Regarding dementia, which of the following is NOT a recognised feature of this condition?

a. A fluctuating level of consciousness suggests a diagnosis of delirium rather than dementia the latter of which can be defined as the deterioration of cognitive functions, such as memory, concentration and judgement, and personality and behavioural changes resulting most commonly from an intrinsic disorder of the brain but infrequently from a reversible organic cause. Dementia typically presents with features of cognitive impairment manifests as forgetfulness, inability to recognise familiar objects, persons and places, and behavioural manifestations that may range from wandering behaviours to aggression or emotional lability and inappropriateness. Dementia encompasses a wide range of disease pathologies such as vascular dementia, neurodegenerative aetiologies such as Pick’s disease and Alzheimer’s disease, infectious processes and metabolic, endocrine and traumatic derangements, some of which may ameliorate with correction of the abnormality.

Sundowning is a phenomenon that is common to both dementia and delirium and describes the worsening of symptoms that occurs towards the end of the day. It has been postulated that the reduction in ambient light levels and external cues causes an increase in disorientation and this forms the basis of simple nursing strategies for orientating demented patients. Strict adherence to routines such as medication timing, bright lighting and set sleep–wake patterns and reinforcement of external cues such as the time, date and place are important nursing tasks that can make a significant difference in the care for this often difficult but vulnerable population.