Mostly, patients themselves do not present to the clinician with dementia, owing to gradual onset and denial of the problem. It is usually the primary carers, caregivers, supporters, partners or family members who initiate the consultation [Brodaty, 1990]. In some circumstances, signs of dementia may occur following a major situational change which uncovers the patient’s cognitive impairment, such as a house move or change in career.

One of the most important aspects of the consultation is the collateral history collected from a partner, relative or friend. This individual should be interviewed alone, as otherwise he or she may be reluctant to give information that may embarrass or upset the patient. Furthermore, partners may compensate for memory deficits, but simple questions in the presence of a partner, such as asking patients the names and ages of their children and grandchildren, can reveal cognitive impairment from ‘head-turning’ signs – where the patient will continually look to the partner for help with responding to questions.

A psychiatric history and symptoms of depression are essential to exclude depression in the differential diagnosis. An up-to-date history of prescription and illicit drug use and an accurate assessment of alcohol intake are important, as these may affect cognitive performance. Also, any history of head injuries or boxing is relevant because these increase the risk of dementia.