Diagnosis and management of dementia in older people

The diagnostic criteria for dementia are increasingly based on molecular rather than clinical features. In particular, dementias associated with fronto-temporal lobe degeneration are now classified as tau-positive or tau-negative, with specific genetic variants associated with sub-types of these two broad categories. Management guidelines for dementia in the community are well established, but this is not the case in the acute hospital setting where diagnosis may be more difficult and co-existing age-associated morbidities and informant history require specific attention. The management of behavioural and psychological symptoms of dementia in the acute hospital setting may also be challenging – non-pharmacological and alternative pharmacological interventions are available that may avoid the need to prescribe antipsychotic drugs.