MBBS OSCE · Neurology
OSCE — Dementia
Eight-minute OSCE station on Dementia: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Dementia.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Dementia is an acquired, persistent, global impairment of higher cortical functions (memory, language, visuospatial skills, executive function, personality) occurring in clear consciousness, sufficient to interfere with activities of daily living. It is not a single disease but a syndrome. The commonest cause is Alzheimer disease (AD) (60 to 70 percent), driven by amyloid-beta 42 plaque deposition and tau-hyperphosphorylated neurofibrillary tangles with a cholinergic deficit; followed by vascular dementia (VaD), dementia with Lewy bodies (DLB) and frontotemporal dementia (FTD). Presentation is progressive and insidious in AD, stepwise in vascular, fluctuating with visual hallucinations and p
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Acute onset or fluctuating course suggests DELIRIUM, not dementia - search for a |
| Safety | Rapid progression over weeks to months raises suspicion of CJD, paraneoplastic l |
| Safety | Early, prominent behavioural/personality change with relative memory sparing poi |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.