Spotlight on Dementia Services is a series of articles focusing on services available for people with memory difficulties and those with a diagnosis of dementia.
In this article, the first in the series, Caregiver-in-Chief, Barbara Stephens highlights what to expect when consulting your GP.
If a person is worried about their memory, or if other changes in cognition are causing difficulties, a visit to the GP is the first step on the journey.
A GP will carry out initial screening tests to determine whether the presenting symptoms suggest that a type of dementia is developing. The GP is the gateway for referral for a specialist assessment, which is necessary to determine whether a person has dementia.
At the initial consultation, the GP will ask questions about medical history, lifestyle and recent concerns, and will undertake some preliminary investigations, including blood tests, to establish whether there might be another explanation for the problems that the person is experiencing.
It is usual, at this stage for the GP to carry out some simple cognitive tests, which might be verbal, or pen and paper tasks. He/she may also ask about significant life events, for example, bereavement, redundancy, illness, and explore whether there are links with reported episodes of anxiety, low mood and depression.
The GP may wish to speak with a close family relative or friend (with the permission of the patient) to gain a fuller picture of the person’s history and any observations of recent changes in behaviour and cognitive function.
People who are concerned about their memory will often delay making this first appointment with their GP, perhaps because they are worried about what might happen, or, sometimes, because they dismiss their symptoms as being the kind of forgetfulness that occurs as a normal part of ageing.
It is, indeed, true that our memory does not function quite as well as we grow older, however, memory loss caused by dementia is significantly different from normal forgetfulness: memory difficulties get progressively worse over time and a wide range of other cognitive problems might be experienced. These might include difficulties with language, organisational ability, decision-making, judgement, spatial awareness, vision and balance.
Early investigation is important because memory difficulties can be symptomatic of other conditions that are treatable, for example, anxiety, depression, physical conditions, such as anaemia, thyroid problems, vitamin deficiency. They might also be the result of side effects of certain medications. These different potential causes of the person’s difficulties need to be eliminated out as part of the screening process.
If the GP concludes, from these initial tests, that the person might be showing early signs of dementia, he/she will make a referral to the local Memory Assessment Service, where a more comprehensive investigation will be carried out to determine whether the person does, indeed, have dementia, and its type.
Dementia is an umbrella term that is used generically to describe a set of symptoms caused by an underlying disease.
There are many different types of dementia. Alzheimer’s disease is the most common form of dementia, characterised by abnormal protein deposits in the brain that cause brain cells to die. Alzheimer’s is a progressive condition; an early sign is difficulty with short-term memory recall.
Vascular dementia is the second most common type of dementia, caused by small strokes that cause localised areas of the brain o die. Vascular dementia progresses in a ‘step-wise’ fashion, and the symptoms will vary depending on which the parts of the brain affected.
In about 10% of cases, the diagnosis is of a mix of Alzheimer’s disease and vascular dementia, his is known as ‘mixed dementia’.
There are many rarer types of dementia, including Dementia with Lewy Bodies, Frontotemporal Dementia, Posterior Cortical Atrophy, Parkinson’s Disease, Semantic Dementia.
In this ‘Spotlight on Dementia Services’ series, we will be covering all aspects of the dementia journey, from early signs and concerns, diagnosis, support services and end of life care. We will be focusing, too, on support for family carers.
If you have questions, or experiences to share, please mail me at barbara@livebetterwith.com
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