About memory problems and dementia
Many causes of memory difficulty are treatable or reversible: low mood and anxiety, poor sleep, medication side effects, thyroid or vitamin deficiencies, alcohol, and sleep apnoea. Mild cognitive impairment is a measurable change that does not yet affect daily function and does not always progress. Dementia is the term for cognitive decline that does affect daily function; Alzheimer's disease is the most common cause, followed by vascular dementia, dementia with Lewy bodies and frontotemporal dementia.
An early, accurate diagnosis matters. It opens access to treatment, support and planning, and for the treatable causes it can restore function entirely.
Symptoms we assess
Reasons for assessment include:
- Repeating questions or forgetting recent conversations and events
- Difficulty finding words, following a conversation or managing money
- Getting lost in familiar places
- Change in personality, judgement or behaviour noticed by family
- Visual hallucinations, fluctuating alertness or acting out dreams
- Memory concerns in someone under 65
- A family history of dementia and a wish to be assessed
How we diagnose it
The assessment takes longer than a standard consultation. The consultant takes a detailed history from you and, with your permission, from someone who knows you well, since the pattern of change is as important as the change itself. A structured cognitive test measures memory, attention, language and visuospatial skills. The neurological examination looks for signs that point to a particular cause, such as parkinsonism or focal weakness.
Blood tests exclude thyroid, vitamin B12 and other reversible causes. An MRI of the brain looks at the pattern of any shrinkage and for vascular disease or other structural causes. Where the diagnosis remains uncertain, more detailed neuropsychological testing or specialist scans are arranged.
Treatment and follow-up
Where a treatable cause is found, it is treated and cognition reassessed. For Alzheimer's disease, medicines that support memory and function are available and are started as early as possible; the consultant discusses their benefits and limits honestly. Vascular risk factors are treated to slow vascular dementia. Dementia with Lewy bodies and frontotemporal dementia have their own management, including care around medication sensitivities.
Treatment is never only medication. The clinic gives practical advice on staying active and socially engaged, on sleep, hearing and vision, on driving and on planning ahead, and links you and your family with the Alzheimer Society of Ireland and local supports. Your GP receives a full letter and a plan for follow-up.
For mild cognitive impairment, review at intervals monitors for change and addresses the risk factors that can be changed.
When to see a GP, and when to see a consultant
See your GP first; blood tests and a brief cognitive screen can be done there. Ask for a consultant referral when memory or thinking is changing progressively, when the change is affecting daily life, when someone is young, when there are unusual features such as hallucinations or personality change, or when the GP's assessment has not given a clear answer.
