There are currently about 800,000 people in the UK living with dementia and this figure is expected to double over the next 40 years.
Statistics suggest that more than half of the people who are living with dementia have not been diagnosed, and this is a growing problem. As a result, we will increasingly come into contact with older people whose friends or relatives suspect they may have dementia, but who have not sought a diagnosis.
This early stage of the condition can be a very sensitive time for the patient, who may or may not be aware that they are experiencing changes in their mental state. This makes the initial consultation extremely important - particularly because early diagnosis is critical for enabling quality of life for the patient.
To complicate things further, people who have early-stage dementia are often very good at concealing their symptoms and convincing those around them they are able to cope. As a result, traditional ways of establishing a diagnosis of dementia are considered less effective and smarter approaches to diagnoses and communication with the patient must be used.
I am glad of the opportunity to share some learning from my work in the dementia field and hope this will be useful when you are next faced with what can be a very challenging situation.
Rather than asking simple general knowledge questions to probe the patient's memory, try tapping into their everyday life and ask them about things that mean something to them.
For example, while people with early-stage dementia may be able to name the prime minister and tell you what year it is, they often struggle to say what they have eaten for breakfast, or which medication they are currently taking.
Becoming muddled over these answers can be a sign that the person is experiencing the memory loss associated with early dementia and needs an intervention.
If possible, encourage the patient to attend their appointment with a close friend or relative - this will give you an informant who knows the person well and can help you to establish whether the answers they give are correct.
Remember that dementia is not just about memory; it also affects a person's ability to reason and process information, which is why practical reasoning tests can be invaluable for a GP.
One easy way to test the patient's reasoning ability in your surgery is to buy a large clockface with moveable hands. Ask the patient to arrange the hands of the clock to tell a certain time, such as 'ten past eleven'.
Another approach is to find out how easy it is for the patient to lay a place at the table - use some cutlery, a plate and some glasses, and ask the person to arrange them on the desk for somebody sitting opposite them.
Tests like these can be accurate and revealing - witnessing a moment of hesitation is often a sign the patient is becoming confused by simple, everyday tasks, which is one of the earliest symptoms of dementia.
At an early stage, dementia also affects speech. Listen out for slips of the tongue that are not corrected, or signs the patient is struggling to find the right word when answering a question or giving information.
Keep it simple
Even the most seasoned clinician might admit to feeling uncertain about how to communicate with a patient who is confusing their words and forgetting simple things. The following tips should help to ensure the appointment is beneficial for everyone involved.
- Speak slowly and distinctly, using clear and simple words.
- Keep statements brief - patients may lose the thread of the conversation if you take too long.
- Try not to ask open questions, as this can be confusing.
- Use real names for people and objects, rather than words like 'she', 'it' or 'them', as this makes it easier to follow conversations.
Dementia is complicated; understanding how it expresses itself in behaviour must underpin our strategies to determine whether a patient is exhibiting the earliest, most subtle signs of dementia.
We will then be in the best possible position to support them at the time when they feel most anxious about what is happening to them.
- Professor Stokes is director of dementia care at Bupa and honorary visiting professor of person-centred dementia care at the University of Bradford
- Bupa has developed a Talking Toolkit to aid communication with those living with dementia. www.bupa.co.uk/understanddementia.