Dementia Diagnosis Care Staff Guide: Memory Clinics and Tests

Getting a diagnosis of dementia can be a frightening and uncertain process, for the person and for the people around them. Care staff often meet residents and families at exactly this point: when worries about memory are growing, when appointments are being arranged, or just after a diagnosis has been given. Understanding what the process involves helps you support people with patience and accuracy.

This guide summarises the NHS information on how dementia is assessed and diagnosed, what the main tests are, and how care staff can help. It does not replace advice from a GP or memory service.

Why memory problems are not always dementia

The NHS stresses that dementia is not a natural part of ageing, and that anyone worried about their memory should see a GP. It also notes that memory problems do not necessarily mean dementia. Other causes include depression, anxiety, delirium from a medical condition such as an infection, an underactive thyroid and the side effects of some medicines. This is why a careful assessment matters, and why sudden confusion should always be treated as urgent. Our guide to the 4AT delirium screening tool explains how to spot it.

The first step: seeing a GP

According to the NHS, the GP will usually:

• ask about the person's symptoms and general health, including difficulty with everyday tasks such as personal care, cooking, shopping and paying bills
• carry out a physical examination to help rule out other causes
• arrange tests, such as blood and urine tests
• ask the person to complete a memory or cognitive test

The NHS recommends that someone who knows the person well attends the appointment to describe the changes they have noticed. For a resident, this could be a family member, or a keyworker with detailed knowledge of daily life, ideally with the person's agreement.

The tests explained

Cognitive tests

The NHS says cognitive tests assess short- and long-term memory, concentration and attention, language and communication, and orientation to time and place. One test commonly used by GPs is the GPCOG. Scores can be affected by education level, so someone with less formal education may score lower without having dementia, and someone with more may score higher while still having dementia. Cognitive tests cannot diagnose dementia on their own, but they can show that further investigation is needed.

Blood and urine tests

These are used to rule out other causes of symptoms. The NHS lists checks of liver, kidney and thyroid function, HbA1c for diabetes, and vitamin B12 and folate levels. A urine test or other investigations may be ordered if an infection is suspected.

Brain scans

The NHS explains that an MRI scan is recommended to help confirm a diagnosis and its type, and can show blood vessel damage in vascular dementia or shrinkage in specific brain areas. A CT scan can check for signs of a stroke or brain tumour. SPECT or PET scans may be used if results are unclear, though most people will not need them, and an EEG is used only if epilepsy is a concern. A normal scan does not rule out dementia, and not everyone needs one.

The NHS is clear that no single test diagnoses dementia. The diagnosis comes from combining the history, examination and tests.

Referral to a memory service or specialist

The NHS says dementia can be hard to diagnose when symptoms are mild. If other causes have been ruled out, the GP may refer the person to a specialist such as an old-age psychiatrist, a geriatrician or a neurologist, who may work in a memory clinic with other professionals. Specialists may order more detailed memory tests or a brain scan. The NHS suggests writing questions down beforehand and noting medical terms used, and says people can ask to return with further questions.

What a diagnosis should involve

The NHS says the doctor should ask whether the person wants to know the diagnosis, and then explain what it may mean and allow time for questions. Unless the person declines, they and their family or carer should be told about:

• the type of dementia, or plans for reassessment if it is unclear
• likely symptoms and how the condition may progress
• possible treatments
• a named professional to coordinate care
• local support services and advocacy
• effects on driving or work, and sources of financial and legal advice

Written information should be provided, and the GP should arrange regular follow-ups to check how the person is managing and whether new care needs have arisen. Capacity and consent matter throughout. Our guide to Mental Capacity Act and DoLS training requirements explains the legal framework staff need to understand.

How care staff can help

• Keep dated notes of changes you notice, such as new forgetfulness, getting lost, missed medicines, changes in mood or sleep, or difficulty with familiar tasks. Be specific and factual.
• Report sudden changes or signs of illness promptly, as infections and medicines can cause confusion.
• Help the person prepare for appointments, bring glasses and hearing aids, and give them time to answer questions themselves.
• Be ready to sit with someone after a diagnosis, listen without rushing and avoid false reassurance.
• Pass on information about local support and advocacy, and help families find out who the named coordinating professional is.
• Make sure the diagnosis is recorded accurately and shared appropriately in the care plan.

Supporting your own learning

Understanding the diagnostic pathway helps you explain things clearly and support people through uncertain times. Record what you learn in your CPD log, and explore our CPD resources for care staff for further learning.

Frequently asked questions

Does a normal brain scan mean there is no dementia?

No. The NHS says a normal scan does not rule out dementia.

Can a care worker go to the appointment?

Often yes, with the person's agreement. The NHS recommends that someone who knows the person well attends to describe changes.

Does everyone get a brain scan?

No. The NHS says brain scans are usually done after simpler tests have ruled out other problems, and not everyone needs one.

This article draws on the NHS pages on dementia diagnosis and tests (last reviewed July 2023), so please check for the latest NHS guidance.