Memory Disturbance and Dementia
Experiencing a difficulty with memory can be the first sign of dementia. However, it is important to know that there are a number of other treatable neurological and medical conditions such as chronic migraine, obstructive sleep apnoea, or anxiety and depression that can also result in problems with memory. This means that having symptoms of a disturbance in your memory does not always necessarily mean a diagnosis of dementia.
Dementia also does not necessarily mean that you need to have a problem with your memory. Alzheimer's disease is the most common form of dementia and it usually presents with memory problems. However, there are other types of dementia that can present with very different symptoms. The first signs of dementia can therefore present differently, depending on the type of dementia present.
Certain types of dementia can present with progressive changes in behaviour or personality, or a disturbance in speech and language abilities, or even a disturbance in the way in which you process visual information. In the small number of people who develop dementia under the age of 65, they tend to have a wider range of presentations including symptoms of anxiety and depression which can often lead to a misdiagnosis.
What is Dementia and what causes it?
Dementia is clinical term that is used to describe any condition that affects a person's cognitive abilities to the point where it starts to impact on that person's daily functioning. In the case where cognitive symptoms are present but a person is still functioning normally, this is classed as Mild Cognitive Impairment (MCI).
Dementia is therefore not a single disease, but rather, arises as a consequence of many different diseases that result in cognitive impairment. However, in everyday terms, when most people talk about dementia, they are primarily referring to a class of diseases that lead to progressive and irreversible deterioration in neurocognitive function over time.
In this main category of progressive dementia, the underlying cause is predominantly due to a dysregulation of brain regulatory pathways that lead to an abnormal build up of proteins in the brain. This accumulation of excess protein material in the brain then leads to toxic processes that eventually result in the destruction of brain cells and finally to cognitive impairment.
You can find out more about these different types of progressive dementia in the section below.
Some Forms of Dementia
What does a dementia assessment involve?
The starting point for any dementia assessment is always based on obtaining a good understanding of a person's symptoms and how they might be impacting on their daily functioning, if at all. It is also normally very important to hear from a person's close family or friends on what their experience of these symptoms have been, as individual accounts can sometimes differ. Finding out if there are any relevant external circumstances that might be affecting a person's functioning, mood, or general wellbeing is also part of this process.
For some guidance on what symptoms you should be looking for, you can take a look at a helpful symptom checklist that the Alzheimer's Society has put together. Please be aware that checklist is purely there as a guide and that having these symptoms does not necessarily mean that you are developing dementia. (view checklist here).
The next step in the assessment usually involves objective neuro-psychological testing, something that is also usually carried out at the first appointment. This helps to identify any strengths or weaknesses in a person's cognitive abilities to see if it correlates well with the symptoms being reported.
Depending on the findings of this initial assessment, if there is a sense that dementia is a possibility, you could either be provided with a provisional diagnosis, or given a sense of what your symptoms might be originating from.
If you have not already had a scan of your brain prior to the appointment. This would usually be the next step in the assessment. The scan of choice would normally be an MRI brain scan as this provides us with the most detailed images of your brain. However, if there are good reasons why you are unable to have an MRI scan, a CT scan can also be done as an alternative. These types of scans are known as structural imaging scans as they are done to assess for any changes in the volume of different brain regions. A loss of brain volume in specific areas can provide very useful clues as to which form of dementia we might be facing.
However, as useful as structural imaging scans are, they cannot provide us with any information regarding the underlying protein abnormality that is causing the dementia. As such, although the findings are helpful, they are also not specific.
For over a decade now, technological advancements have allowed us to detect the presence of Amyloid Beta protein in the brain, the protein that is most associated with Alzheimer's Disease. One way in which this can be done involves the use of a nuclear imaging technique known as Positron Emission Tomography or PET. Using radioactive tracers that bind to amyloid beta, one can obtain a good visual image of where, and how much amyloid protein is in a person's brain. This is known as an Amyloid PET scan. Alternatively, sampling of cerebrospinal fluid (CSF) through the use of a lumbar puncture technique can also be used to detect the presence of Amyloid Beta. However, this is rarely done privately as people generally prefer to have a PET scan over a lumbar puncture.
Amyloid PET scan for diagnosing
Alzheimer's Disease
A NEW BLOOD TEST FOR ALZHEIMER'S?
Since early 2025, we now have the ability to detect the presence of amyloid protein through a blood test, known as plasma pTau217, which is something that we now routinely offer in our clinic. However, although a blood test seems very easy to do, it is important to be aware that there are a number of cautions when using this technique. Firstly, different laboratory assays of used to perform this test yield results that vary in accuracy. We are therefore highly selective in the assay that we choose to use in our practice in order to offer the highest level of test accuracy. Secondly, sample collection and handling, if not performed correctly, can lead to erroneous results and so we ensure that our collection processes are highly regulated.
