis such as thyroid disorders; vitamin deficiencies Medical imaging (CT scan, MRI, PET Scan) Relieving discomfort especially in the later stages of the disease Blood tests to rule out other possible diagnosis such as thyroid disorders; vitamin deficiencies		Psychoeducation and psychosocial support (including for patient’s carers)