We tend not to think of dementia, a chronic disease, as an Emergency Medicine sensitive diagnosis. However as an increasing absolute number of people presenting to EDs have dementia (12.5% >70; 25% >80; 50% >90). This disease often is not diagnosed, so it is important for Emergency docs to have a good working knowledge of this chronic cognitive decline.
- We don’t generally think of dementia as an ED diagnosis though it often impacts on management and disposition
- Diagnosis is often not already established (70%)
- Important to distinguish confidently from delirium and depression
- Valuable to have a quick screening tool (not the MMSE — too long to be practical in the ED)
- There is a tendency to assume that ‘someone else’ has already established the diagnosis of dementia and that anyone who is not on donepezil does not have dementia! Although half of the population over 85 has some degree of dementia, the diagnosis is often not established until significant functional impairment has taken place – in other words – lots of older patients you see in ED have undiagnosed dementia!
- The diagnosis of dementia is relevant to establishing a discharge plan – poor medication compliance, impaired self-care, insufficient home support need to be considered if you are planning to manage a new medical diagnosis at home.
What is dementia?
- Chronic memory loss (short-term more than long-term) of such severity as to interfere with function AND
- One of :
- Apraxia (difficulty executing motor tasks eg. dressing, self-care)
- Aphasia (any language impairment, often word finding )
- Agnosia (difficulty recognizing familiar objects)
- Loss of executive functioning (planning, organizing, sequencing, abstracting)