How is dementia diagnosed?
Dementia is difficult to diagnose in some people. In the beginning, symptoms are often put down to other causes. There may also be a degree of protection by friends, carers and relatives who help the person to look after themself and, by doing so, cover up the person's inability.
Saying that, commonly, it is not the person with the symptoms but rather their relatives, carers or friends who have concerns that the person may have dementia. They may be concerned about the person's memory or behaviour. However, people with a high intellect or a demanding job may notice themselves that their mental ability is starting to fail.
Visit your doctor
The first step if you are concerned that you may be developing dementia is to see your doctor. Or, if you are worried that someone close to you may have dementia, you should encourage them to see their doctor. They may agree for you to see their doctor with them.
Your doctor may suggest some special tests to look at your memory and mental ability, to see whether dementia is likely or not. This does not take long and is usually a series of questions or other exercises that your doctor asks you to complete.
Your doctor may also suggest some routine tests to make sure that there are no other obvious causes for your symptoms. For example, blood tests to look for infection, vitamin deficiencies, an underactive thyroid gland, etc. If infection is suspected, they may suggest a urine test, a chest X-ray or other investigations. They may also ask questions to make sure that your symptoms are not due to, for example, depression, any medicines that you may be taking, or excess alcohol intake.
Referral to a specialist
Referral for the opinion of a specialist is usually needed to confirm the diagnosis of dementia. This is usually to one of the following:
- A specialist memory clinic.
- A psychiatrist specialised in looking after older people.
- A specialist in the care of elderly people.
- A neurologist.
The specialist may be able to determine the likely cause of dementia and decide if any specific treatment may be helpful (see below). To help with this, they may suggest further investigations such as a magnetic resonance imaging (MRI) scan of the brain.
Other more sophisticated tests may be done if an unusual cause of dementia is suspected.
Usually referral is made to a specialist team as early as possible. This is partly so the person developing dementia and their carers can obtain advice about advance planning. In the earlier stages, people are better able to make decisions about how they wish to be cared for. They are also better able to decide who they want to manage their affairs once they become unable to do so themselves. Special memory clinics give lots of information on dementia and how to manage it. Sometimes before dementia is established, there is an earlier phase called mild cognitive impairment. People with mild memory symptoms are often referred to the specialist clinics, so that they can have information early. This is in case their symptoms get worse and turn into dementia.
Research is underway to try to find ways of diagnosing dementia earlier and more easily, as well as to try to predict who may develop it. Researchers have been looking at proteins (biomarkers) in the blood or the fluid that bathes the brain (the cerebrospinal fluid) in people who have Alzheimer's disease or may go on to develop Alzheimer's disease. Further work is needed before any of this can be used to predict Alzheimer's disease.
Further reading and references
Dementia; NICE CKS, August 2016 (UK access only)
Dementia Fact Sheet; World Health Organization (WHO), April 2016
Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease; NICE Technology Appraisal Guidance, March 2011
Guidelines for the diagnosis and management of Alzheimer's disease; European Federation of Neurological Societies (2010)
Robinson L, Tang E, Taylor JP; Dementia: timely diagnosis and early intervention. BMJ. 2015 Jun 16350:h3029. doi: 10.1136/bmj.h3029.
Dementia: Supporting people with dementia and their carers in health and social care; NICE Clinical Guideline (November 2006, last updated September 2016)
Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset; NICE Guidelines (October 2015)
Health matters: midlife approaches to reduce dementia risk; Public Health England Guidance, March 2016
Laver K, Dyer S, Whitehead C, et al; Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews. BMJ Open. 2016 Apr 276(4):e010767. doi: 10.1136/bmjopen-2015-010767.
Howard R, McShane R, Lindesay J, et al; Donepezil and memantine for moderate-to-severe Alzheimer's disease. N Engl J Med. 2012 Mar 8366(10):893-903. doi: 10.1056/NEJMoa1106668.
Brechin D et al; Alternatives to antipsychotic medication: Psychological approaches in managing psychological and behavioural distress in people with dementia, The British Psychological Society, March 2013
Living with dementia - Planning ahead; Alzheimer's Society
Dementia; NICE Quality Standard, June 2010
Dementia: independence and wellbeing; NICE Quality Standard, April 2013
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