Private memory assessment: what it involves and how it fits with NHS care

A memory assessment is a structured clinical review of memory and thinking. It usually combines a conversation about your symptoms and daily life, ideally with someone who knows you well, a physical examination and tests of memory and cognition, followed in some cases by blood tests and brain imaging. The aim is not just to label a condition. It is to look for causes that can be treated, to work out whether dementia is present and, if so, which type, and to plan support.

The NHS says a GP will ask about your symptoms and other aspects of your health, and whether you find it difficult to manage everyday activities such as washing and dressing, cooking and shopping, and paying bills. It recommends that, if possible, someone who knows you well comes along to describe changes they have noticed and to help remember what was said.

The NHS stresses that memory problems do not necessarily mean you have dementia, and lists other causes including depression and anxiety, sudden confusion (delirium) caused by a medical condition such as an infection, an underactive thyroid (hypothyroidism) and side effects of some medicines. To help rule these out the GP will do a physical examination and may organise blood and urine tests, and you will be asked to do a memory or cognitive test.

NICE guideline NG97 on dementia is consistent. If dementia is still suspected after initial assessment, it advises a physical examination and appropriate blood and urine tests to exclude reversible causes of cognitive decline, and cognitive testing using a validated brief structured instrument such as the 6-item cognitive impairment test (6CIT), the 10-point cognitive screener, the Mini-Cog or Test Your Memory. Reversible causes it names for investigation include delirium, depression, sensory impairment such as sight or hearing loss, and cognitive impairment from medicines with a high anticholinergic burden.

The NHS says that if the GP has been able to rule out other causes, they may refer you to a specialist such as an old-age psychiatrist, a geriatrician or a neurologist, who may work in a memory clinic with other professionals. NICE says to refer to a specialist dementia diagnostic service, such as a memory clinic or community old age psychiatry service, if reversible causes have been investigated and dementia is still suspected.

At that stage NICE says to diagnose a dementia subtype, if possible, once initial specialist assessment, including an appropriate neurological examination and cognitive testing, confirms cognitive decline and reversible causes have been ruled out. It says to consider neuropsychological testing if it is unclear whether the person has cognitive impairment, whether it is caused by dementia or what the correct subtype is, and to offer structural imaging, which can be CT or MRI, to rule out reversible causes and assist with subtype diagnosis. It advises MRI when vascular dementia is suspected and the subtype is uncertain, and notes that Alzheimer's disease should not be ruled out based solely on CT or MRI results.

A private memory assessment is simply this pathway delivered outside the NHS: an appointment with a doctor or other clinician, cognitive tests and, depending on the service, blood tests and scans arranged privately. The main practical difference is speed of access and the choice of clinician, not a different standard of assessment.

Questions worth asking before booking include: who will see me (a consultant old-age psychiatrist, neurologist or geriatrician, or another professional), and what are their qualifications; what is included, such as blood tests, brain imaging and written report; how will the findings be shared with my GP; what happens if dementia or another condition is diagnosed, including follow-up and access to medicines, support and care planning; and what is the total cost, including any scans and review appointments. A private result is most useful when it is sent to the GP, so the record, medicines and local support can follow.

Be cautious of any assessment that offers a diagnosis from a single short questionnaire or a home screening score, or that moves straight to a treatment or supplement without ruling out other causes. The NHS and NICE sequence above is a reasonable benchmark.

The NHS says that after tests, your doctor should ask whether you want to know your diagnosis, explain what it might mean and give you time to talk and ask questions. Unless you decide otherwise, they should talk to you and your family or carer about the type of dementia, or about being reassessed in future if it is unclear, the symptoms and how the condition might develop, the treatments you might be offered, the name of a professional to coordinate support, local care and support services, advocacy services, the effect on driving or employment and where to get financial and legal advice. You should also be given written information.

After a diagnosis the GP should see you from time to time to check how you are managing, and the NHS notes the importance of planning ahead, such as a Lasting Power of Attorney or an advance statement about future care. The NHS also says people with dementia or mild cognitive impairment may be able to take part in research through the Join Dementia Research service.

The NHS page quotes an Alzheimer's Society study showing that 1 in 4 people wait for 2 years before getting help for dementia symptoms, and says an accurate and early diagnosis can have many benefits, including the best chance to prepare for the future. Whether through the NHS or privately, an earlier assessment also gives the best chance of finding and treating a reversible cause.

Sudden confusion, a rapid change in thinking or behaviour over hours or days, or confusion with fever, new weakness, a severe headache or a head injury needs urgent medical assessment through NHS 111, an urgent GP appointment or 999 and A&E, because it can be delirium, infection or stroke rather than dementia. The NHS lists sudden confusion caused by a medical condition such as an infection as a recognised alternative cause.

The NHS route runs through the GP to a memory service, with tests and imaging arranged within the NHS, and waiting times vary by area. A private route can shorten the wait for the first appointment, but long-term follow-up, prescribing and community support usually still involve NHS and local authority services, so keep your GP informed. Whichever you choose, bring a list of medicines and a person who knows you well, and ask for results in writing.