How does Dementia get Diagnosed?
In every developed country with an aging population dementia represents a significant public health challenge, and the numbers worldwide are increasing in the developing communities. Timely and accurate diagnosis is crucial for accessing appropriate care and support services in the countries where those services exist. How can you find out about the dementia diagnosis process in the UK, and what are the key steps, challenges, and recent developments?
In each of the four health systems in the UK there is a National Health Service (NHS) pathway. The diagnosis of dementia typically begins with a visit to a general practitioner (GP). The NHS has established guidelines outlining a standardized pathway for dementia diagnosis and management. GPs play a central role in initial assessment, conducting cognitive screening tests and gathering relevant medical history.
Relectuance to speak to a GP
One problem with this is the reluctance of people affected to speak to their GP. In recent years there has been a marked improvement in the interest that GPs have in finding people with dementia and directing them to services. About ten years ago, as few as 20% of people with dementia in some parts of the UK had their diagnosis.
People who were pushing for diagnosis were often accused of being in the sway of the pharmaceutical companies, who would profit from prescription of the small number of not very impressive medications available at the time. One doctor told me that he would withhold his suspicion of dementia from the patient and family because “there’s nothing you can do.” That was wrong in so many ways and would be rare now.
When at last, the person is persuaded to see their family doctor, they’ll be tested to see if the problems they are having are caused by something reversible, like a vitamin B deficiency or an infection. It might involve a bit of time going back and forward, but it’s needed because these questions need to be answered before moving to the next step.
Memory Assessment Service (MAS)
If dementia is suspected, GPs may refer the person to a Memory Assessment Service (MAS) for further evaluation. This is often a two-step process, and a nurse may come to the person’s house to conduct some tests and decide if the person should move forward to the MAS, sometimes called the memory clinic, or psychiatry of old age. In some parts of the country the gap between GP and nurse can be six months, and then another gap of six months before reaching the consultant at the MAS. This now means that it might be years since the problem started before there is a definitive diagnosis and some older frail people drop out of the pathway at this point.
MAS teams, comprising specialists such as physicians for older people, psychiatrists of old age, neurologists, psychologists, allied professionals like physios and occupational therapists, and dementia nurses, conduct a comprehensive assessment to confirm the diagnosis and determine the underlying cause of cognitive impairment. A range of diseases cause dementia and some of them don’t respond to the medication that is available.
The assessments include a range of physical and mental tests and evaluations and brain imaging (e.g., MRI or CT scans) to detect structural abnormalities. Assessments also consider the individual's functional abilities, behaviour, and quality of life. Distinguishing between different types of dementia, such as Alzheimer's disease, vascular dementia, Lewy body dementia, or frontotemporal dementia, is important for appropriate management and treatment planning and to help the family and the person to know what to expect.
Challenges still persist
Despite the structured approach, challenges persist. These include variability in access to diagnostic services across regions, long waiting times for assessments, and disparities in awareness and understanding of dementia among healthcare professionals and the public. Additionally, stigma and fear associated with dementia contribute to delays in seeking help and diagnosis.
Efforts to improve dementia diagnosis and care in the UK include the implementation of national dementia strategies, initiatives to increase public awareness and understanding, and investment in research to enhance diagnostic tools and treatments. Continued efforts to enhance early detection, support services, and research are needed for addressing the growing impact of dementia on individuals, families, and society as a whole. The more you know about it, the better it will be, so read what you can and let me help if I can. Sources of information are available on this website.
