Professor Michael Saling presents an approach to the assessment of memory complaints to help GPs differentiate true early dementia from the worried well. Early referral to a neuropsychologist is important to the patient and the family, as obtaining the correct diagnosis is critical. This is part two of this series Listen to Part 1>>

Practice points

• People who are anxious, stressed or generally feeling unwell, give quite a strident complaint and they draw your attention to their memory issue, sometimes repeatedly, quite obviously and prominently. They will give you quite a well contextualised account
• When errors of capture are the predominant feature of the complaint, that’s very likely to be related to depression, stress or anxiety.
• Letter-based tasks don’t change in early Alzheimer’s disease despite the fact that they are difficult. Easier language-based tasks, the semantically-based task, drops quite considerably.
• Early onset dementia is approximately the late forties, but more likely within the fifties, or maybe even sixty years of age or so. That would also raise the question of an atypical onset.
• The atypical onsets of dementia are displayed in a language form. This begins with a focal language condition that we call “logopenic aphasia” and it presents as very slow halting language in which they clearly are dysnomic; they are missing out on names of things and their sentences are quite simplified.
• The other variant that is not uncommon is the posterior cortical variance, which takes the form of visual spatial disturbances. This is closely related to Alzheimer’s disease pathology.
• Lewy body dementia usually has about a twelve to thirty-six month history of Parkinsonism before the features of dementia set in and well-formed animate hallucinations and fluctuating cognitions occur.
• Rapid eye movement (REM) sleep behavioural disorder is a very big feature of diffuse Lewy body dementia.