Consultation 1 - initial consultation

The patient or family have raised concerns about features of significant cognitive change e.g. memory difficulties, functional performance, changes in behaviour.

The patient's first presentation could be unanticipated or planned. It could be presented by the patient during a standard consultation, a carer / family member by phone or at a consultation, or by practice staff either nursing / allied health, administrative, or community service providers.

Review the nature of the presenting memory and thinking difficulties with the patient, review all current medications including over the counter and complimentary. Check for features of significant cognitive change to rule out clinical problems - refer Features of significant cognitive change tab for further information.

Consider differential diagnosis: assess for delirium (CAM test), depression (GDS) and drugs (medication review). Refer to the Differential diagnosis - 3Ds tab for further information.

Treat reversible causes, consider referral for psychiatric treatment.

Decision Point One

Dementia / cognitive change is unlikely - reassure and address anxiety or depressive symptoms or other unstable chronic illness. Consider review in 3 - 6 months.

Dementia is less likely but concern about cognitive change is present or Dementia / significant cognitive change is possible - plan for assessment and investigation - refer to Consultation two: Baseline information collection for further information.

Ask the Practice nurse to establish carer network, explain consultation process required to understand and plan a response including the need for informant / carer history. Plan a longer consultation at a later time.