What happens during an assessment for dementia?
This page tells you about the typical steps involved in an assessment for dementia.
Diagnosing dementia is often difficult, particularly if its in the early stages. This is because there isn't one simple test for dementia and the early symptoms can be similar to those of lots of other common conditions.
There is more than one way that you might end up being assessed for possible dementia. Most people start by visiting their GP because of their symptoms. The process which follows is described as steps 1-4 in this page and 'Receiving a diagnosis of dementia'.
If you are admitted to hospital, and are over 75 years of age, your assessment may start in hospital. This is because anyone over the age of 75 who is admitted urgently to hospital should now be assessed for confusion and memory problems.
If you visit your GP, even if you are visiting for another reason, they may ask you whether you are worried about your memory. This is because GPs are now encouraged to ask this question to certain patients at increased risk of dementia. You could be included in this group if:
- you have Parkinson’s disease
- you have had a stroke or a ‘mini-stroke’
- you are over 60 years of age and have diabetes or a heart condition.
If any of these apply to you, and you have been experiencing problems with your memory or thinking, you may need to have a further assessment. This could involve being referred to one of the specialists listed in Step 3.
The assessment process can vary. Not all the steps listed in this page will apply to you, and your experiences may be different to those explained here. However the assessment and diagnosis process for dementia typically follows the steps listed on this page.
Concerned about somebody else's memory?
Get advice on how to start a conversation with somebody who may be displaying early signs of dementia.
Step 1: Assessment by a GP
If you (are someone close to you) are worried that your symptoms may be a result of dementia, the first person to consult is the GP. You may see the GP in their surgery, or they may prefer to make a home visit, as it can be better to examine you when you are in a familiar environment. The GP will carry out the initial assessment in a number of ways, including:
- Taking a 'history' - the GP will spend some time talking to you and someone who knows you well. (The doctor may contact someone close to you by phone if they can't attend in person.) They will ask about how and when your symptoms started and how they are affecting your life. The GP will look at your, and your family's, medical history. They will also review any medicines you are taking.
- Physical examinations and tests - the GP may carry out a physical examination, particularly if there is a chance you have had a stroke, or have Parkinson's disease. They will also take samples (blood and possibly urine) to send off for tests. These may identify other conditions that are causing the symptoms, such as thyroid problems or vitamin deficiencies.
- Tests of mental abilities - the GP will ask you a series of questions or give you a short pen-and-paper test. These are designed to test your thinking, memory and orientation.
After their assessment, the GP will explain their findings and discuss what actions need to be taken. They will probably not be able to make a diagnosis at this stage. If they are able to make a diagnosis of dementia, they might be able to identify what type of dementia it is - but this is usually only possible if the condition is more advanced, or if it is a more common type of dementia (such as Alzheimer's disease).
It is likely that the GP will refer you for further assessment to get more information to help make a diagnosis.
Step 2: Referral to a specialist
You may be referred to a specialist service for further assessments. This might be a memory assessment service, memory clinic or other specialist service within a community mental health team. These services are set up especially to assess people with memory problems. They have teams of different types of health professionals who can look at your case in more detail.
Normally it will be the GP that refers you to a specialist centre for further assessment, if they think this is necessary. If you (or someone close to you) feel that a referral would be helpful, but the GP has not yet suggested it, you can ask them to refer you.
Sometimes people choose not to carry on with any further assessments - for example if they choose not to find out if they have dementia. If this is the case, you can tell the GP that you do not want to be assessed any further. A specialist (such as a consultant) will have more knowledge and experience of assessing dementia than a GP. They will also have more time allocated for appointments and access to more specialised investigations such as brain scans and in-depth mental testing. Once you have been referred, you should not have to wait longer than 4-6 weeks to see a specialist.
The GP will make the referral to a consultant with special expertise in a particular area of medicine. Who they refer you to may depend on your age and symptoms, and the kind of consultant available in your area. The main types are explained below.
- Old age psychiatrists are psychiatrists who specialise in the mental health of older people, and also dementia. They may sometimes offer support to younger people with dementia.
- General adult psychiatrists specialise in diagnosing and treating a wide range of mental health problems, as well as dementia. If you are under 65 years of age, you may be referred to one of these psychiatrists to help with the diagnosis.
- Geriatricians specialise in the care of older people, including physical illnesses and disabilities. You may be referred to one of these specialists to see whether your symptoms are due to a condition other than (or as well as) dementia.
- Neurologists specialise in diseases of the brain and nervous system. Some neurologists have particular experience in diagnosing dementia. They tend to see younger people and those with less common types of dementia.
