Care pathways for patients with mild cognitive impairment and dementia:

All the three care providers play a role in the care pathway for these patients. The primary care centres are responsible for the initial examination of patients with suspected MCI or dementia. The basic assessment aims to involve multiple perspectives on the patients’ current condition including his or her social situation:

• A structured anamnesis including interviews with nearest and dearest
• An assessment of the physiological and psychological condition of the patient
• Cognitive tests including MMT and the Clock test
• A structured assessment of patient activities of daily life and level of activity

In addition, tests to include other conditions include:

• A CT scan
• Relevant neuropsychological tests
• Blood tests to exclude hyperkalaemia, high levels of homocystein as well as of thyroid hormones
• In case of clinical suspicion, the basal investigation also includes liquor tests for Borrelia and Syphilis

The physician and a specialized nurse at the primary care unit continuously monitor patients with MCI. The monitoring includes at least yearly visits to the physician, including a pre-visit to the specialized nurse according to the Swedish National Guidelines for dementia care. Moreover, patients can contact the specialized nurse at request at any time between visits to the physician. If patients with MCI or mild dementia deteriorate and develop moderate/severe dementia, the aid assistance coordinator, who belongs organizationally to the community, designs an individual care plan for those patients together with representatives from the hospital and the Primary Care Centre. Based on the care plan, community care resources are made available for the patient, including basic home care. Basic, long-term care of patients with dementia is provided by cross-professional teams under the management of the community. These teams are also led by a specialized community nurse with the support from the general practitioner and the specialized nurse at the primary care centre. The primary care physician has always the overall medical responsibility for the patient.