Diagnosis and management of dementia in older people

Abstract

Inconsistencies between diagnostic criteria for different dementia aetiologies have led to the 5th edition of the Diagnostic and Statistical Disorder of Mental Disorders abandoning ‘dementia’ as a diagnostic term. Diagnostic criteria for dementia that remain are increasingly based on molecular rather than clinical features. In particular, dementias associated with fronto-temporal lobe degeneration are now classified as tau-positive or tau-negative, with specific genetic variants associated with subtypes of these two broad categories. Management guidelines for dementia in the community are well established, but this is not the case for acute hospital settings, where diagnosis can be more difficult and coexisting age-associated morbidities and informant history require specific attention. The management of behavioural and psychological symptoms of dementia in acute hospital settings can also be challenging – non-pharmacological and alternative pharmacological interventions are available that may avoid the need to prescribe antipsychotic drugs.