One of the most difficult situations families can face is recognising that someone close to them is experiencing changes consistent with dementia, while that person insists that nothing is wrong and refuses to seek medical advice.
It can leave relatives feeling frightened, frustrated and unsure what to do next. They can see that something has changed. Questions are being repeated. Everyday tasks are becoming more difficult. Bills are being forgotten, appointments missed, or familiar routines disrupted. Yet when concerns are raised, the response is often, “I’m just getting older.”
Sometimes the person does agree to attend an appointment, completes a brief memory test and is told they have scored within the expected range. Families can be left wondering whether they imagined the changes they have been witnessing at home.
If this sounds familiar, it is important to know that a normal score on a cognitive screening test does not necessarily rule out dementia, and there are still practical steps you can take.
Dementia is never diagnosed by one test alone
One of the biggest misconceptions about dementia diagnosis is that it depends on the result of a single memory test.
In reality, a diagnosis of dementia should be based on a comprehensive assessment. Cognitive screening forms an important part of that assessment, but it is only one piece of a much larger puzzle.
A thorough diagnostic assessment may include:
- a detailed medical history
- changes noticed over time
- information from family members or close friends
- how the person is managing everyday activities
- physical examination
- blood tests to rule out other possible causes
- brain imaging where appropriate
- one or more cognitive assessments.
Each part provides different information. No single test can tell the whole story.
Why someone can score well on a memory test
Brief cognitive screening tests are designed to identify whether further assessment may be needed. They are valuable tools, but they have limitations.
There are several reasons why someone experiencing genuine cognitive changes may still achieve a good score.
Familiarity
If someone has completed the same assessment several times, they may become familiar with the questions or tasks. Over time, they may remember the assessment itself rather than demonstrating how their everyday memory is functioning.
Concentrating during the appointment
Some people are able to focus intensely during a short, structured appointment because they recognise they are being assessed. This is sometimes described as showtiming.
Their performance during twenty minutes in a clinic may not reflect how they manage during the remaining twenty-three hours and forty minutes of everyday life.
Everyday life is far more complex
Remembering three words, drawing a clock or stating today’s date tells us something about how the brain is functioning, but it cannot fully reflect the demands of everyday living.
A brief assessment cannot show whether someone is:
- managing their medication safely
- paying bills on time
- preparing meals appropriately
- recognising hazards around the home
- finding their way around familiar places
- organising daily routines
- coping with increasingly complex decisions.
These are often the very difficulties that families notice first.
Look for patterns rather than isolated incidents
Everyone forgets things occasionally.
Missing one appointment, misplacing your keys or forgetting someone’s name from time to time is usually a normal part of life.
Dementia is different because it involves persistent changes that gradually affect everyday functioning.
Rather than focusing on isolated incidents, look for patterns.
For example:
- repeatedly asking the same questions within a short period
- regularly forgetting to take medication
- getting lost in familiar places
- struggling with tasks that were previously routine
- increasing difficulty managing finances
- noticeable changes in judgement or decision-making.
Looking for patterns over weeks or months provides a much clearer picture than focusing on one unusual day.
Keep a diary of what you notice
One of the most helpful things families can do is keep a written record of the changes they are observing.
Try to record:
- what happened
- when it happened
- whether anyone else witnessed it
- how it affected everyday life.
For example:
- Tuesday 14 May – Asked what time the GP appointment was four times within an hour.
- Forgot to collect the grandchildren from school, which had never happened before.
- Found three unopened electricity bills hidden in a kitchen drawer.
- Placed the kettle inside the fridge without noticing.
Specific, dated examples carry far more weight than simply saying, “Their memory seems worse.”
The diary also demonstrates something that a one-off appointment cannot show: change over time.
Share your concerns with the GP
Many families are unaware that they can contact the person’s GP to share concerns, even if the person does not want to discuss memory problems themselves.
Confidentiality prevents the GP from discussing someone else’s medical information with you without their consent.
It does not prevent you from sharing information with the GP.
Many practices are happy to receive a letter or email describing the changes you have observed and asking for it to be added to the person’s medical record.
If the person later attends the surgery for any reason, the GP already has valuable background information that may not become apparent during a brief consultation.
