When should I consider referring a patient with suspected dementia to a specialist for further evaluation?

Consider referring a patient with suspected dementia to a specialist dementia diagnostic service (such as a memory clinic or community old age psychiatry service) if:

• Reversible causes of cognitive decline (including delirium, depression, sensory impairment such as sight or hearing loss, or cognitive impairment from medicines with increased anticholinergic burden) have been investigated and dementia is still suspected.
• The patient has rapid cognitive decline, unusual or neurological presentations, or cognitive impairment under the age of 55 years.
• The patient has suspected rapidly progressive dementia, in which case refer to a neurological service with access to specialized tests (including cerebrospinal fluid examination) for conditions like Creutzfeldt–Jakob disease.
• The patient has complex physical and psychiatric problems making assessment in primary care inappropriate.
• People with learning disabilities and suspected dementia should be referred to a psychiatrist with expertise in this area.

Initial assessment in primary care should include history, physical examination, cognitive testing, and investigations to exclude reversible causes before referral.

Referral does not necessarily require a clinic appointment; advice can be provided to the referrer to ensure specialist involvement for diagnosis and access to post-diagnostic support and treatment.

Specialist clinicians include secondary care medical specialists (psychiatrists, geriatricians, neurologists) and other healthcare professionals with specialist expertise in dementia diagnosis and management.

These recommendations ensure accurate diagnosis, appropriate subtype identification, and timely access to treatment and support services.

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