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Map of Medicine supports evidence-based management of dementia
The Map of Medicine ‘Dementia’ care map has recently been updated to include the latest guidance from NICE, WHO, and the European Federation of Neurological Societies (EFNS). It provides succinct, accessible information on the diagnosis, assessment, and management of people with dementia, as well as advice on dealing with co-morbid emotional disorders and supportive information for carers.
A particular focus of the care map is the non-pharmaceutical management of non-cognitive symptoms and challenging behaviour. A report to the Department of Health in 2009 estimated that approximately 140,000 people with dementia may be inappropriately prescribed antipsychotic drugs every year in the UK1. The adverse effects of these medications can be extremely distressing and disabling. Long-term use can actually worsen symptoms and increase the risk of stroke. The unlicensed use of these drugs to ‘control’ agitated dementia patients is believed to contribute to ,1,8000 deaths each year1.
In a BBC Panorama interview last October, care services minister Paul Burstow promised that the use of antipsychotic drugs for dementia would be reduced by two-thirds by November 20112. The Alzheimer's Society, Age UK and the Department of Health want all prescriptions for antipsychotics be reviewed by the end of March 20123. The newly-updated Map of Medicine care map supports this approach by advising against the routine use of antipsychotics except in specifically defined situations, ie where there is severe distress or immediate risk of harm, or as a last resort for treating patients with moderate or severe dementia.
The care map emphasises the adverse effects associated with these drugs, including an increased risk of cerebrovascular events and premature death, and provides details regarding alternative medications and non-pharmaceutical approaches, such as multisensory stimulation and bright light therapy. The care map is also up-to-date with the latest NICE recommendations on prescribing donepezil, galantamine and rivastigmine for mild Alzheimer’s disease (AD) and memantine for moderate/severe AD.
For our next publication in October, the ‘Dementia’ care map is being updated with contributions from speech and language therapists from the Royal College of Speech and Language Therapists (RCSLT), as well as the Department of Health National Clinical Director for Dementia, Professor Alistair Burns.
“Including AHPs in the development of the Map of Medicine for dementia is very positive and should contribute to providing individualised care that policy documents consistently highlight as necessary for people with dementia”
Professor Karen Bryan, SLT and Head of the Division of Health and Social Care, University of Sussex.
See the updated care map.