Rapid Responses to:

EDITORIALS: Elizabeth England Improving the management of dementia BMJ 2006; 332: 681-682 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Detection of dementia in acute hospitals also needs to be improved

Alasdair MJ MacLullich, Duncan R Forsyth, David Anderson, Roger Bullock, Daya Gunawardena, Jackie Morris, Peter Passmore   (12 April 2006)

Detection of dementia in acute hospitals also needs to be improved 12 April 2006
Alasdair MJ MacLullich, MRC Clinician Scientist Fellow & Honorary Consultant in Geriatric Medicine Queen's Medical Research Institute, University of Edinburgh EH16 4TJ, Duncan R Forsyth, David Anderson, Roger Bullock, Daya Gunawardena, Jackie Morris, Peter Passmore Send response to journal: Re: Detection of dementia in acute hospitals also needs to be improved	In the commentary on the paper by Downs and colleagues (1) Dr England rightly states that the rates of dementia detection and specialist referral in primary care are below optimal standards (2). This means that the majority of patients with dementia lack a formal diagnosis and therefore they and their families are denied access to information about their condition and appropriate multidisciplinary care. Furthermore, they are denied access to pharmacological and non-pharmacological treatments. Clearly, improving detection of dementia in primary care is essential. However, many studies also show that dementia is underdetected in acute hospitals. Cognitive impairment (mainly delirium and dementia) is extremely common in these settings, affecting around 30% of patients (3, 4). This means that screening for dementia would detect very large numbers of patients with this condition. Many of these patients are likely to have never had a formal diagnosis. Aside from screening for dementia, it is also crucial that rates of the detection of delirium improve. Delirium is probably the most common acute medical condition in acute hospitals, and the majority of cases of delirium occur in patients with dementia (4). Therefore, any patient not known to have dementia who presents with delirium clearly requires comprehensive assessment for possible dementia. Clinical experience and several studies show that this occurs infrequently. To help address this, a group of geriatricians, old age psychiatrists and mental health nurses functioning under the auspices of the British Geriatrics Society have recently published a set of guidelines, 'Delirious about Dementia' (5). This document is aimed at improving detection and management of dementia by geriatricians working in acute hospitals and includes a brief diagnostic algorithm for use by non-specialists. We hope that this and other documents will improve the unacceptably low standards of detection and ongoing management of dementia and also delirium in acute hospitals. References (1) Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study. Downs M, Turner S, Bryans M, et al. BMJ 2006 332: 692-696 (2) England E.Improving the management of dementia. BMJ 2006; 332: 681 - 682 (3) www.bgs.org.uk/PDF%20Downloads/WhoCaresWins.pdf (4) Inouye SK. Current concepts - Delirium in older persons. New England Journal of Medicine 2006; 354(11):1157-1165. (5) www.bgs.org.uk/Publications/Publication%20Downloads/Delirious- about-dementia.pdf Competing interests: All listed authors have received honoraria and/or hospitality from Shire as part of an unrestricted educational grant in support of the development of 'Delirious about Dementia'.