Dementia: early signs and how it is assessed

What are the early signs?

Early symptoms are often mild and tend to progress very gradually. Alzheimer's disease is the most common form of dementia, and vascular dementia is usually the second most common.

Is forgetfulness always dementia?

The NHS says it is normal for memory to be affected by stress, tiredness, certain illnesses and medicines. It suggests talking to a GP if someone is becoming increasingly forgetful, particularly if they are over 65.

What happens at the GP?

NICE says a history from someone who knows the person well can be supplemented with a structured tool such as the IQCODE. The NHS says a GP may arrange blood tests to rule out other causes of memory problems. NICE also recommends cognitive testing with a validated brief tool, and says a normal screening result alone should not rule dementia out. The NHS says there is no single test for dementia, and that diagnosis rests on a combination of assessments and tests. Memory and thinking tests usually start with a GP, and a specialist may later arrange brain scans such as a CT or MRI scan.

When is a memory clinic involved?

NICE says dementia should be suspected after reversible causes such as delirium, depression, sensory impairment or the effects of some medicines have been looked into, and referral to a specialist dementia diagnostic service applies if it is still suspected. The specialist assessment includes a neurological examination and cognitive testing, and a dementia subtype is diagnosed where possible. The first memory clinic appointment is usually long, and people are asked to bring someone who knows them well.

What if it is unclear whether it is delirium or dementia?

NICE says that when it is unclear whether someone has delirium, dementia or both, the delirium is treated first. Delirium is a sudden state of confusion; NHS pages advise calling 999 or going to A&E for sudden confusion, because some causes can be life threatening and need prompt assessment.