1.  General guidelines about Dementia                                                                                                    

a.  Thorough history taking and examination including MSE

b.  Ask and note down (mention ICD/DSM criteria)

1.   Consciousness:    Conscious, confused, clouding, delirium, stupor, coma.

2.   Attention:             Digit Forward/Digit Backward (Digit Span test) Ask 3/5 item to remember & ask again

Write a sentence and ask to do it e.g. pick up the ball pen.

3.   Concentration:    Serial subtraction 100 - 7, 40 - 3

- Ask to say days of week] in reverse order, month of year

4.   Orientation:         Time, Place, Person

5.   Memory:               Immediate, Recent, Remote

6.   Judgment:             Personal Judgment, Social Judgment, Test Judgment

2.  Investigations required

a.  Psychometric investigations: Mini Mental State Examination (MMSE)

b.  Radiological: CT or MRI of brain

c.  Laboratory: (if physical complications are present)

3.  Treatment

a.  If patient is in early stage

i)  Donepezil 10 mg

ii)  Memantine 10 mg

iii)  Rivastigmine 1.5 mg

iv)   Symptomatic and supportive treatment including nutrition to be given as per the need of the patient

v)    If the patient has anxiety or depression or psychotic symptoms, he/she may be treated accordingly as per STG in the relevant section.

Early identification and treatment may treatment may delay or arrest the process of cognitive decline. Treatment of dementia is based on the cholinergic hypopthesis of memory. Cholinesterase inhibitors like donepezil, rivastigmine and galantamine are indicated for patients with dementia. Donepezil should be started with dosage of 5mg/day which may titrate to 10mg/day in 2 weeks. Antipsychotic may be indicated for controlling aggressive behavior, psychotic symptoms and severe agitation. Resperisone (1 to 3 mg) and quetiapine (25 to 400mg) may be used.

b.  If patient is in mid or late stage

i)  Medication written in 3 (a) may be given as per clinical judgment

ii)  Special care may be given to oral, physical and sleep hygiene

4.  Follow-up

a.  Physical check-up at OPD

b.  Through telephonic conversation/TeleManas

c.  Follow-up by Targeted Intervention (ARDSI-Mizoram Chapter) in Aizawl

5.  Referrals

a.  Depending upon the severity and complications of the patient, he/she may need to be referred to medicine/surgery department.

b.  To TeleManas

c.  To the nearest DMHP

d.  To psychiatry OPD at Kulikawn Hospital

e.  To higher centers outside Mizoram through Referral Board.