When does forgetfulness become dementia?

[NetZeroZealot]

I've just spent a couple of weeks staying with my dear 88 year old Dad.

I'm really concerned about his memory, which has really deteriorated over the past year or so, and spending a lot of time together with just the 2 of us (Mum was away) has highlighted this.

For example - reads the Times every day but doesn't know the name of the PM. ("that little Indian man")
Gets very confused about time of day and even the month and year.
Sometimes forgets if he's had a meal.
Can't remember some grandchildren's names.
Repeatedly asks same question, e.g. what time is something happening.
Can't remember basic words/names like names of supermarkets, some types of food ...

BUT - very capable of lucid and interesting conversation and appears fully mentally engaged most of the time.

I'm not sure what I should do.

Honestly, I have no idea how that is justified. I don’t want to question other teams, but, in general, a MMSE of 17/30 would be indicative of moderate dementia. I also don’t want to question you, but did she engage with the test properly? Sometimes people can struggle emotionally with the screen and so the result isn’t reflective of their actual ability, iyswim. Also, were there other health problems going on? Sometimes those can affect the assessment.
If I were you, and especially if she’s getting worse, I would get back in touch with the memory clinic. They’re usually happy to review if the situation has changed, and it does sound like drugs might be helpful now.

It varies. In our area the initial test is done at the memory clinic.

@MereDintofPandiculation That’s interesting. I thought that all GPs pre screened and NICE guidelines say that GPs should engage in brief cognitive screening (usually 6CIT or GPCOG) before referral to specialist services. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations#diagnosis Otherwise, how would a GP know when to refer? A significant number of people visit their GP with “memory problems” when their memory is actually clinically fine in terms of dementia, and a quick 6CIT would rule dementia out. A memory clinic assessment is really very full on and most people just don’t need that. Are waiting lists very long in your area? Here, they’re 6-8 weeks but we can only manage that by making sure that GPs only refer clinically appropriate patients-and even then we end up rejecting referrals as unsuitable.

The GP sees the patient and decides whether to refer, first taking blood samples to rule out other causes, and perhaps referring for MRI.

Initial short test is done by junior member of memory team - seems to be a short term training position. Depending on results, person then may be referred for full memory tests.

This is based on two cases, but before COVID. Things may have changed since.

(By short test I mean the one where you're asked where you are, who the PM is, recall a name and address which you were given earlier, recognise some outlines of animals, draw a clock, etc)

Thanks @JennieTheZebra . Yes, she did engage with the test, though I know my dad was busy telling the doctor doing the test that mum would never have been very good at questions like the cube drawing, subtraction and clock drawing, because she's never liked maths. Hopefully they would have ignored this - it's true she hates maths, but her mental arithmetic used to be great, and she was a really good artist...

She does have other health problems, notably arthritis, mysterious digestive issues, terrible insomnia and anxiety. I realise the last two could have made her MMSE score worse - but equally, it could be that both are linked to underlying dementia. I spoke to her today and she's increasingly not coping - she's too anxious to go out on her own, she's not remembering things, she won't really see anyone other than my dad because of social anxiety, and today she's complaining that she feels really faint and things look blurry (this is new). I just wish they'd refer her for a brain scan to at least give an idea of whether she might have dementia. She' s seeing the GP again this week, so we'll see what they say.

@tobyj if your mum is complaining of new blurry vision you should take her to an optician asap. It could be Age Related Macular Degeneration which can be treated but, if not treated, will cause loss of vision in the central part of the eye's vision.

If the optician sees signs of it they will refer you to your local hospital for regular tests and when needed injections into the eye. My mum noticed wavy lines and blurred vision and started treatment over a decade ago. My dad had not mentioned any symptoms but was referred to the hospital after a routine eye test. The hospital just monitored my dad for a few months then discharged him as the bleeds were not in his field of vision.

There is a test on this web page - a grid of lines which look wavy to those with AMD - as well as more information.
www.hopkinsmedicine.org/health/conditions-and-diseases/agerelated-macular-degeneration-amd

Re attendance allowance, usual advice says don’t gloss over anything when applying, state how things are on the worst day or night, not the average.

Update. GP said he doesn't think Dad has dementia, just old age. And he has been unwell recently (Covid a few weeks ago, bronchitis now). I'm still not convinced.
Mum is doing the AA form. She complained about having to print out such a long document to sign it. I think she's also quite overwhelmed at the moment.
Family visiting this weekend so hopefully they will perk up a bit.

Did the GP do any tests? Like these:

patient.info/doctor/general-practitioner-assessment-of-cognition-gpcog-score

memtrax.com/memtrax-versus-the-mini-mental-status-exam/

From what you say he is struggling with - grandchildren's names and the date etc - I am surprised the doctor didn't suggest testing at the memory clinic.

No, I don't think the GP did any tests, although I wasn't there.

Have you spoken yourself to the GP or is this all coming from your parents? Have been through this with each of my parents.

Mum was getting more forgetful in 2019. I talked to Dad and said there was medication which could slow it down if it was dementia so we really ought to get her to the GP. He reluctantly agreed.

I called the GP and explained. He booked her in for a double appointment and then called her to ask her to come for a well woman check. I was staying with them so said I would go with them - we get on well so there was no real pushback from her. In the appointment he did blood pressure and then asked about her memory. He said ok let's do a little test and asked a few of the questions on those tests - repeat a simple address back to him and then remember it for later, what's the date, year, season. Count down in 7s from 100, count backwards from 20 to 1. Spell world backwards. What was that address again? She did badly so was referred to the memory clinic.

I would make a list of the 5 things that have concerned you the most and speak to the GP yourself. You could even do a few of these questions with your dad yourself. The other thing I did about the same time was ask my parents to give authorization to the GP surgery to discuss their health with me. They had to give signed letters to the GP but after that I could talk to them about all their health issues. It became very useful as their health got worse.

www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/is-it-getting-older-or-dementia