In our article “What to Expect when Being Assessed”, we discuss important information used by consultants when considering a diagnosis of dementia. Everyone’s experience will be different, however, below we share John’s path to a diagnosis of dementia. Here is a little bit about John:
John is an 82-year old retired policeman who lives in a small town on the West coast of Scotland with his wife, Louise.
Louise encourages John to go along with her to see his GP as she is concerned about John’s memory and small changes she has noticed in his day-to-day activities and behaviour.
Louise had noted that John was becoming more forgetful and regularly repeating himself, asking the same question several times in a row.
The GP takes a history of John’s symptoms, an account of Louise’s concerns, and a note of his own findings which include:
The kind of problems John is having
When the symptoms started
The impact on work and family life
Issues of safety (for example, driving)
A family history of dementia
Past medical history.
Louise reports that she has noticed John’s memory problems becoming increasingly worse over the last 1.5 to 2 years.
John states that he used to be the ‘sharpest tool in the box but that his memory isn’t quite what it used to be.
Louise describes a recent event when John had driven into town and forgotten where he had left his car.
Louise described how John used to be a great gardener but more recently had struggled to do any work in the garden or the house.
On cognitive testing, John scores a below-average mark.
The GP arranges for a blood test to rule out any condition such as thyroid problems which may be an underlying cause of cognitive impairment.
The GP also asks about any current and new medications to ensure that these are not having a detrimental effect on memory.
The GP refers John to a psychiatrist at a local memory clinic as he has some concerns about John’s memory and cognitive functioning.
At the memory clinic, the psychiatrist arranges for John to receive an MRI brain scan that shows general cortical atrophy and visibly pronounced atrophy of the medial temporal lobes. This means certain areas of the brain where cells have died.
The psychiatrist confirms a likely diagnosis of Alzheimer’s disease, based on John’s reporting of his cognitive difficulties, its impact on his daily life; Louise’s observation of the progressive nature of the symptoms; the cognitive test results; and the MRI result. It has also been confirmed that there is no apparent alternative reason or cause for cognitive decline.
The consultant arranges for John to be prescribed Donepezil on an ongoing basis. A referral is made for John and Louise to receive post-diagnostic support in moving forward. A follow-up appointment is made for John with the consultant for a 3-monthly review.
This case study portrays an example of one path to diagnosis, and we hope that you found it helpful. However, it is important to bear in mind that although John’s primary symptoms are mainly memory loss, people can experience various other symptoms leading up to diagnosis.