Common symptoms

Early signs of dementia vary by pathology and the individual. Common symptoms include occasional memory loss, difficulty finding words, apathy or depressive symptoms, withdrawal from social engagement or change in physical function such as gait impairment, repetitive purposeless movements or frequent falls (Arvanitakis et al 2019).

Each subset of dementia is affected differently by risk factors, however several risk factors are common among dementia syndromes. These include a history of smoking, alcohol intake, hypertension, obesity, hyperlipidaemia and metabolic disease. It has been identified that the presence of three of these risk factors more than doubles the risk of developing dementia (Peters et al 2019).

Often, a specialist review is needed to formally diagnose dementia, particularly in early-stage or atypical dementia, but there is a place for ‘non-specialist’ healthcare professionals to identify and act on possible signs of dementia.

If dementia is suspected it is important to differentiate between dementia and other similarly presenting issues such as polypharmacy, depression, delirium or age-related cognitive decline.

This needs to be done by an appropriately skilled clinician if it is not within your scope of practice, but it is important to consider the following:

Early detection

The opportunity to detect early-stage dementia in the community has been recognised, and guidance from the US outlines seven practice recommendations that encourage healthcare professionals to have more proactive conversations about dementia detection (Maslow and Fortinsky 2018):

» Make information about cognitive changes readily available to older people and their families.

With appropriate training and knowledge, a healthcare professional could conduct a cognitive impairment test to determine whether further investigation is needed and if onward referral is required.

The sensitivity of these tests varies and they are often only validated in specialist settings, nevertheless they can be used to establish the need for further investigation (De Roeck et al 2019, Arevalo-Rodriguez et al 2021). However, to support wider use of these tests, further work must be done on licensing and education (Mattke et al 2023). For example, the commonly used Mini-Mental State Examination is proprietary and may require fees in certain cases (Mattke et al 2023).

The National Institute for Health and Care Excellence (NICE) (2019) states that people with suspected dementia should be referred to a specialist diagnostic service. This should follow full history taking, assessment using a validated brief cognitive testing tool and investigation or exclusion of reversible causes of cognitive decline (NICE 2018).

During discussion and assessment of suspected dementia it is important to provide clear advice and support to people. There should be adherence to the principles of the Mental Capacity Act 2005 and an appropriate care plan should be developed as required.