Dementia and major neurocognitive disorder

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Target exams

Red flags

• Acute cognitive change on a dementia background — treat as delirium until proven otherwise; search infection, drugs, metabolic causes
• Visual hallucinations, fluctuations, RBD, and parkinsonism — think DLB; extreme caution with antipsychotics (neuroleptic sensitivity)
• Early behavioural disinhibition or language collapse with relative memory sparing — consider FTD spectrum, not late-life AD alone
• Antipsychotic for 'agitation' without medical work-up or non-drug plan — mortality risk in elderly dementia; black-box-style caution
• Bradycardia, syncope, or significant conduction disease before or during cholinesterase inhibitors — review ECG and drugs
• Unsafe driving, wandering, fire risk, or financial exploitation — capacity and risk management, not only a cognitive score
• Young-onset or rapidly progressive course — widen differential (autoimmune, CJD, space-occupying, reversible causes)