The ED may be the first port of call for patients with changes in behaviour associated with dementia. The ED is frequently attended by dementia sufferers who have had either:

  • An acute deterioration in their condition
  • A fall, or collapse either at home, or elsewhere, such as a residential/nursing home

It is easy, in a busy ED, to fail to fully address the issues. Simply taking a full history may require several phone calls to carers and GPs, and examination may require the help of multiple people including relatives/loved ones.

Using a systematic approach to history taking, examination and investigation of these patients will hopefully minimise errors and help identify reversible co-morbidities.

Common errors

The assessment of patients with dementia is challenging for many reasons, and errors can be made. For example:

  • It can be difficult to separate dementia from delirium and depression. All may affect a patient concomitantly
  • The impairments caused by dementia may make patient interaction more difficult
  • Symptoms and signs can be more difficult to elicit
  • It can be difficult to assess levels of distress and pain