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Assessment
and diagnosis
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DISC Tel: 0845
120 4048 email: info@disc.org.uk |
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
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.
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.