Alzheimer disease

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Target exams

Red flags

• Acute fluctuating confusion on known Alzheimer disease — treat as delirium until proven otherwise; search infection, pain, constipation, retention, drugs, metabolic causes
• Bradycardia, syncope, or significant conduction disease before or during cholinesterase inhibitors — ECG review, hold drug, seek medical advice
• Severe aggression or psychosis with risk of harm — safety and medical exclusion first; antipsychotics only time-limited last line with explicit mortality counselling
• Rapidly progressive course over weeks — widen differential (CJD, autoimmune, space-occupying, toxic-metabolic); do not assume typical AD
• Unsafe driving, wandering, fire risk, or financial exploitation — capacity and risk management, not a cognitive score alone
• Young-onset or strong family history — specialist pathway; do not routine-test genes without counselling