Dementia diagnosis pathway

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)

20 minutes to administer
Cut off - <26/30
Good sensitivity and specificity
Requires registration and completing training or signing disclaimer to access
Access MoCA site

6-CIT

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

Test your memory (TYM)

5 minutes
Can be done by carer
Cut off <43
Printed version

Mini-Addenbrookes

5 minutes
Cut offs <25 or <21
Printed version

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