Diagnosis and specialist referral

Diagnosis of dementia:

Initial assessment in non-specialist settings

At the initial assessment take a history (including cognitive, behavioural and psychological symptoms, and the impact symptoms have on their daily life):

• from the person with suspected dementia
• and if possible, from someone who knows the person well (such as a family member).

If dementia is still suspected after initial assessment

• conduct a physical examination and
• undertake appropriate blood and urine tests to exclude reversible causes of cognitive decline and
• use cognitive testing

When using cognitive testing, use a validated brief structured cognitive instrument such as:

• the 10-point cognitive screener (10-CS)
• the 6-item cognitive impairment test (6CIT)
• the 6-item screener the Memory Impairment Screen (MIS)
• the Mini-Cog Test
• Your Memory (TYM)

When taking a history from someone who knows the person with suspected dementia, consider supplementing this with a structured instrument such as the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) or the Functional Activities Questionnaire (FAQ).

Refer the person to a specialist dementia diagnostic service (such as a memory clinic or community old age psychiatry service) if:

• reversible causes of cognitive decline (including delirium, depression, sensory impairment [such as sight or hearing loss] or cognitive impairment from medicines associated with increased anticholinergic burden) have been investigated
• and dementia is still suspected

If the person has suspected rapidly-progressive dementia, refer them to a neurological service with access to tests (including cerebrospinal fluid examination) for Creutzfeldt-Jakob disease and similar conditions.

Reference:

• NICE (June 2018). Dementia: assessment, management and support for people living with dementia and their carers