Cognitive Impairment and Dementia


If any of the following are present or suspected, 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
Useful Management Information
  • 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
Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)


If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • 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

If your patient does not meet the minimum referral criteria

  • Consider other treatment pathways or an alternative diagnosis
  • If you still need to refer your patient:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service
Standard Referral Information

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g. tracheostomy in place, oxygen required)
  • 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 functioning – low/medium/high
  • 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

Essential referral information

Without this information the referral will be returned

  • 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.

Additional Referral Information
  • 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)
Clinical Override

Clinical override of referral criteria may be requested in the following situations:

  • Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
  • Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
  • Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.

Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.

Out of scope services

Not all services are appropriate to be seen in the Queensland public health system. Exceptions can always be made where clinically indicated. It is proposed that the following are not routinely provided in a public Cognitive Impairment and Dementia service

  • Outpatient follow-up of adults for acquired brain injury or neuro developmental disorder i.e., except whether there is a new onset of memory/cognitive decline.
  • Presentations that would be more appropriately assessed and managed by specialist mental health services e.g. where a primary psychiatric diagnosis (e.g. major depression, generalised anxiety disorder, schizophrenia) is the most likely cause of the patient’s presenting symptoms
  • Assessments of financial and testamentary capacity
  • Formal occupational therapy driving assessments

Out of scope for Cognitive Impairment and Dementia interventions

  • Allied Health – Speech and Language therapist, Occupational Therapist & Social Worker
  • Post Diagnosis Counsellor
  • Genetic testing/counselling
  • Request for ACAT assessment (My Aged Care)
  • 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.

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.


To provide feedback about contents on this website or general referral questions please email or phone 3413 7402.