Mental Issues and Treatment - Dementia Brief

by Rick Doray*

In the field of medicine there are three categories of diagnostic errors to which a doctor or clinician can fall prey. First, there are lack of data errors. A health condition may present silently or atypically. It may be a new disorder. Sometimes health care providers just do not have enough data to make an accurate diagnosis. This type of error is very difficult to eliminate. Hopefully, these errors will be reduced and committed less often as medical/health knowledge advances. Type 2 errors are healthcare system errors. These errors can be caused by specialty competition for resources in a health facility or by system redesign changes. Health systems can be overtaxed and errors can result due to a lack of available resources.

Type 3 errors are cognitive errors and are committed by the provider. These types of errors are caused by insufficient data collection; data misinterpretation; a lack of system-level checks, such as second opinions, specialist consultations and laboratory results; or even carelessness (Graber, Gordon, Franklin, 2002). Clinical personnel should be careful to not make rushed analysis or avoid using system level checks to ensure their diagnosis. Residents and Physician Assistants need second opinion approval from qualified supervising providers to enter a diagnosis on a patient's chart; it might be well if all chronic condition diagnoses were peer reviewed to ensure consensus and accuracy.

There are more than 70 conditions which can cause dementia. Clinicians may fall into the "trap of commonality" to diagnose a condition as dementia when it may be something else. Clinicians may also misclassify a temporary dementia condition as permanent. This misdiagnosis can haunt a patient even after the condition causing the dementia has been ameliorated or cured. It is important that health service providers be alert for reversible dementia conditions so timely treatment can follow. If not, permanent damage can be done to the patient's nervous system. Clinicians should not be in such a rush that delirium is diagnosed as dementia.

Apparent Dementia may be due to other conditions. Polypharmacy, the interaction between multiple drugs that the patient may be taking, should be watched for. The mix of different medications may produce temporary conditions in a patient that mimic the onset of dementia. The patient improves as the drugs are secreted from the body. This process normally takes longer to happen in the elderly as opposed to younger people.

Normal Pressure Hydrocephalus, or NPH, causes the ventricles of the brain to fill with fluid. Sufferers of NPH begin to have cognitive and motor complications that present as dementia. NPH is treatable and the patient can return to precondition functionality, but only if caught before permanent damage has been done to the brain. Depression may be another condition which can be misdiagnosed as dementia. A patient under assessment may give a multitude of lack of response or I don't know answers which may be seen as a mild onset of dementia. In reality they are suffering from severe depression. This pseudodementia may show considerable improvement as the patient is successfully treated for depression.

Clinical assessment should take a multifaceted approach. A clinician needs to take into account the patient's physiological and social state as well as their psychological one. Clinicians should be just as careful to rule out all possible diagnoses as they are to code one. Assessment needs to take into account the particular needs of the patient, both cognitive and physical. For example, a slowed motor response may be due to arthritis and not to reflex inhibition. Difficulty in answering written questions may be due to poor eyesight or lower education achievement.

The clinician needs to be sensitive to the particular cultural differences of the patient and how that difference may affect the interaction between provider and patient. These differences can be particularly pronounced between male providers and women of certain cultures. For example, Muslim women may be reluctant to fully engage younger male staff members. Older Veterans with PTSD may not wish to interact with clinicians who are perceived to be of the nationality of an opposing force in a previous military engagement*. Clinicians need to be familiar with the 2003 APA approved guidelines for clinical work with older adults. These guidelines will help providers become proficient working with older adult populations.


1. Graber, M., Gordon, R., & Franklin, N. (2002). Reducing diagnostic errors in medicine:  What's the goal? Academic Medicine, 77, 35-46.

* Note: Aug 31, 2010 - This is my brief.  I didn't originally put a byline on it since I figured it was being posted on my blog.  But I have found this article posted without attribution around the web.  Which it is fine to post it if you want - but I want to maintain my rights as the author, so please make sure you add the byline as well.  Thanks.