Features of significant cognitive change
Considering the features of significant cognitive change and of memory complaints will help determine the next steps at Decision Point One.
Features of significant cognitive change can be clarified by investigating the following:
Who is providing the report?
- Family - This is often significant, especially if that family member / close friend is not a patient of the practice. It is entirely ethical to listen to what a family member has to say about their loved one if they wish to speak to you, even if you do not feel it appropriate to discuss the case with them. The information provided may assist in making the diagnosis, as many people with early dementia lack insight into their symptoms (anosognosia).
- Patient - This needs to be viewed with caution. Check for depression or worsening of a pre-existing chronic illness.
- Other health care staff - This is usually significant
Why are the symptoms presenting now?
- Acute hospital admissions may be associated with a delirium that exposes an underlying dementia.
- Stressful life events can expose cognitive difficulties previously compensated for by a spouse or bring scrutiny from usually more distant family members.
What kinds of memory symptoms?
- Forgetting why you went into a room is the commonest complaint of healthy older people and may not be a matter of concern.
- Difficulty recalling recent events – such as that an only granddaughter had a baby three weeks ago – while retaining well learned distant information such as the month of marriage or wartime prime ministers – is more likely to be significant.
What else may be interfering? E.g. worry, anxiety, or sleep loss due to:
- Major family upheavals.
- Major community commitments.
- Busy, active and over-committed lives.
Are there associated concerning symptoms?
- Change in behaviour – anxiety or depression.
- A change in functional performance – withdrawal from usual activities, errors in cooking, banking and driving.[1]
The dementia pathway (Yates, M and Pond, D)