Table 83 Clinical clues suggesting dementia

Patient presentations

• new psychological problems in old age 1 • ill-defined and muddled complaints

. • uncharacteristic behaviour

• relapse of physical disorders

• recurrent episodes of confusion

Problems noted by carers

• 'not themselves'—change in personality, e.g. humourless

• domestic accidents, especially with cooking and heating

• unsafe driving

2. • false accusations . • emotional, irritable outbursts

• tendency to wander

• misplacing or losing items, e.g. keys, money, tablets, glasses

• muddled on awakening at night

Mental state observations

• vague, rambling or disorganised conversation 3 • difficulty dating or sequencing past events

' • repeating stock phrases or comments

• playing down obvious, perhaps serious, problems

• deflecting or evading memory testing

Source: After McLean 6

There is always the likelihood of accidents with household items such as fire, gas, kitchen knives and hot water. Accidents at the toilet, in the bath and crossing roads may be a problem, especially if combined with failing sight and hearing. Such people should not drive motor vehicles.

Without proper supervision they are likely to eat poorly, neglect their bodies and develop medical problems such as skin ulcers and infections. They can also suffer from malnutrition and incontinence of urine or faeces.

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