Dementia: diagnosis and emergency behavioral complications.

Dementia is a relatively common syndrome seen in the elderly emergency department population. The emergency physician usually sees demented patients secondary to behavioral complications. Diagnosing the syndrome of dementia principally consists of ruling out treatable causes, which can be performed either in an in-patient or out-patient location. The emergency presentations of dementia include disturbances of activity, aggression, and psychosis. Complications that are primarily treated non-pharmacologically include circadian rhythm disturbance, catastrophic reaction (excessive emotional response), and wandering, as well as some mild verbal outbursts and delusions. Pharmacologic interventions are usually necessary for agitation, physical attacks, and significant delusions or hallucinations. Neuroleptic medication is the principal pharmacologic class with which to treat these symptoms, although benzodiazepines are also effective.