Assessing dementia. Part II: Clinical, functional, neuropsychological and social issues

Comprehensive assessment of the dementing person entails looking beyond syndromal diagnosis to broader aspects of the individual's functioning and circumstances. Systematic attempts are being made to conceptualize the stage, severity and sub-type of dementia and these may prove useful in daily practice. Clinical aspects of a broader assessment include attention to possible coexisting psychiatric syndromes and the disruptive behavioural changes common in dementia. In addition, alternative perspectives to the medical model can contribute valuable information for future planning. Functional assessment can delineate lost abilities that limit the person's adaptive capacity and indicate retained skills necessary for independent living. The neuropsychological approach can identify spared abilities and specific impairments, as well as quantifying changes over time. Attention to social issues can clarify the strengths and deficiencies of the support network and define the burdens of caring. A general approach, which emphasises the need for dementia assessment to be comprehensive, multidisciplinary, naturalistic, intervention oriented, practical and longitudinal, is proposed. This assessment approach is closely linked to the most important role of the clinician, that of continuing care and management.