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Delirium in dementia — DGM MCQ

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EasyDeliriumDelirium in dementiaDGM

An 88-year-old woman with known Alzheimer's disease is suddenly more confused and sleepy. Her daughter says she usually recognises family and eats independently. She now has inattention and new urinary retention. Current medicines include donepezil and amlodipine. What is the most likely diagnosis?

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Correct answer: A — Delirium superimposed on dementia

A sudden change from baseline with inattention in someone with dementia indicates delirium superimposed on dementia. Dementia progression is slower, remote vascular dementia does not explain the acute change, insomnia alone does not cause inattention, and mild cognitive impairment is too mild. Known dementia increases delirium risk but should not be used to dismiss acute deterioration.

Reference: NICE CG103; NICE NG97