This subject is not the subject of this guideline and is dealt with in detail by a separate EUROCODE document. However, its importance is such that a very brief summary is given here.

Driving

All patients should be advised that even mild problems with memory may be associated with impaired reaction times (I). Enquiry should be made about recent accidents, getting lost, near misses, slower or faster driving, and minor scrapes when manoeuvring (I). The occurrence of such events may increase the urgency of advice to limit or stop driving. Family members should be involved in the discussion, especially if the patient is advised to stop altogether since they may need to take an active role in preventing driving and providing alternative transport. Recommendations to have a driving assessment, if such a facility is available, often help (III). The patient and family should be advised that insurance may be invalid if the patient continues to drive against medical advice (I).

Information and support

At the point of diagnosis, or shortly thereafter, it is often appropriate to give patients and families written material which outlines the sources of support which may be available (I). These may include

• access to financial benefits
• local and national Alzheimer’s Association
• support groups for patients and carers
• domiciliary support with ADLs
• medication reminder systems
• assistive technology
• internet resources

It is also important to give advice about local laws about

• donation of proxy decision-making powers (power of attorney) relating to future financial or medical treatment
• making a will
• driving

In the early stages, supportive counselling can help the patient and families to come to terms with the current and future losses which they experience.

As the illness progresses, it is often appropriate to point the patient’s family to sources of advice about

• day care
• respite care
• long term care

and the financial implications of these.

Nonpharmacological treatment of cognitive disorder

Therapies targeted at orientating the patient, training in specific skills or cognitive retraining may help a little in the short term, but the effects are not sustained and these approaches can lead to frustration in some patients. Whilst they may promote hope, there is no evidence of long term benefit (I)