When should I consider referring a patient with suspected Alzheimer's disease to a specialist for further evaluation?

You should consider referring a patient with suspected Alzheimer's disease to a specialist dementia diagnostic service, such as a memory clinic or community old age psychiatry service, if reversible causes of cognitive decline have been investigated and dementia is still suspected ¹,². Reversible causes include delirium, depression, sensory impairment (like sight or hearing loss), or cognitive impairment from medicines associated with increased anticholinergic burden ¹,².

• Specific referral scenarios:
• If the person has suspected rapidly-progressive dementia, refer them to a neurological service with access to tests for conditions like Creutzfeldt–Jakob disease ¹,².
• For people with mild cognitive impairment (MCI), if their symptoms deteriorate, refer them for specialist assessment and management ².
• If the person has learning disabilities and suspected dementia, refer them to a psychiatrist with expertise in assessing and treating mental health problems in people with learning disabilities ².
• Consider admission and specialist referral if the person is severely disturbed and admission is needed to ensure their health and safety or the safety of others, or if assessment in primary care is not appropriate due to complex physical and psychiatric problems ².

Specialists involved in diagnosis include secondary care medical specialists (e.g., psychiatrists, geriatricians, neurologists) and other healthcare professionals (e.g., GPs, nurse consultants, advanced nurse practitioners) with specialist expertise in assessing and diagnosing dementia ¹. A referral to a diagnostic service does not always require a clinic appointment ¹.