Scope
Adults with suspected cognitive decline or established dementia. Current evidence comes from Dementia Australia’s February 2026 professional assessment resource, the 2024 national psychotropic-medicines clinical care standard, Queensland’s current acute severe-BPSD pathway and Austroads driving standards. The 2016 comprehensive dementia CPG is not used as current claim evidence because its NHMRC approval period elapsed and the Commonwealth-funded replacement remained unpublished at the source check.
The Bottom Line
- Establish acquired cognitive change and loss of everyday function from the person and an informant over time, using culturally, linguistically and sensory-appropriate assessment rather than one screening score alone.
- Separate progressive decline from delirium, depression, medicine effects, infection, dehydration, sleep disorder, sensory loss and metabolic or neurological disease with focused examination, review and investigations.
- Communicate a provisional or confirmed diagnosis honestly and in line with the person’s wishes, support decision making and begin discussion of practical support, future preferences and carers while the person can participate.
- For changed behaviour, identify pain, delirium, physical illness, environment, communication barriers and unmet need and use person-specific non-medicine strategies before psychotropic medicine whenever immediate danger permits.
- Use psychotropic medicine for behaviour only for an appropriate documented reason after consent and alternatives, set a measurable goal and review benefit, harm, dose reduction and cessation; sedation itself is not a care goal.
Practical clinical workflow
1
Document onset and progression, affected cognitive domains, activities of daily living, driving, falls, medicines, alcohol, mood, sleep, behaviour, safety, supports and carer observations.
2
Assess mental and physical state, vision and hearing, function and relevant laboratory or imaging questions, urgently routing an acute fluctuating change through the delirium pathway.
3
Use an appropriate cognitive tool as one component of assessment, seek specialist input when diagnosis, subtype, younger onset or capacity is uncertain and communicate results over more than one visit when needed.
4
For distress or aggression, describe antecedents and consequences, treat physical and environmental triggers, retrieve an existing behaviour support plan and involve the person and chosen supports.
5
Review psychotropic medicines and driving under the national standards, transfer the behaviour and medicine plan across settings and connect the person and carers with local dementia and respite services.
Safety boundaries and escalation
- Sudden cognitive deterioration, focal neurology, reduced consciousness, seizure, head injury, sepsis physiology or acute medicine toxicity is an emergency and must not be attributed to dementia progression.
- Immediate serious risk to the person or others may require emergency medication or restrictive intervention under local law, but consent, indication and review must be documented as soon as practicable.
- Unsafe wandering, driving, fire or weapon access, abuse, neglect, severe carer exhaustion or inability to meet basic needs requires urgent safeguarding and service coordination.
- Psychotropic medicines can cause falls, stroke, sedation and other harm; do not allow an emergency prescription to continue across transitions without indication, response and stop-review information.
Implementation
Dementia Australia and ACSQHC sources are national; the severe-BPSD acute pathway is explicitly Queensland-only, and Austroads is implemented by state and territory licensing authorities. The final replacement comprehensive Australian dementia guideline was still unpublished on 20 August 2026. This page therefore limits itself to current assessment, behaviour, medicine-safety and driving evidence and requires local diagnostic and service pathways.
Clinical use boundary
This independently written summary is not an official guideline. Check the linked source version, current TGA-approved product information where medicines are involved, and the applicable state, territory and local pathway at the point of care.
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- Dementia AustraliaAssessment and diagnosis of dementiaClinical professional resource updated 4 February 2026 · accessed 2026-08-20view source
- Australian Commission on Safety and Quality in Health CarePsychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard2024 national clinical care standard · accessed 2026-08-20view source
- Queensland Health and Royal Flying Doctor Service Queensland SectionPrimary Clinical Care Manual, 12th edition: Severe behavioural and psychological symptoms of dementia — adultISBN 978-1-876560-22-5 · 12th edition 2025, v1.03 with updates through 21 July 2026; section 5, printed pages 338–341 · accessed 2026-08-20view source
- Austroads and National Transport CommissionAssessing Fitness to Drive for commercial and private vehicle driversAP-G56-22; ISBN 978-1-922700-21-6 · Edition 6.0, 2022 · accessed 2026-08-20view source
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