Skip to main content Accessibility help
×
Hostname: page-component-77c78cf97d-xcx4r Total loading time: 0 Render date: 2026-04-24T13:54:21.886Z Has data issue: false hasContentIssue false

Chapter 9 - Dementia and Related Disorders

Published online by Cambridge University Press:  04 April 2024

By
Ayesha Bangash  and
Farooq Khan
Edited by
George Tadros  and
George Crowther
George Tadros
Affiliation:
Aston University, Birmingham
George Crowther
Affiliation:
Leeds and York Partnership NHS Foundation Trust, Leeds
Get access

Summary

Dementia is a syndrome associated with an ongoing decline of brain function. It is common among older in-patients. Hospital admissions tend to be due to comorbid conditions rather than the dementia itself. Falls, infections, poor nutrition, dehydration, and delirium affect the length of stay and the functioning of patients with dementia. Without a timely diagnosis of the dementia and its associated clinical features, patients can experience adverse outcomes, which cause care home admissions instead of a discharge home. This chapter discusses the epidemiology, risk factors, assessment, and treatment of dementia in a general hospital setting.

Keywords

dementiaolder peoplehospitalacute hospital careassessmentmanagementtreatmentin-patientliaison

Information

Type
Chapter
Information
Handbook of Old Age Liaison Psychiatry , pp. 110 - 123
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Alzheimer’s Society. What is dementia? London, Alzheimer’s Society, 2017. www.alzheimers.org.uk/download/downloads/id/3416/what_is_dementia.pdf.Google Scholar
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: World Health Organization, 1992. http://www.who.int/classifications/icd/en/bluebook.pdf.Google Scholar
Alzheimer’s Society. Facts for the media. London, Alzheimer’s Society, 2017. www.alzheimers.org.uk/about-us/news-and-media/facts-media.Google Scholar
Sampson, E.L., Blanchard, M.R., Jones, L., Tookman, A., and King, M. Dementia in the acute hospital: Prospective cohort study of prevalence and mortality. Br J Psychiatry 2009, 195(1): 61–6.CrossRefGoogle ScholarPubMed
Ames, D., Tuckwell, V. Psychiatric disorders among elderly patients in a general hospital. Med J Aust 1994, 160(11): 671–5.CrossRefGoogle ScholarPubMed
Laurila, J.V., Pitkala, K.H., Strandberg, T.E., and Tilvis, R.S. Detection and documentation of dementia and delirium in acute geriatric wards. Gen Hosp Psychiatry 2004, 26(1): 31–5.CrossRefGoogle ScholarPubMed
Goldberg, S.E., Whittamore, K.H., Harwood, R.H., Bradshaw, L.E., Gladman, J.R.F., and Jones, R.G. The prevalence of mental health problems among older adults admitted as an emergency to a general hospital. Age Ageing 2012, 41(1): 80–6.CrossRefGoogle ScholarPubMed
Russ, T.C., Shenkin, S.D., Reynish, E., et al. Dementia in acute hospital inpatients: The role of the geriatrician. Age and Ageing 2012, 41(3): 282–4.CrossRefGoogle ScholarPubMed
Jackson, T.A., Gladman, T.R.F., Harwood, R.H., MacLullich, A.M.J., Sampson, E.L., et al. Challenges and opportunities in understanding dementia and delirium in the acute hospital. PLoS Medicine 2017, 14(3), e1002247.CrossRefGoogle ScholarPubMed
Crowther, G.J.E., and Bennett, M.I. How well are the diagnosis and symptoms of dementia recorded in older patients admitted to hospital? Age and Ageing 2017, 46: 112–18.Google ScholarPubMed
Budson, A.E., and Solomon, P.R. Memory Loss, Alzheimer’s Disease and Dementia (2nd ed.). Elsevier, 2016. See esp. Section II, Differential diagnosis of memory loss and dementia, pp. 47–145.CrossRefGoogle Scholar
Carson, A., Zeman, A., Myles, L., and Sharpe, M. Handbook of Liaison Psychiatry. Cambridge: Cambridge University Press, 2007. See esp. Chapter 14, Neurological disorders, pp. 305–64.Google Scholar
