Dementia, Delirium and Cognitive Syndromes
Differential diagnosis, aetiology, presentation, investigation, management and prognosis of delirium and major neurocognitive syndromes.
How to prepare for MRCPsych Paper B
Integrate clinical formulation, safety and current UK practice with disciplined appraisal of design, bias, estimates and applicability.
Core concepts
Concept 1
Delirium is an acute, often fluctuating disturbance of attention and awareness caused by physiological stress, whereas major neurocognitive syndromes usually have a more persistent progressive or stepwise course.
Exam cue: Use onset, fluctuation, attention, arousal and precipitating illness to distinguish delirium from a chronic cognitive syndrome.
Concept 2
Cognitive assessment combines history, collateral evidence, function, mental and neurological examination, medication review and targeted investigations; a screening score is only one component.
Exam cue: Map the cognitive profile and functional consequence before considering likely aetiology and management.
Risk pitfalls and guardrails
Excluding delirium because a person already has dementia or because the presentation is quiet rather than agitated.
Guardrail: Do not choose an option because it is merely familiar or associated; show why it best answers this lead-in.
Treating one cognitive score as a diagnosis without language, education, sensory, mood and functional context.
Guardrail: Do not diagnose from one feature; establish context, course, impairment, exclusions and the classification system in use.
Memory anchors
What is the core bedside clue to delirium?
Acute or fluctuating impaired attention and awareness, often with altered cognition or perception.
Can delirium and dementia coexist?
Yes; dementia increases delirium risk, and an acute change requires a search for precipitating causes.
What makes cognitive impairment clinically major?
It interferes with independence in everyday activities, interpreted in the person's context.
Why obtain collateral history?
It helps establish baseline, onset, trajectory, function, safety and changes the person may not recognise.
What should management include after diagnosing dementia?
Aetiology-specific care where appropriate, risk and capacity work, physical health, support, future planning and review.
Checkpoint rule
Do the check-up only after you can summarize each concept in one sentence and identify one dangerous pitfall from memory.
Knowledge Check (after reading)
Short check-up to confirm understanding of this module.
Check-up Questions
A patient has gradual episodic memory loss followed by broader cognitive decline. Which pathology is classically associated with Alzheimer disease?
A patient has fluctuating cognition, recurrent well-formed visual hallucinations and spontaneous parkinsonism. What is most likely?
Answer all questions to submit.
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Move forward only after this module is stable.
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