Establishing a diagnosis of dementia is a complex assessment and usually requires several consultations.
Below is a framework for the initial assessment, however, several more consultations may be required. Similarly, fewer consultations may be required if the presentation is less complex.
Consultation 1: Usually an unanticipated visit where concerns are first identified by the patient, the GP or sometimes a relative. This consultation involves:
- A brief history of the problem
- GPCOG (or equivalent cognitive assessment tool)
- Consideration of differentials:
- Medication review
- Rule-out delirium
- Consider depression
Consultation 2: Collection of Information
- More detailed history taking
- Consider using Geriatric Depression Scale
- Invite a relative to attend next consult for collateral, if the patient consents.
Consultation 3: Collateral & Review
- Further clarification of symptoms
- Collateral if possible
- Review of blood results
- Consider direct referral for CT or MRI brain (if accessible)
Consultation 4: Review & Disclosure
- Review history and investigations to date.
- Disclose diagnosis or
- Disclose your impression of the most likely diagnosis and explain referral pathways
- Provide relevant Patient Information Leaflets (PIL)