Integrated care pathways in dementia: a challenge to National Institute for Health and Clinical Excellence/Social Care Institute for Excellence guidance

An integrated care pathway (ICP) is proposed for the diagnosis of dementia syndromes, encompassing the various disciplines which may be involved (psychiatry, geriatrics, neurology, clinical genetics) due to the heterogeneity of presentation at the clinical and aetiological level. This proposed ICP challenges guidance recently issued by the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE), which requires a 'single point of referral' to access all dementia services. The proposal is prompted by the non-unitary nature of dementia, which may be envisaged as a 'boundary' condition transcending traditional professional categories and involving a wide array of professional groups in patient diagnosis in secondary care. Diversity rather than uniformity may best serve patient needs in such a heterogeneous syndrome.