DIAGNOSES OF THE CONDITIONS THAT CAUSES DEMENTIA: WHO IS RESPONSIBLE FOR MAKING THE DIAGNOSIS?

Thursday, April 2, 2009 3:59

Well, who is responsible for making the diagnosis? The answer is that we all have an important part to play. Relatives, friends, and sometimes people with dementia themselves need to face up squarely to the possibility that someone they love or care for may be developing dementia. Unless they do so and arrange for them to see a doctor as early as possible, the illness causing the dementia, if it does indeed exist, may progress further during the period of inaction. This would be particularly important if the person who was the object of the concern were to have one of the treatable underlying causes.

The doctor that most people will see first is the general practitioner. He or she should be willing to listen carefully to the history of the apparent intellectual decline, should undertake a careful and complete examination, and arrange appropriate tests. In the first instance these will probably be the simple blood tests described earlier, undertaken in the hope that a treatable cause will be discovered. When a more complicated assessment is required, the general practitioner will usually refer the patient to a specialist who may be a geriatrician, a psychiatrist specializing in diseases of the elderly, or a neurologist, depending upon the patient’s age and other factors. These hospital specialists may extend the examination and arrange additional tests. They will often ask a psychologist, trained to assess intellectual function and behaviour, to help with the assessment. Often it will be necessary to repeat this after a period of time.

In some parts of the country there are special memory disorders clinics. They are staffed by doctors and psychologists who are specially trained to detect dementia, even in its early stages, to try to diagnose the underlying cause, and to help plan ahead with the family if the condition is untreatable. Many patients attending a memory disorders clinic will have a physical, psychiatric, and psychological assessment — a very intensive programme.

Others who may be involved in helping to make the diagnosis include occupational therapists and specially trained psychiatric nurses who work in the community.