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Cognitive Impairment and Dementia

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


  • Very rapid onset of cognitive +/- other neurological symptoms
  • Suspected delirium deemed unsafe to manage in the community by the treating medical practitioner
  • Imminent safety risk to self or others
  • Refer to local Healthpathways or local guidelines
  • Referral to accredited pharmacist for Home Medical Review/Residential Medication Management review if evidence of polypharmacy
  • If malnourished, consider referral to a dietitian
  • Referral to occupational therapy driving assessment if locally available. 
  • Telehealth opportunities as appropriate

Clinician resources

Patient resources

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Presence of concerning features (may include but not limited to):
      • Behavioural and Psychological Symptoms of Dementia (BPSD) – moderate to severe stage include rapidly evolving (over weeks)
      • Unresolved safety concerns in current living situation (patient or care giver)
      • Suspected self-neglect or abuse
      • Rapidly evolving (over weeks)
      • Significant care-giver stress
  • Category 2
    (appointment within 90 calendar days)
    • Patients with a suspected dementia who do not meet category 1 criteria
  • Category 3
    (appointment within 365 calendar days)
    • No category 3 criteria

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

 

2. Essential referral information Referral will be returned without this

  • Relevant medical, psycho-social history (psychological symptoms), co-morbidities, allergies and assessment of adherence.
  • Brief information regarding the cognitive, behavioural and functional changes/decline and their timeline
  • Safety concerns require to be listed e.g. unsafe walking & driving, medication non-compliance, unintentional weight loss, living alone, compromised insight (if relevant)
  • Current list of medications 
  • Investigation blood test results – FBC, ELFT, Calcium, TSH, Vitamin B12 (if available)
  • Recent brain imaging reports (CT or MRI Head) within last 6 months (if available)

NB If a specific test result cannot be obtained due to access, financial, religious, cultural or consent
reasons a clinical override may be requested. This reason must be clearly articulated in the body of
the referral.

3. Additional referral information Useful for processing the referral

  • Assessment of cognitive function with a validated instrument  (if available)
  • Rockwood Clinical Frailty Scale score (if available)
  • Is there currently a GP Management Plan (GPMP), Team Care Arrangement (TCA) or Mental Health Management Plan (MHMP) in place for the patient or has a Health Assessment (HA) recently been done?    If so, please attach or provide information.
  • Enduring Power of Attorney & Advance Health Directive & Statement of Choices document (copy)
  • Availability of transport to appointment and willingness to attend appointment or is home visit required? (This may vary dependant on your local region service)

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.