How dementia is assessed and diagnosed


Expert reviewer Professor Graham Stokes, Bupa Global Director of Dementia Care
Next review due September 2020

When there are concerns that someone is having memory problems or may have dementia, the first step is for them to visit their GP. It’s usually best for a close family member to go too, to fill in any gaps and verify any information.

The GP will need to rule out any other possible causes of confusion or memory problems. They’ll do a physical examination and ask about medical history and recent problems. If they think dementia is the cause, they’ll refer on to the local mental health team or memory clinic.

Diagnosing dementia can be difficult and take time. You probably won’t get a definite answer from the GP immediately. In older people, other conditions can be confused with dementia, including delirium and depression. It is very important to see a health professional though – you can’t diagnose it on your own.

Can I go to a loved one’s GP appointment?

You can go with someone to their GP appointment if they agree. If they don’t, the GP may ask to see you separately or telephone you later. Without permission, the GP won’t be able to give you any details about the patient’s case, but they can listen to the information that you give them.

Even if you are there at the appointment, there may be some questions the GP wants to ask you separately so as not to embarrass or upset your loved one.

If your loved one refuses to go to the GP, you can still contact their GP to tell them about your concerns. If you agree, the GP can then speak to the patient to tell them you’re worried about them and try to persuade them to come to the surgery.

What will happen at the GP?

What the GP will ask

It helps to have some idea of what the doctor will ask during the consultation so that you can be prepared. You may also want to jot down any questions you have in advance – it’s easy to forget at the time.

The doctor will ask about dementia symptoms. They’ll want to know if these changes have come on gradually or suddenly. They may ask about:

  • memory problems and confusion
  • ability to pick up new information
  • behaviour and any signs of personality change

Examination

As well as asking about dementia symptoms, the doctor will need to do a general health assessment. They’ll carry out an examination and do some basic tests such as blood tests. This is done to rule out other possible causes such as thyroid problems.

What happens next

The GP is unlikely to confirm a diagnosis of dementia on the spot. They may say they suspect it. In most cases, they’ll make a referral to the local memory clinic or older persons’ mental health team for a fuller assessment.

In some cases, the GP may suspect there could be another cause for the dementia-type symptoms. They may arrange some more tests. This could include a chest X-ray and urine test to rule out infection. They may also organise a hearing test. It may seem surprising but poor hearing can be mistaken for confusion in elderly people.

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Seeing other specialists

If the GP suspects dementia, they’ll make a referral to the local mental health services for older people, or the local memory clinic. These services will carry out more tests, to make a formal diagnosis of dementia. They’ll also start the most suitable treatment.

In some cases, the GP may also refer to a late-life psychiatrist or a neurologist. Neurologists specialise in diseases of the brain or nervous system. The GP will usually only refer to these specialists if:

  • they’re not sure if the symptoms are caused by dementia
  • the person with suspected dementia is under 65 years old
  • the symptoms seem to be getting worse more quickly than is normal
  • there are significant behavioural problems
  • the symptoms may be reversible; for example, if the GP thinks they’re caused by vitamin B12 deficiency
  • there are prominent difficulties with movement, such as slowness, stiffness or tremor (shakes)

If the GP suspects a physical illness such as Parkinson’s disease, they may make a referral to a geriatrician (a doctor who specialises in diseases of older age).

You usually have to wait a few weeks for an appointment at a memory clinic. These, and older adult mental health teams, are usually based in the community, perhaps at a local community hospital. Some are based at the local district hospital. If you’re referred to a specialist or for a scan, this will be a hospital appointment.

What tests are there for dementia?

The most widely used test for dementia is called the Mini-Mental State Examination, or MMSE. There are others, called the GPCog, Memory Impairment Screen and Mini-Cog, but they’re all similar. They are designed to pick up issues in a number of areas known to be a problem in dementia, such as memory, concentration and attention.

A range of health professionals often work together to carry out this testing. This can include a psychiatric nurse and a psychologist. As part of the test, they may ask the person being tested to:

  • repeat words back to them
  • name as many of something as they can (animals, for example)
  • do some simple maths
  • follow simple commands
  • do some simple drawing, such as copying shapes or drawing a clock

They will also ask questions to find out whether the person knows where they are, what is happening and the time and date.

If your loved one is being tested, it’s important not to jump in to help. You’ll be able to answer most of the questions, but the purpose is to see if your loved one can remember for themselves. The way they answer the questions can also reveal more about their condition. For instance, they may or may not remember the right words to use, or speak fluently or hesitantly. You may be asked for any missing information later.

Diagnosing dementia is difficult, particularly in the early stages. No single test can provide a definite diagnosis. In some cases, mental examination tests might be repeated a few months later to see if the results have changed.

While it’s understandable that many people look for information on how to diagnosed dementia, it isn’t possible to diagnose dementia yourself. It’s really important to see a doctor if you’re concerned about yourself or a loved one. This is because you can then access available treatment. The doctor will take the results of the mental state exam into account when coming to a diagnosis. But they’ll put it together with the results of a physical examination, any physical test results, any dementia symptoms, past medical history, and general mood and appearance.

You may find quizzes and tools online that claim to be able to spot dementia symptoms. Some may be based around the tests that clinicians use, but it’s important to remember that these don’t work as stand-alone tools. They always need to be delivered and interpreted by a medical professional.


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Related information

    • Psychiatry. Oxford Handbook of Geriatric Medicine (online). Oxford Medicine Online. oxfordmedicine.com, published June 2012
    • Can I speak to a GP about someone else's health? NHS Choices. www.nhs.uk, last reviewed July 2015
    • Assessment of dementia. BMJ Best Practice. bestpractice.bmj.com, last updated August 2016
    • Mental Health. Oxford Handbook of General Practice (online). Oxford Medicine Online. oxfordmedicine.com, published April 2014
    • The evaluation and formulation of dementia. Practical Dementia Care (online). Oxford Medicine Online. oxfordmedicine.com, published May 2016
    • Map of Medicine. Dementia. International View. London: Map of Medicine; 2016 (Issue 4)
    • Assessment of memory deficit. BMJ Best Practice. bestpractice.bmj.com, last updated February 2016
    • Dementia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2016
    • English National Memory Clinics Audit Report. Royal College of Psychiatrists, 2013. www.rcpsych.ac.uk
    • UK Memory Services and Clinics. Royal College of Psychiatrists. www.rcpsych.ac.uk, last updated November 2012
    • Older People: Dementia: NICE and SIGN on dementia. GP Update Handbook (online). GP Update Ltd, gpcpd.com, accessed January 2017
  • Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, September 2017
    Expert reviewer Professor Graham Stokes, Bupa Global Director of Dementia Care
    Next review due September 2020



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