The elderly population is increasing and with it the incidence of dementia, posing an enormous challenge to primary care, psychiatry and social services. At 75 years 5.9% of elderly people have dementia, rising to 20.3% at 85 years.

Dementia. A patient with dementia has a progressive irreversible global deterioration in cognitive ability, including memory loss, personality changes, deterioration in language, problem-solving and social and personal functioning. The most common dementias are Alzheimer’s disease and vascular dementia.

Acute confusional state can be difficult to distinguish from dementia, and the two can coexist. Acute confusional state is caused by an underlying medical cause which is usually reversible. Typical features are an acute or semi-acute onset and fluctuating course.

Your key aims are to:

• Make a diagnosis and differentiate between treatable and non-treatable cognitive decline
  
• Refer promptly to secondary care when appropriate
  
• Make sure that patients who have mental capacity are given the same rights of determining their management plan as anyone else
  
• Look after the patient’s physical problems
  
• Take part in shared care.

Patients may refer themselves to the GP or be brought by a partner or carer. Always take a presentation of dementia seriously especially in the early stages as these are patients who benefit most from intervention.

Clinical Presentation of Dementia

• Memory loss – short or long term
  
• Language problems (e.g. aphasia)
  
• Deterioration in problem-solving, orientation, concentration and judgement
  
• Gradual loss of daily living skills
  
• Behaviour problems (e.g. aggression). Depression is common in dementia but remember that depression alone can present with features of dementia.

Clinical Presentation of Acute Confusional State

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