Dementia and cognitive decline

Presentation and immediate needs

Progressive cognitive change affects everyday independence. Memory, language, visuospatial, executive and behavioural changes vary by cause.

Begin assessment → History, examination and context

History, examination and context

Obtain a timeline and collateral on daily function, medicines, mood, sleep, sensory impairment and neurological symptoms. Assess delirium first when deterioration is acute.

Consider the branch → Acute deterioration or fluctuation superimposed on cognitive decline?

Acute deterioration or fluctuation superimposed on cognitive decline?

Use clinical findings and collateral. Uncertainty needs clarification, not a default negative answer.

Yes / concerning features → Priority assessment; No / not established → Formulation and care discussion; Uncertain / not assessed → Obtain the missing information

Priority assessment

Assess for delirium before interpreting a chronic cognitive screen.

After appropriate assessment → Formulation and care discussion

Obtain the missing information

Review the examination, timeline, relevant investigations and consented collateral. Escalate urgent concerns while uncertainty is resolved.

Reassess the branch → Acute deterioration or fluctuation superimposed on cognitive decline?

Formulation and care discussion

Assess potentially reversible contributors, seek appropriate specialist diagnosis and discuss support needs. Consider condition-specific treatments, meaningful activity, environmental adaptation and caregiver support.

Agree follow-up → Reassess and follow up

Reassess and follow up

Review function, distress, falls, nutrition, medicines, decision-specific capacity and caregiver burden. Discuss future preferences sensitively.