7. Review

A. Mild cognitive impairment

  • Ensure that your practice has in place a system for recalling patients who may have mild cognitive impairment, for review.
  • When a patient is recalled for a review, capture and record any changes in his/her presentation, including diagnosis.

B. Dementia diagnosis

  • Review all patients with a diagnosis of dementia at least every 15 months (QOF DEM2).
  • Review carers’ needs; consider whether they need referral for a carer’s assessment;
  • Signpost people to sources of advice, guidance and support in the community

Regular health checks

  1. General physical health check including blood pressure, pulse (check for new atrial fibrillation). Those with vascular dementia are likely to be on other QOF registers too (eg hypertension, CHD, CVA/TIA) which require other specific checks like cholesterol, taking certain preventative medication etc.
  2. Medication review including cholinesterase (if shared care guideline and GP is issuing not secondary care), co-prescribing of anticholinergics (stop if possible), vascular risk reduction.
  3. Assess falls risk and consider suitable prescribing or referral if high.
  4. Assess for any triggers to behavioral problems over past 12 months and what helped resolved the problems (drug or environmental). Liaise with carer to promote preventative strategies (e.g. clean urine pot/supply of antibiotics in case of urine infection, regular aperients, analgesia available).
  5. Ensure any care preferences are documented and shared with local agencies (e.g. out of hours, ambulance provider, care home staff).

C. Prescribing of low dose antipsychotics