Ethics of Dementia Care

Potentially reversible dementias comprise a heterogeneous group of physical and psychiatric conditions that may be identified in approximately 10% of patients presenting with symptoms of dementia. There is evidence that the prevalence has fallen in the last twenty years. Depressive illness, structural brain lesions and normal pressure hydrocephalus account for more than half the cases and recently identified causes include the autoimmune encephalopathies. Reversible dementias tend to be more common in younger patients (under 70 years of age). Treatment of the underlying condition should be vigorously pursued although complete reversal of cognitive impairment is rare, occurring in less than 10% of identified cases. Care protocols for the assessment of patients presenting with memory disorders should include as basic minimum a full blood count, serum electrolytes and calcium, thyroid, liver and kidney function, random glucose, vitamin B12 and folate levels, and brain neuro-imaging (either magnetic resonance or computed tomography).