Dementia is thought to affect over 700,000 people in the UK and accounts for a large amount of health and social care spending. The most common cause of dementia in the UK is Alzheimer's disease followed by vascular and Lewy body dementia. These conditions may coexist.

Dementia is a spectrum of disorders displaying progressive global deterioration in:

• Cognition (Memory, Orientation, Concentration, Speech)
• Behaviour
• Personality

Dementia is symptom complex rather than specific disease and for a diagnosis the deterioration must be sufficient to affect work, social function or relationships.

Diagnosis is dependant on the exclusion of non-organic psychiatric disorder.

Assessment

• diagnosis can be difficult and is often delayed
• assessment tools recommended by NICE for the non-specialist setting include:
  • 10-point cognitive screener (10-CS)
  • 6-Item cognitive impairment test (6CIT) - >8 is significant
• assessment tools not recommended by NICE for the non-specialist setting include the abbreviated mental test score (AMTS), General practitioner assessment of cognition (GPCOG) and the mini-mental state examination (MMSE) have been widely used. A MMSE score of 24 or less out of 30 suggests dementia

Investigations

in primary care, a blood screen is usually sent to exclude reversible causes (e.g. Hypothyroidism). NICE recommend the following tests: FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels.

Secondary care - neuroimaging to exclude other reversible causes (e.g. Subdural haematoma, normal pressure hydrocephalus) and help provide information on aetiology to guide prognosis and management

Confusion blood screen:

• FBC
• U&E