Case Study on Diagnosing Dementia

Before we start to discuss building brain-health focussed clinical services, let’s remind ourselves of the current context by taking a quick look at a typical example of steps to receiving a dementia diagnosis through a memory clinic.

We’ll do this by following Mary on her path to a diagnosis:

• Mary is a 78 year old former schoolteacher who lives with her husband James.
• Mary was referred to the local memory clinic by her GP.
• James had been prompted to make the initial GP appointment after he had noticed Mary getting more forgetful and regularly repeating herself, asking the same questions several times in within the space of an hour.
• At the initial memory clinic appointment, James reports that he feels Mary’s memory problems have become noticeable and grown steadily worse over the last 2 or 3 years.
• Mary reports that her memory is not quite as sharp as it used to be but feels this is perfectly normal for her age.
• James describes a couple of recent occasions where Mary has gotten lost when out at the local shops on her own.
• James has also had to start taking over more activities around the home, such as the majority of the cooking. Mary would have previously always been the cook of the house but now struggles to manage using the oven and hob independently.
• On cognitive testing, Mary scores 19 out of 30 on the Mini-Mental State Examination (MMSE).
• Mary is referred for an MRI brain scan which shows general cortical atrophy as well as visibly pronounced atrophy of the medial temporal lobes.
• She has a blood sample taken to rule out any potentially reversible underlying causes of cognitive impairment such as acute infection, thyroid problems or vitamin B12 deficiency.
• Mary is also asked about any regular medications she takes to check if they could be having detrimental effects on her memory – particularly if any medications were known to affect acetylcholine activity.
• The psychiatrist at the memory clinic concludes that, based on the progressive nature of the impairments, the cognitive test and MRI results, the report from James of cognitive difficulties impacting on daily functioning and in the absence of any clear alternative or reversible cause for cognitive decline, the most likely diagnosis is one of Alzheimer’s dementia.
• Mary is started on a 5mg dose of donepezil and assigned a Dementia Link Worker to coordinate post-diagnostic support.