At-a-glance
- Separate “memory complaint” from dementia: consider depression, delirium, sleep apnoea, meds (anticholinergics), alcohol, and sensory impairment.
- Screen and structure: brief cognitive test + collateral history + functional impact assessment.
- Reversible causes: actively check (don’t assume).
- Early planning: carers, safety (falls, meds, finances), safeguarding, and capacity considerations matter as much as the diagnosis.
Primary care work-up (fast but robust)
- History: onset and progression, functional decline (IADLs), behavioural changes, hallucinations, vascular events, sleep, mood, alcohol.
- Collateral: family/carer account is often decisive; ask specifically about finances, medication errors, driving incidents, and wandering.
- Cognitive test: choose a short, repeatable tool (local preference) and interpret in context (education/language/delirium).
- Medication review: anticholinergics, sedatives, opioids; simplify where possible.
Safety + referral triggers (what to prioritise)
- Refer for specialist assessment: persistent cognitive decline affecting function, diagnostic uncertainty, atypical features (rapid progression, early hallucinations, parkinsonism), or significant behavioural symptoms.
- Immediate concerns: delirium, self-neglect, safeguarding risk, severe carer strain, or unsafe driving → escalate rapidly.
- Support plan: social prescribing, carers assessment, advanced planning discussions, and signposting to local dementia services.
Frequently asked questions
What are the most common “lookalikes” for dementia in primary care?
Depression, delirium, medication effects (especially anticholinergics/sedatives), sleep disorders (including OSA), alcohol misuse, and sensory impairment (hearing/vision).
What is the single most useful extra piece of information?
A collateral history describing functional change over time (finances, meds, cooking, navigation, driving incidents) is often more informative than test scores alone.
When should I worry about safety immediately?
Delirium features, self-neglect, safeguarding concerns, unsafe driving, wandering risk, or severe behavioural symptoms require rapid escalation and a safety plan.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.