OSCE APIE Scenario: Alzheimer's Disease

The Alzheimer’s scenario is a communication exam with clinical questions folded inside it. The actor performs confusion convincingly: repetitive questions, a fixed false belief, distress at correction, and the marks follow how you respond, moment by moment, before any task gets done.

Assessment. Two assessments run in parallel. The clinical one: observations if tolerated, hydration and nutrition (people with dementia quietly stop eating and drinking on wards), continence, skin, and the change-from-baseline question that finds delirium: is today different from her normal, and how fast did it change? The personal one: the “This is me” document or the family’s knowledge: routines, preferences, what her words and behaviours usually mean. Pain deserves its own line, because it hides: use an observational tool like Abbey (the pain station’s non-verbal branch) and treat new agitation as possible pain or delirium before treating it as behaviour.

Planning. Person-centred goals: needs met with the least distress, risks managed with the least restriction, family engaged as partners. The Mental Capacity Act frames every decision: capacity presumed, assessed per decision, best-interests process only where capacity is absent for that decision, least restrictive option always.

Implementation. The communication technique is the procedure here: approach in her eyeline, her name first, short sentences, one idea at a time, generous pauses, warm tone (tone outlives vocabulary in dementia). Don’t argue with her reality; validate the feeling and redirect. During care tasks: explain each step just before it happens, hand objects to her rather than doing everything to her, stop when she says or shows stop. For wandering: understand it, reduce triggers, distract, supervise; restriction is a legal last resort. For meals: quiet setting, one course at a time, finger foods if cutlery frustrates, time.

Evaluation. Distress down, intake up, needs met: measured against her baseline, not a textbook’s. Behaviour incidents reviewed for their trigger and the plan adjusted. Family informed and heard. And the reflexive check the examiner values most: did care happen with her, at her pace, or to her, at yours? The actor’s debrief answers that honestly, and so does the checklist.

Five questions below, then the anxiety and depression scenario, where the risk questions must be asked out loud.