Consideration of possible diagnosis of dementia

Establishing a diagnosis of dementia is a complex assessment and usually requires several consultations.

Below is a framework for the initial assessment, however, several more consultations may be required. Similarly, fewer consultations may be required if the presentation is less complex.

Consultation 1: Usually an unanticipated visit where concerns are first identified by the patient, the GP or sometimes a relative. This consultation involves:

  • A brief history of the problem
  • GPCOG (or equivalent cognitive assessment tool)
  • Consideration of differentials:
    • Medication review
    • Rule-out delirium
    • Consider depression

Consultation 2: Collection of Information

  • More detailed history taking
  • Consider using Geriatric Depression Scale
  • Bloods
  • Invite a relative to attend next consult for collateral, if the patient consents.

Consultation 3: Collateral and Review

  • Further clarification of symptoms
  • Collateral if possible
  • Review of  blood results
  • Consider direct referral for CT or MRI brain (if accessible)

Consultation 4: Review and Disclosure

  • Review history and investigations to date.
  • Disclose diagnosis or
  • Disclose your impression of the most likely diagnosis and explain referral pathways
  • Provide relevant Patient Information Leaflets (PIL)