GP Assessment Blood screen B12 TSH U & E Calcium B Glucose Cholesterol Folate FBC

1. GP Assessment Blood screen B12 TSH U & E Calcium B Glucose Cholesterol Folate FBC Exclude/treat Aggravating factors Physical illness Vitamin deficiency Head injury Hypothyroidism Depression presenting as dementia Referred by: Family/friend/neighbour A&E/Ambulance service Homecare/Day Centre Social Services Patient presenting with memory problems or other causes ruled out? Vascular problems – known patients with CVA and memory problems? Yes Refer to Memory Clinic. Assessment completed in primary care based clinics or if needed at patient’s home MMSE/DEMTEC/CAMCOG Family and personal history, physical health history, mental state presentation, carer concerns Referral

2. Refer to Memory Clinic. Assessment completed in primary care based clinics or if needed at patient’s home MMSE/DEMTEC/CAMCOG Family and personal history, physical health history, mental state presentation, carer concerns Follow-Up in 12 months via telephone to ascertain if reassessment required Yes Attend diagnostic clinic – Diagnosis of Alzheimer’s disease? Family Support Worker input – link to appropriate community support Diagnosis of Mild Cognitive Impairment? No No Yes Diagnosis of vascular dementia? – signpost as appropriate Diagnosis of depression? – signpost as appropriate No mental health problems? – support in primary care Drug treatment for Alzheimer’s disease? Signpost as appropriate No Diagnosis

3. Signpost as appropriate Drug treatment for Alzheimer’s disease? No Yes Follow-Up 4 weeks supply at introductory dose, seen within 3 weeks or sooner to ascertain any problems/adverse reactions to medication Liaise with the consultant and arrange clinic appointment as appropriate Liaise with the consultant. Review for a prescription of the titrated dose No Problem? Yes Problem? Yes Monitor again 2 to 3 weeks to ascertain if any problems or adverse reactions to medication No Problem? Yes Monitor again 6 weeks to ascertain any problems or adverse reactions to medication No Problem? Yes Discharge to Primary Care for 12 month GP appointment – this should be completed as per QOF No Treatment/ Follow-up