Screening for Cognitive Deficits or Diagnosing Dementia?
CQUIN guidelines issued by the UK Government conflate two separate processes: screening for cognitive deficits and diagnosing dementia. The difference is illustrated by the case of an elderly patient admitted to a hospital emergency unit at midnight. Screening for cognitive deficits is an important part of the initial assessment—if a patient is disorientated and drowsy then the patient may be delirious and this is important to recognise, investigate and treat. Dementia is a chronic condition and should only be diagnosed once acute causes of cognitive dysfunction have been excluded, so it is not an appropriate time to try to diagnose or 'case find' dementia. Dementia diagnosis needs to be carried out once the patient has had their medical problems treated, is properly rested and in a calm environment.