The consultant usually works in a specialist team, alongside a number of doctors at various stages of training in that particular specialty. Although you may not always see the consultant, they are responsible for your case and will discuss it with the doctor you see. The consultant also works with other health professionals during the assessment. These might include:
- mental health nurses
- occupational therapists
- social workers
- dementia advisers (professionals who provide information, advice and guidance to people with dementia and their carers).
Step 3: Assessment by a specialist
Assessment for dementia by a specialist can be a confusing and daunting prospect. Many memory services offer pre-diagnostic counselling. This is a chance for you to talk things over with a health professional before your assessment. You can choose to have somebody you trust such as a partner, friend or family member with you for this.
The discussion can be an opportunity to share what you already know about dementia, express your wishes and raise any concerns you have about the assessment process. However, if you do not receive counselling before your assessment, you can still ask questions at any time during the assessment process. Having counselling, or asking questions at another point, can help you to:
- understand the reasons why you have been referred
- learn more about the assessment process
- give consent (or not) to go ahead with the assessment
- prepare for the possibility of receiving a diagnosis.
You may be asked if you want to know your diagnosis at the end of the assessment process. If you don't want to find out your diagnosis, the specialist can discuss this with someone you trust instead of with you directly.
The specialist's assessment may take place at your home or at a hospital. They will gather information about you and your symptoms (in more detail than the GP) by:
- Taking a history - as with the GP, the specialist will talk to you and those close to you for up to 90 minutes.
- Physical examinations and tests - if these have not already been carried out by the GP.
- Tests of mental abilities - you will have a more detailed assessment of your memory and other thinking processes. This assessment consists of a range of pen-and-paper tests and questions. These will test things like your memory, orientation, language and visuospatial skills (for example, copying shapes). These tests can be very good at helping to determine the type of problem you might have, particularly in the early stages. The assessment can also be used as a baseline to measure any changes over time, which can help with making a diagnosis. The test is often given by a trained professional such as a mental health nurse or occupational therapist. In some cases you will be assessed by a clinical psychologist or neuropsychologist (professionals whose speciality includes the diagnosis of mental health problems).
- Scans - you might be sent for a brain scan. This might involve a wait of several weeks. There are a few different types of brain scan, which are explained below.
Types of brain scan
CT (computerised tomography), CAT (computerised axial tomography) and MRI (magnetic resonance imaging) scans are widely used. They all show structural changes to brain tissue.
SPECT (single photon emission computerised tomography) and PET (positron emission tomography) scans are less widely-used. They show changes in brain activity.
CT and MRI scans can identify conditions with similar symptoms to dementia such as a brain bleed, tumour or build-up of fluid inside the brain. If there is dementia, these scans may show that the brain has shrunk in certain areas, particularly those involved in storing short-term memories. MRI may show changes caused by damaged or diseased blood vessels in the brain, potentially indicating that a stroke may have occurred at some point, which could lead to vascular dementia.
SPECT and other more specialised scans can show areas where brain activity is reduced. These are mostly used if the diagnosis of dementia type is still unclear after a CT or MRI scan.
Sometimes a brain scan may not find any evidence to explain your symptoms. If this happens, the doctor may arrange for another scan to look at your brain using a different method. They may also ask you to come back for some more detailed tests.
A scan showing no unexpected changes in the brain does not rule out conditions such as Alzheimer's disease. This is because during the early stages of the disease the changes can be difficult to distinguish from those seen in normal ageing.
Step 4: Outcome of the assessment
Once the assessment process has finished, the specialist will begin to make a diagnosis. To do this, they will bring together all the information they have gathered from your medical history, symptoms, physical exams, tests and any scans you have had.
Once all the information has been collected and analysed, the specialist will make their diagnosis. They may find that your symptoms are caused by dementia. If this is the case it is likely that they will be able to diagnose the type or cause of dementia (for example, Alzheimer's disease or vascular dementia).
You will then have a consultation meeting with the specialist to discuss your results (see 'Receiving a diagnosis of dementia').
You can change your mind about whether you want to know your diagnosis at any time during the assessment process, and your wishes will be passed on to your consultant.
If the specialist has been able to make a diagnosis, they will write a letter to your GP with the details of the diagnosis. The letter might also include other information such as a recommended care plan. This plan will give details of the support or care you might need in the future. It explains options for you to access this support if you need it.
In some cases the consultant may diagnose mild cognitive impairment rather than dementia, especially if they think your symptoms are not causing you severe difficulties with daily living, or if they could be explained by another condition such as depression. if this is the case, the specialist may discharge you back to your GP. If your symptoms get significantly worse after 6-12 months you would be re-referred back to the consultant.
Mild cognitive impairment
Sometimes a dementia assessment might lead to a diagnosis of MCI (mild cognitive impairment).