Burns, A., and Iliffe, S. Dementia. BMJ 2009, 338: b75.CrossRefGoogle ScholarPubMed
Robinson, L., Tang, E., and Taylor, J.-P. Dementia: Timely diagnosis and early intervention. BMJ 2015, 350: h3029.CrossRefGoogle ScholarPubMed
Husain, M., and Schott, J.M. Oxford Textbook of Cognitive Neurology and Dementia. Oxford: Oxford University Press, 2016. See esp. Chapter 36, Dementia with Lewy bodies and Parkinson’s disease dementia, pp. 399–413.CrossRefGoogle Scholar
McKeith, I.G., Boeve, B.F., Dickson, D.W., et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology 2017, 89(1): 88–100.CrossRefGoogle ScholarPubMed
Yousaf, T., Dervenoulas, G., Valkimadi, P.-E., et al. Neuroimaging in Lewy body dementia. J Neurol 2019, 266(1): 1–26. doi: 10.1007/s00415-018-8892-x.CrossRefGoogle ScholarPubMed
Alzheimer’s Society. Facts for the media. London, Alzheimer’s Society, 2017. www.alzheimers.org.uk/about-us/news-and-media/facts-media. Also Alzheimer’s Research UK. Dementia statistics hub. London: Alzheimer’s Society, 2018. www.dementiastatistics.org/statistics/prevalence-by-age-in-the-uk/#:~:text=A%20person%27s%20risk%20of%20developing,over%20the%20age%20of%2080.&text=people%20under%2065%20have%20dementia,%2C%205.2%25%20of%20the%20total.Google Scholar
Age UK. Later life in the United Kingdom, 2019. London, Age UK, 2019. www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/later_life_uk_factsheet.pdf.Google Scholar
Alzheimer’s Society. Can genes cause dementia? London, Alzheimer’s Society, 2020. www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/alzheimers-disease-and-genes#content-start.Google Scholar
Alzheimer’s Society. Dementia risk factors and prevention. London, Alzheimer’s Society, 2020. www.alzheimers.org.uk/about-dementia/dementia-risk-factors-and-prevention.Google Scholar
Cunningham, E.L., McGuiness, B., Herron, B., and Passmore, A.P. Dementia. Ulster Med J 2015, 84(2): 79–87.Google ScholarPubMed
Russ, T.C., Shenkin, S.C., Reynish, E., et al. Dementia in acute hospital inpatients: The role of the geriatrician. Age Ageing 2012, 41(3): 282–4.CrossRefGoogle ScholarPubMed
Leonard, M., McInerney, S., McFarland, J., Condon, C., Awan, F., O’Connor, M., et al. Comparison of cognitive and neuropsychiatric profiles in hospitalized elderly medical patients with delirium, dementia and comorbid delirium–dementia. BMJ Open 2016, 6: e009212.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association, 2013. See esp. Neurocognitive disorders, pp. 591–643.Google Scholar
Pendlebury, S.T., Klaus, S.P., Mather, M., de Brito, ., and Wharton, R.M. Routine cognitive screening in older patients admitted to acute medicine: Abbreviated Mental Test Score (AMTS) and Subjective Memory cCmplaint versus Montreal Cognitive Assessment and IQCODE. Age Ageing 2015, 44(6): 1000–5.CrossRefGoogle ScholarPubMed
Velayudhan, L., Ryu, S.-H., Raczek, M., Philpot, M., Lindesay, J., Critchfield, M., and Livingston, G. Review of brief cognitive tests for patients with suspected dementia. Int Psychogeriatr 2014, 26(8): 1247–62.CrossRefGoogle ScholarPubMed
Noone, P. Questionnaire review: Addenbrooke’s Cognitive Examination, III. Occupational Medicine 2015, 65: 418–20.CrossRefGoogle Scholar
Rascovsky, K. A primer in neuropsychological assessment for dementia. Practical Neurology, The Neurology Hub, July–August 2016. https://docs.google.com/viewerng/viewer?url=http://v2.practicalneurology.com/pdfs/pn0716_CF_Neuropsych.pdf.Google Scholar
Nightingale, S., Michael, B.D., Defres, S., et al. Test them all: An easily diagnosed and readily treatable cause of dementia with life-threatening consequences if missed. Pract Neurol 2013, 13(6): 354–6.CrossRefGoogle ScholarPubMed
