clinical features

Last reviewed 08/2023

Dementia may generally be described as referring to a widespread deterioration in mental function, without impairment of consciousness.

Suspect dementia when

  • family members report to the physician about memory impairment but the patient denies it (1)
  • the patient is questioned, he/she looks at the carer for an answer - the ‘head-turning sign’ (2)

widespread deterioration in mental function. This refers to the loss of a variety of abilities in the spheres of:

  • decline in memory – mostly impairment of learning new material or retaining new information (1), repetitive questioning, difficulty recalling time or date (2)
  • failure of other areas of higher cognitive functioning which  will affect normal daytime activities and executive functions  (1,3) –
    • difficulty in performing complex tasks
    • difficulties in judgement and planning, analytic thought
    • problems in finding one’s way around familiar places (spatial awareness) - 
    • impairment in language – problems with expressing themselves or getting “lost” in conversations (1)
  • challenging behaviour (behavioural and psychological symptoms of dementia (BPSD)
    • depression
    • apathy
    • agitation
    • disinhibition
    • psychosis (delusions or hallucinations)
    • wandering
    • aggression
    • incontinence (4)
    • challenging behaviour is frequently associated with high levels of strain and distress for the family carers and has been a common cause of admissions to institutional care (4)
  • the basic tasks of self-care

If impairment of consciousness is present together with general intellectual impairment, then the condition is defined as delirium or confusional state - acute or sub-acute.

The clinical picture at any one time is determined by:

  • the patient's previous personality and intellectual endowment
  • the nature of the pathological process and the stage that it has reached