Warning

Please note: If the patient already has a dementia diagnosis, please telephone the CMHNT to request Fast Track Back.

The completion of physical checks and blood screening can identify treatable or contributing factors to memory problems e.g. anaemia, poor diabetic control, hypothyroidism and/or the impact of sensory deficits/current medication

Primary care assessment

The initial assessment should include a history (including cognitive, behavioural and psychological symptoms, and the impact symptoms have on their daily life):

  • from the person with suspected dementia
  • if possible, from someone who knows the person well (such as a family member)

If dementia is still suspected after initial assessment:

  • conduct a physical examination
  • undertake appropriate blood and urine tests to exclude reversible causes of cognitive decline
  • use cognitive testing
Blood tests required
  • FBC
  • U&E, TFT, CRP, LFT, Calcium
  • B12/folate
  • HbA1c

Using Ordercomms the 'Dementia screen' test group can be used

Treat any issues identified before referral.

Review medication, particularly anticholinergics and stop if possible. Consider polypharmacy review by pharmacotherapy team.

Cognitive testing

There are several validated, brief, structured, cognitive tests which can be used in primary care. Some have licensing restrictions. Do not rule out dementia solely because the person has a normal score on a cognitive test. 

It is best to become familiar with one test which allows consistency and can provide a baseline for repeat testing.

Montreal Cognitive Assessment (MoCA)

6-CIT

  • 4-5 minutes
  • Cut off >7 (inverse scoring)
  • Online version here
  • Printed version here

Test your memory (TYM)

Mini-Addenbrookes

Referral

Refer via SCI Gateway using DG Memory Pathway Referral template under locality and Psychiatry of Old Age.

Ensure the patient consent box is ticked.

Referrals are discussed by a multidisciplinary team

Possible outcomes of MDT assessment
No dementia diagnosis

Patient can be referred back in future

Mild Cognitive impairment / Does not meet the criteria for dementia diagnosis at present

Patient will be booked for further testing by memory clinic in timescale advised by consultant psychiatrist or psychologist

Diagnosis confirmed
  • Patient will be booked in for an appointment with a clinician for diagnosis delivery
  • Clinician will inform GP when diagnosis has been delivered and if a prescription is required
  • Any prescription should only be provided once the clinician contacts the GP
  • Post diagnostic support referrals will also be completed following discussion with the patient

Editorial Information

Next review date: 06/09/2024

Author(s): Fionnuala Edgar.