Smailovic, U., and Jelic, V. Neurophysiological markers of Alzheimer’s Disease: Quantitative EEG approach. Neurol Ther 2019, 8: 37–55.CrossRefGoogle ScholarPubMed
Kansal, K., and Irwin, D.J. The use of cerebrospinal fluid and neuropathological studies in neuropsychiatry practice and research. Psychiatr Clin North Am 2015, 38(2): 309–22.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (NICE). Donepezil, Galantamine, Rivastigmine and Memantine for the Treatment of Alzheimer’s Disease. London: NICE, 2011. donepezil-galantamine-rivastigmine-and-memantine-for-the-treatment-of-alzheimers-disease-pdf-82600254699973 (nice.org.uk).Google Scholar
Cochrane. Rivastigmine for people with Alzheimer’s disease [internet]. London: Cochrane; 2015 [cited 2020 Dec 19]. Available from: www.cochrane.org/CD001191/DEMENTIA_rivastigmine-people-alzheimers-disease.Google Scholar
Rowland, J.P., Rigby, J., Harper, A.C., et al. Cardiovascular monitoring with acetylcholinesterase inhibitors: a clinical protocol. Adv Psychiatr Treat 2018; 13(3), 178–84.CrossRefGoogle Scholar
Cochrane. Memantine as a treatment for dementia. London, Cochrane, 2019. www.cochrane.org/CD003154/DEMENTIA_memantine-treatment-dementia.Google Scholar
Lefevre, G., Callegari, F., Gsteiger, S., et al. Effects of renal impairment on steady-state plasma concentrations of rivastigmine: A population pharmacokinetic analysis of capsule and patch formulations in patients with Alzheimer’s disease. Drugs Ageing 2016, 33(10): 725–36.CrossRefGoogle ScholarPubMed
Ames, D., O’Brien, J.T., and Burns, A. (eds). Dementia (5th ed.). Boca Raton, FL: CRC Press, 2017. See esp. Chapter 16, Managing people with dementia in the general hospital, pp. 172–83.CrossRefGoogle Scholar
Royal College of Psychiatrists. Who Cares Wins: Improving the Outcome for Older People Admitted to the General Hospital: Guidelines for the Development of Liaison Mental Health Services for Older People. London: RCPsych, 2005. www.bgs.org.uk/sites/default/files/content/resources/files/2018-05-18/WhoCaresWins.pdf.Google Scholar
White, N., Leurent, B., Lord, K., Scott, S., Jones, L., et al. The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: A longitudinal cohort study. Int J Geriatr Psychiatry 2015, 32(3): 297–305.CrossRefGoogle Scholar
Royal College of Psychiatrists. National Audit of Dementia Care in General Hospitals, 2016–2017: Third Round of Audit Report. London: RCPsych, 2017. www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/national-clinical-audits/national-audit-of-dementia/round-3/nad-care-in-general-hospitals-2016-17-third-round-of-audit-report.pdf?sfvrsn=5dffeef8_4.Google Scholar
Sheehan, B., Lall, R., Gage, H., Holland, C., Katz, J., and Mitchell, K. A 12-month follow-up study of people with dementia referred to general hospital liaison psychiatry services. Age Ageing 2013, 42, 786–90.CrossRefGoogle ScholarPubMed
Deci, E. and Ryan, R. 2002. Handbook of Self-Determination Research. Rochester, NY: University of Rochester Press.Google Scholar
Hynninen, N., Saarnio, R. and Isola, A. The care of older people with dementia in surgical wards from the point of view of the nursing staff and physicians. Journal of Clinical Nursing 2015, 24(1–2): 192–201.CrossRefGoogle ScholarPubMed
Bradshaw, L.E., Goldberg, S.E., Schneider, J.M., and Harwood, R.H. Carers for older people with co-morbid cognitive impairment in general hospital: Characteristics and psychological well-being. International Journal of Geriatric Psychiatry 2013, 28(7): 681–90.CrossRefGoogle ScholarPubMed
