Assessment and diagnosis

  

   DISC

   Oxford Dementia Centre

   Institute of Public Care

   Roosevelt Drive

   Oxford OX3 7XR

   Tel: 0845 120 4048

   www.disc.org.uk

   email: info@disc.org.uk

 

 

 

 Home

 

 

 

 

 

This fact sheet offers information on the way in which dementia is assessed and diagnosed.

 

You may also find the following fact sheets helpful:

 

·            What is dementia?

·            Treatment and therapy for people with dementia

·            Making your home dementia friendly

·            Enduring power of attorney and receivership

 

Is it dementia?

 

When people become aware of difficulties in thinking, remembering or reasoning, they react in different ways.  The person you care for may have become angry and frustrated but often there is a strong desire to ‘mask’ or cover up these changes by making excuses or avoiding situations where the extent of the problems might be revealed.  Carers often go along with this behaviour until some of the difficulties described above begin to get in the way of a person’s ability to carry out activities of daily living, such as washing, dressing and cooking or there is some sort of crisis.

 

At this point GPs are usually the first people to be approached by carers for an explanation and a diagnosis of the symptoms.  According to guidelines for assessment of dementia in primary care, doctors are recommended to:

 

·            Seek information about the difficulties from both the individual and their family

 

·            Take a medical and social history

 

·            Carry out a physical examination

 

Information drawn from these sources will enable GPs to identify whether there is a treatable reason for memory loss including infections, other conditions or psychological illness.

 

An assessment or test of memory and brain function should also be carried out. The most common tool used by GPs is a short questionnaire known as Mini Mental State Examination (MMSE).

The person with suspected dementia is asked to answer a series of questions and the final score gives some indication of whether there are problems with memory.  You may find that your family doctor is reluctant to make an assessment or diagnosis of dementia and may refer the person for a specialist assessment.  The initial symptoms of dementia are very similar to depression or acute confusion and it is often hard to distinguish them.  There may be a case for a short course of medication if the person has severe depression.  However some people with dementia will benefit from anti-dementia drugs for which a specialist assessment is needed.

 

A specialist assessment should also be carried out for people where:

 

·               Diagnosis is very uncertain

·               People are demonstrating severe behavioural or psychological symptoms eg they are hitting out at people or constantly shouting

·               There are safety concerns eg wandering away from home and getting lost

·               There are risks of abuse or self harm

·               There is a need for a specialist assessment of testamentary capacity

(ie making a will) or driving

·               Complex or multiple problems are being experienced (for example, the person is abusing alcohol)

·               There may be a dual diagnosis eg dementia and learning disability

 

Specialist Assessment

 

If a person with memory difficulties is referred for specialist assessment, they will usually be seen either in the local Department that deals with mental health assessment by a psychiatric geriatrician or a Memory Clinic where these are available locally. In some areas, a home assessment visit can be arranged.  Depending on the set up of the service, a number of different professionals will be involved all of whom have expertise in particular areas.

 

The assessment often begins with a psychiatric history undertaken by the psychiatric geriatrician (a consultant who specialises in the psychiatry of old age).  This will enable other conditions, which perhaps initially look like dementia to be ruled out.  Therefore it is likely that:

 

·               A psychiatrist will investigate aspects of physical and mental ill health.

 

·               A psychologist will test thinking, memory and behaviour.

 

·               An occupational therapist assesses physical function including movement.

 

·               A social worker who is also a care manager, may be asked to discuss how the carer is coping with aspects of day-to-day life to see what local authority help they might be eligible for

 

Carers are often called upon to provide information if the person is not able to themselves.

 

The following areas are usually covered:

 

·               When the symptoms began, the progression of the condition and the pattern of symptoms

·               Previous personality as reported by carers or other family members

·               Past medical history, with careful note taken of any head injury, epilepsy, disorder in any of the major body systems, cancer

·               Co-existing medical conditions and any medications being taken which may have triggered memory and reasoning abilities

·               Alcohol and tobacco consumption

·               Family history, (including major illnesses) as some diseases associated with dementia are hereditary

·               Personal and family circumstances (although these are not important in making the diagnosis, they need to be considered in planning care and support)

 

Diagnosis

 

Once a comprehensive assessment is completed all the information is collected and it is possible to make a diagnosis in many cases, although only a post mortem can reveal dementia with 100% certainty.

 

Living with uncertainty

 

Many carers will be living with someone who has a diagnosis of ‘possible’ dementia.  The lack of certainty along with the absence of a cure can be extremely difficult to live with.  There are services available to support carers and the person they care for to maintain the best possible quality of life.

 

 

 

This fact sheet can be made available in large print.

 

We are constantly looking to improve our information.  It helps if you let us know whether the information in this fact sheet was/was not useful and if there are other fact sheets that you would have found helpful that we have not yet provided.

 

While the information contained in this fact sheet is believed to be correct, DISC does not accept liability for any error/s it may contain.