Introduction

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