Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Acute change is not routine dementia
Hours-to-days confusion, reduced arousal, focal neurology, head injury, suicidal behaviour, sudden inability to manage essentials or immediate safeguarding concern needs urgent assessment before elective cognitive work-up.
Action: Use ABCDE and glucose, 4AT and the appropriate stroke, infection, trauma, mental-health or safeguarding pathway, obtain baseline collateral, correct communication barriers and defer diagnostic cognitive interpretation until acute physiology permits.
Synopsis
Assess persistent cognitive and functional decline using supported history, collateral and subtype-directed examination, separate delirium and treatable contributors from neurodegeneration, and plan diagnosis, capacity, safety and carer support without premature labelling.
Dementia is acquired cognitive decline that interferes with everyday function; a low score without functional change does not establish it.
First establish chronology and baseline through the person and collateral: memory, executive, language, visuospatial, behaviour, IADLs and ADLs.
Exclude delirium first with 4AT when change is acute or fluctuating and reassess after acute illness, pain and communication barriers improve.
Key red flags
Rapid progression over weeks, seizures, focal deficits, early gait disorder, severe headache or systemic illness requires expedited neurological and medical investigation.
Rapid or focal change
Weeks-to-months progression, seizure or new focal finding requires expedited alternative-disease investigation.
Investigation priorities
01
4AT when acute change existsFirst step
Identify superimposed delirium before dementia interpretation.
Management branches
First-line diagnostic sequenceExclude delirium, establish decline and test function
Persistent cognitive concern is raised by the person, carer or clinician.
Optimise communication, use 4AT if acute change exists and obtain collateral cognition and function chronology.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.