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Diagnosing dementia in care homes

Dementia is a clinical syndrome and at one level simply implies brain failure (analogous to heart failure or liver failure). Any clinician with the proper skills and access to all the relevant information should be able to make a diagnosis of dementia. This includes colleagues in primary care who feel willing, able and supported to make the diagnosis.

While NICE guidance suggests that memory clinics should be the single point of referral for the diagnosis of ‘dementia syndrome’, in some cases it may be inappropriate, for example where patients are frail or clearly have dementia syndrome but refuse referral.

In terms of brain scanning, the NICE Dementia Guideline states “Imaging may not always be needed in those presenting with moderate to severe dementia, if the diagnosis is already clear.” This may particularly apply to older and frailer patients with established dementia.

A diagnosis of dementia allows for advanced care planning and prompt discussion with family and carers about escalation planning to help prevent inappropriate admissions. It is well documented that hospital admissions can be highly distressing for patients with dementia and their families and very challenging for acute hospital units. Length of stay tends to be longer and readmission rates are higher in patients with dementia.

It is also important that we diagnose and code patients with dementia so that their risk of delirium may be understood should they need to go to hospital. A diagnosis can also explain some behaviour’s and may help moderate use of antipsychotic drugs.

Dementia diagnosis is a two stage process. First, you need to differentiate it from depression, delirium, the effect of drugs and the changes in memory expected as part of normal ageing. Two key features for a diagnosis of dementia are that the patient’s symptoms should affect daily living activities and be progressive. Second is to determine the cause of condition – the most common causes are Alzheimer’s disease, vascular dementia and Lewy body dementia.

Further information

© 2022 NHS Havering Clinical Commissioning Group.