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)