Tadd, W. Hillman, Calnan, A., Calnan, S., Bayer, M., T. and Read, S. Dignity in Practice: An Exploration of the Care of Older Adults in Acute NHS Trusts. PANICOA, 2011. http://www.bgs.org.uk/pdf_cms/reference/Tadd_Dignity_in_Practice.pdf.Google Scholar
Banks, P., Waugh, A., Henderson, J., Sharp, B., Brown, M., Oliver, J. and Marland, G. Enriching the care of patients with dementia in acute settings? The Dementia Champions Programme in Scotland. Dementia (London) 2014, 13(6): 717–36.Google ScholarPubMed
The Butterfly Scheme. Home page, November 2014. http://butterflyscheme.org.uk/november-2014.Google Scholar
Alzheimer’s Society. This is me: A support tool to enable person- centred care. Alzheimer’s Society, 2010. www.alzheimers.org.uk/thisisme.Google Scholar
Jolley, D., Benbow, S.M., and Grizzell, M. Memory clinics. Postgraduate Medical Journal 2006, 82(965): 199–206.CrossRefGoogle ScholarPubMed
Goldberg, S., Whittamore, K., Harwood, R., Bradshaw, L., Gladman, J., and Jones, R. The prevalence of mental health problems among older adults admitted as an emergency to a general hospital. Age and Ageing 2012, 41(1): 80–6.CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists. National Audit of Dementia Care in General Hospitals, 2012–13: Second round audit and update. Royal Collage of Psychiatrists, 2013. www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/national-clinical-audits/national-audit-of-dementia/round-2/nad-round-2-national-report-2013.pdf?sfvrsn=ed5a6094_2.Google Scholar
Griffiths, A., Knight, A., Harwood, R. and Gladman, J.R. Preparation to care for confused older patients in general hospitals: a study of UK health professionals. Age and Ageing 2014, 43(4): 521–7.CrossRefGoogle ScholarPubMed
The Alzheimer’s Society. 2009. Counting the Cost: Caring for People with Dementia on Hospital Wards. Alzheimer’s Society. www.alzheimers.org.uk.Google Scholar
Nolan, L. Caring for people with dementia in the acute setting: A study of nurses’ views. British Journal of Nursing 2007, 16(7): 419–22.CrossRefGoogle ScholarPubMed
Cowdell, F. The care of older people with dementia in acute hospitals. International Journal of Older People Nursing 2010, 5(2): 83–92.CrossRefGoogle ScholarPubMed
Royal College of Nursing. Dignity in Dementia: Transforming General Hospital Care. Royal College of Nursing, 2011. www.rcn.org.uk/__data/assets/pdf_file/0019/405109/RCN_Dementia_project_professional_survey_findings_.pdf.Google Scholar
Sampson, E., White, N., Leurent, B., Scott, S., Lord, K., Round, J. and Jones, L. Behavioural and psychiatric symptoms in people with dementia admitted to the acute hospital: prospective cohort study. British Journal of Psychiatry 2014, 205(3): 189–96.CrossRefGoogle Scholar
Sampson, E., White, N., Lord, K., Leurent, B., Vickerstaff, V., Scott, S. and Jones, L. Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: A longitudinal cohort study. Pain 2015, 156(4): 675–83.CrossRefGoogle ScholarPubMed
Wancata, J., Windhaber, J., Krautgartner, M. and Alexandrowicz, R. The consequences of non-cognitive symptoms of dementia in medical hospital departments. International Journal of Psychiatry in Medicine, 2003, 33(3): 257–71.CrossRefGoogle ScholarPubMed
Husebo, B.S., Ballard, C., Sandvik, R., Nilsen, O.B., and Aarsland, D. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. British Medical Journal 2011, 343. doi: 10.1136/bmj.d4065.CrossRefGoogle ScholarPubMed
Holmes, J., and House, A. 2000. Psychiatric illness predicts poor outcome after surgery for hip fracture: A prospective cohort study. Psychological Medicine 2000, 30: 921–9.CrossRefGoogle ScholarPubMed

Accessibility standard: Unknown

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×