Alzheimer’s disease - relevance to frailty and the emergency department
Alzheimer’s disease (AD) is the most common cause of dementia (≈60-70% of cases). In the ED it is encountered as pre‑existing cognitive impairment and frequently as an acute deterioration - commonly delirium superimposed on dementia. ED clinicians must:
- identify acute change,
- search for reversible precipitants,
- reconcile and safely continue anti‑dementia medications,
- optimise the environment and involve carers,
- ensure clear documentation and handover to primary and specialist care (NICE NG97; RCEM Silver Book).
Pathophysiology and clinical course
- Progressive neurodegeneration with beta‑amyloid plaques and tau tangles leading to synaptic dysfunction and neuronal loss.
- Typical progression: mild cognitive impairment → mild dementia (memory and executive deficits) → moderate dementia (increasing dependence, neuropsychiatric symptoms) → severe dementia (loss of basic activities of daily living).
- Comorbid frailty, sensory loss and polypharmacy are common and increase the risk of acute deterioration and adverse outcomes.
Presentation in the ED: what to expect
- Common reasons for attendance: falls, functional decline, behavioural disturbance, dehydration, infection, and delirium.
- On arrival document: baseline cognition and function (ask carer/family), known diagnosis (type and stage if known), current anti‑dementia and psychotropic medications, existing advance care plans and any capacity assessments.