Comprehensive Geriatric Assessment
Cognition, delirium and psychological health
Differentiate delirium, dementia, depression and other cognitive/psychological problems. Use baseline cognition and collateral history appropriately.
Learning objectives
• Differentiate delirium, dementia, depression and other cognitive/psychological problems. • Use baseline cognition and collateral history appropriately. • Recognise delirium as an acute clinical syndrome requiring cause-finding and prevention measures. • Keep cognitive impairment conceptually separate from decision-specific capacity.
Learner handbook (PDF)
Open source ↗Why this module matters
Acute confusion, dementia, mood symptoms and communication problems frequently overlap. Misclassification can derail the entire care plan.
Core teaching
Cognitive and psychological assessment should establish baseline cognition, look for acute change and consider mood, anxiety, distress and communication needs. Delirium and dementia can coexist; new inattention or fluctuating cognition should not be attributed to dementia without assessment for delirium and its causes.
NICE delirium guidance was updated in 2023 and supports active identification, prevention and assessment. Collateral history is often essential. Hearing and visual impairment can worsen apparent cognitive difficulty and should be addressed.
Cognition is not capacity. Capacity is decision-specific and time-specific and belongs to the dedicated legal framework. CGA should identify when capacity assessment may be needed, not infer incapacity from a cognitive score.
Case step
Mrs Morgan’s daughter says her mother was occasionally forgetful but managed bills and medication prompts. The current confusion fluctuates over hours. The learner must distinguish baseline cognitive vulnerability from probable acute delirium.
Interactive element
Delirium-versus-baseline timeline: learner labels acute fluctuation, collateral evidence and information still needed; a capacity warning appears if cognition is wrongly equated with incapacity.
Practice points
- Document baseline as well as current state.
- Use collateral information when history is incomplete.
- Convert every important finding into an action or explicit decision not to act.
- State uncertainty rather than disguising it as a score.
- Name ownership and review whenever the plan crosses teams or settings.
Reflection prompt
What will you change when assessing acute confusion in someone with pre-existing cognitive impairment?