If an assessment is arranged, a few practical steps can make it far more useful:
- Send the diary in beforehand, so the clinician is not relying solely on what happens in the room.
- Book a double appointment where possible, so there is time to talk properly rather than rushing through a standard slot.
- Mention if the person has completed the same short test several times. It is entirely reasonable to ask whether a more detailed assessment, such as the ACE-III, might be appropriate — you will find an overview of the different assessments at the end of this article.
Encourage assessment without focusing on dementia
For many people, the word dementia carries fear and uncertainty.
Rather than insisting that they need a dementia assessment, it can sometimes be more helpful to suggest a general health check.
This is entirely appropriate because many conditions can cause symptoms that resemble dementia or make existing symptoms worse, including:
- medication side effects
- infections
- vitamin deficiencies
- thyroid disorders
- hearing or vision problems
- sleep disorders
- depression.
Checking these possibilities is an important part of good clinical practice.
What if they still refuse?
Adults who have mental capacity have the legal right to make decisions that other people may disagree with, including declining medical assessment.
That can be incredibly difficult for families to accept.
If this happens, continue keeping your diary, maintain communication with the GP, and preserve the relationship with the person wherever possible. If you ever have genuine concerns about the person’s safety or wellbeing, you can also contact your local adult social care team for advice.
You are not giving up.
You are ensuring that when the person is ready—or when circumstances change—the information needed to support an assessment is already available.
The key message
A cognitive screening test is one part of diagnosing dementia. It is not the diagnosis itself.
Families often notice changes months, and sometimes years, before a formal diagnosis is made because they are observing everyday life rather than a single clinical appointment.
Dementia is diagnosed by building a picture over time, not by relying on one score from one test on one day.
If you believe something has changed, trust your observations, keep a record, share your concerns with healthcare professionals, and continue encouraging assessment when the time is right.
The people who know someone best are often holding some of the most important pieces of the diagnostic puzzle.
Common cognitive assessments you may come across
Different GP practices, memory clinics and hospital services use different assessment tools. No single test is “the best” test, and not every service uses every assessment. The choice of assessment depends on the person’s needs, symptoms and the clinician’s judgement.
GPCOG (General Practitioner Assessment of Cognition)
A short screening tool commonly used in general practice. It combines questions for the individual with information from someone who knows them well. It is designed to identify whether further assessment may be helpful rather than diagnose dementia.
MMSE (Mini-Mental State Examination)
One of the best-known cognitive screening tests. It assesses areas such as orientation, attention, memory, language and simple visuospatial skills. Although widely used, it is relatively brief and should always be interpreted alongside other clinical information.
MoCA (Montreal Cognitive Assessment)
A more challenging cognitive screening assessment than the MMSE, often better at identifying subtle cognitive changes. It includes tasks involving executive function, attention, memory, language and visuospatial ability.
ACE-III (Addenbrooke’s Cognitive Examination III)
A comprehensive cognitive assessment that examines attention, memory, verbal fluency, language and visuospatial skills in greater depth than shorter screening tools. It is frequently used within memory assessment services.
RUDAS (Rowland Universal Dementia Assessment Scale)
Designed to reduce the influence of language, education and cultural background on cognitive assessment. It can be particularly helpful for people from diverse cultural and linguistic backgrounds.
Mini-Cog
A very brief screening assessment combining a three-word recall task with clock drawing. It is often used as an initial screening tool in primary care and community settings.
Other specialist assessments
Depending on the person’s symptoms, clinicians may use additional cognitive assessments or refer for detailed neuropsychological testing. These assessments explore different aspects of thinking and can help distinguish between different causes of cognitive impairment.
Whatever assessment is used, it is important to remember that no cognitive test should ever be interpreted in isolation. A diagnosis of dementia is reached by considering the whole clinical picture alongside the person’s history, everyday functioning and the observations of those who know them best.
Further support
If you are worried about someone who may be developing dementia, you do not have to navigate the situation alone.
Useful sources of support include:
- Alzheimer’s Society Dementia Support Line – 0333 150 3456
- Dementia UK Admiral Nurse Helpline – 0800 888 6678
- NHS information on dementia diagnosis – nhs.uk/conditions/dementia/diagnosis