Most importantly, the test only informs a us if amyloid protein is present in the brain. However, as amyloid beta can deposit in the brain for 10-15 years before symptoms begin, and that more than 20% of people at the age of 70 will have detectable levels of amyloid even when they are completely well, the interpretation of the test needs to be guided by the clinical presentation in order to know if it correlates well with a person's symptoms. In short, having a positive test does not automatically mean that a person has Alzheimer's Disease. Conversely, having a negative test also does not mean that a person does not have a different type of dementia caused by different protein abnormalities. As such, interpreting the test result in the clinical context is still of paramount importance.
Why Is It Useful To Diagnose Dementia?
It is not uncommon for some people to question the need for seeking an assessment for dementia, often imbued with a sense that this is a condition for which there is no cure.
However, many studies have been done to show that having a sense of understanding of the diagnosis can provide a range of important benefits that are not immediately appreciated.
Firstly, a large part of the treatment of dementia is focused on the improvement of a person's quality of life. Not uncommonly, having dementia can cause changes in a person's mood or behaviour without them understanding why. Having a diagnosis can help a person and their loved ones to better contextualise these symptoms and also reduce stigma. It also allows for more time to adjust to life with the condition.
From a practical perspective, it can help a person to plan for the future, ensuring that their financial affairs are organised. There is also evidence to say that an early diagnosis helps people to feel more in control and to also live more independently in their own homes for longer, with the right support in place.
Financially, having a diagnosis also ensures that you have more legal protection from discrimination if you are still at work, and possibly opens up avenues of financial and social support if appropriate.
Last but not least, medications and lifestyle interventions can also play an important role in the treatment of dementia symptoms (see section below).
Treatment for dementia
Medications
If a diagnosis of Dementia has been established, a range of research-proven medications can then be commenced to try to improve the cognitive function of people who have certain types of dementia.
These treatments include Cognitive Enhancers such as Donepezil, Rivastigmine, Galantamine and Memantine which help to boost cognitive functioning by increasing the levels of certain neurochemicals in your brain.
In cases where mood fluctuations are experienced, the addition of mood stabilising medications can also be potentially helpful.
Importantly, if a diagnosis of early Alzheimer's Disease is made, there are now also new era-defining treatments (Donanemab and Lecanemab) available that can slow the rate of progression of the condition. These treatments are known as Amyloid Targeting Therapies.
Lifestyle Interventions
However, the treatment of dementia involves more than just the use of medications and ultimately requires a holistic approach to care. A review of a person's lifestyle, including diet, exercise routines, and daily activities can help to improve one's longer term prognosis.
Education and Support
Being given a diagnosis of dementia will have a significant impact on a person and on their family. Understanding the nature of the condition, both from the perspective of the person suffering with the condition, and from the perspective of family members, is crucial in helping to provide the necessary long-term support so as to enable the person with dementia to have the best quality of life possible.
Enlisting the help of local services and supportive organisations like the Alzheimer's Society in this process can be invaluable.
Amyloid Targeting Therapies
There are currently two Amyloid Targeting Therapies, approved in the UK since early 2025, for the treatment of early Alzheimer's Disease.
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Donanemab (Kisunla™)
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Lecanemab (Leqembi®)
These are currently only available privately as they have not been approved for use in the NHS due to the costs of these treatments.
We are one of the first in the UK to be able to offer these new advanced treatments to patients at HCA Healthcare at London Bridge Hospital and you can find out more about these treatments here.
HCA London bridge hospital
All of your dementia assessments and treatments will be carried out at London Bridge Hospital, a distinguished centre for excellence in healthcare in the centre of London, and part of the HCA Healthcare UK network of private hospitals.
Learn more about the similarities and differences between Dementia and Alzheimer's Disease.
Find out more about our delivery of Amyloid Targeting Treatments at London Bridge Hospital.
See our press releases on the new Amyloid Targeting Treatments:
Donamemab and Lecanemab.
Collaboration with the Alzheimer's Society
My previous partnership with the Alzheimer's Society has been showcased in June/July 2017 publication of "Living Well With Dementia", the national magazine of the Alzheimer's Society.
https://www.alzheimers.org.uk/info/20228/junejuly_2017/1109/on_the_spot
Young Onset Dementia
Young onset dementia is dementia that affects people who are under 65 years of age. The different ways in which dementia presents in this age group can make the diagnosis more challenging. As a fair number of people with young onset dementia are still of working age, the impact on their lives is also significantly different and they often require different avenues of support.
You can find out more about Young Onset Dementia with the following links:
