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Table 1 Challenges of diagnosing dementia in the oldest old

From: Dementia in the oldest old: a multi-factorial and growing public health issue

Challenges Repercussions
Medical illness, sensory loss (vision/hearing), and physical impairments increasingly contribute to functional decline Functional impairment is overestimated, leading to overdiagnosis of dementia
Retirement and restricted household responsibilities lead to reduced cognitive demands Functional impairment is underestimated, leading to underdiagnosis of dementia
Cognitive decline may be considered part of normal aging Functional impairment is underestimated, leading to underdiagnosis of dementia
Increased likelihood of cognitive impairment in collateral informants of the oldest old compared with the younger old Functional impairment is underestimated, leading to underdiagnosis of dementia
Lack of normative neuropsychological data Objective cognitive impairments are overestimated or underestimated, leading to misdiagnosis
Limitations of standard diagnostic criteria More sensitive for some dementia subtypes, less sensitive for other types