Text adapted from "The patient with dementia" in Psychiatry in primary care by Kenneth Le Clair, Dallas Seitz and Julia Kirkham. (CAMH, 2019).
Given the aging population, dementia is a condition often seen in primary care settings. It currently affects about 750,000 Canadians and is expected to affect more than 1.1 million people by 2038 (Alzheimer Society of Canada, 2010). Most dementias are associated with older ages, increasing from about two per cent in people aged 65 to 74 years, to 35 per cent among people over age 85. Dementia lowers the threshold for other chronic and acute illnesses to produce significant disability. Primary care practitioners have an important role to play in identifying dementia and managing the complex issues that accompany the condition.
Risks and red flags for dementia
- Advanced age
- History of cardiovascular risk factors (hypertension, dyslipidemia, history of smoking, obesity, physical inactivity, diabetes, atrial fibrillation)
- History of cardiovascular disease or cerebrovascular disease
- Family history of dementia
- History of delirium or new onset depression in late life
- History of head trauma or neurological illness (Parkinson’s)
- Recent motor vehicle accident (older adult)
- Difficulties in taking medication
- Missing appointments
- Repeated calls to your office
- Family concerns about memory loss
- Deferring answers to questions to family members or caregivers
When to refer for further evaluation
Consider referring the patient when there is:
- uncertainty over diagnosis after initial evaluation and treatment
- an indication for neuropsychological testing to differentiate between normal aging and mild cognitive impairment
- significant depression with poor response to treatment
- difficulty in tolerating medications for dementia
- challenging behaviour or significant stress on the caregiver and social environment
- need for genetic counselling
- patient or family request
- an indication for further evaluation of in-home safety, driving or other areas of potential risk.
Consider these referrals to support a patient with dementia:
- Alzheimer Society of Canada’s First Link program for patients newly diagnosed with dementia
- home care services (e.g., in Ontario contact the local Community Care Access Centre)
- geriatric medicine.
- The Primary Care Practitioner Role
- Screening & Assessment
- Assessing dementia and cognitive impairment in the real world
- Resources & References