Two things NICE says about assessing memory problems. First, do not rule out dementia solely because someone scores normally on a cognitive test. NICE also suggests that when a history is taken from someone who knows the person well, it can be supplemented with a structured questionnaire for that person, such as IQCODE. Second, before referring to a memory clinic, other possible causes of declining memory and thinking should be investigated, including depression, sight or hearing loss, and some medicines. If you are worried about a relative, tell the GP what you have noticed, and ask for sight, hearing and the medicine list to be checked.

A case example. A woman in her eighties has dementia. Her husband looks after her day and night. At every appointment he says, "We're fine." A nurse asks if he would talk on his own for a few minutes. He says he has not slept a full night for months. NICE guidance says carers should be offered a confidential conversation about their own needs, separately from the person they care for.

If you look after someone, you can ask the council for help for yourself. The route depends on the nation. In England, under the Care Act 2014, a council must assess a carer when it appears that the carer may have needs for support, now or in future. It must do this whatever it thinks of the level of the carer's needs, and whatever money the carer has. In Scotland, under the Carers (Scotland) Act 2016, a council must offer an adult carer support plan to anyone it identifies as an adult carer, and must prepare one if you ask. Wales and Northern Ireland have their own laws.

NICE advises psychosocial and environmental measures as the first response to distress in a person living with dementia. Before any treatment, a structured assessment should look for reasons and check for causes such as pain, delirium or inappropriate care. Examples from practice include hearing aids and glasses in use, pain treated, curtains open and family welcome. Ask the nurse in charge what can be put in place today.