Specific Issues

The possibility of a comorbid condition suddenly worsening cognitive functioning should be strongly considered and often is the thrust of investigation in the ED. Urinary tract infection, congestive heart failure, or hypothyroidism are just a few of the conditions that may cause a mildly demented but functioning individual to rapidly deteriorate. The condition blurs with that of delirium as discussed above. The differential diagnosis is important particularly for consideration of depression imitators, the so-called treatable causes of dementia (T§ble 221-Z).

Depression may coexist with dementia; however, depression-imitating dementia (pseudodementia) should be considered. Appropriate inpatient or outpatient follow-up may be arranged for further psychiatric evaluation. If the patient is thought to be seriously depressed, consideration should be given to admission.

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