An exploration of the UK unpaid carer's world

2g letter to caree 16 March 2015                                                                                  hidden page                                                              

Dear Dr L 

This lovely 78 year old lady was assessed at her home by Memory Assessment Nurse  MH with her husband present. This memory assessment along with a CT scan and blood results has been discussed with our consultant Psychiatrist Dr E.  Please see below for full report, diagnosis and action plan.

Presenting Situation

Caree has experienced gradual onset of memory impairment over the past 12 months. Feels this has got worse since an admission to hospital due to a damaged hip. It is particularly short term memory impairment; long term memory is patchy but generally intact. Caree experiences word finding difficulties at times and sometimes uses the wrong words. She feels this is something that worsens when talking to new people. Caree is cared for by her husband who has also noticed memory troubles with his wife. Caree has poor mobility and uses a wheelchair to mobilise. She has a paid carer that attends once daily to help her with her morning ADLs.

ACE-111 Results

Overall score 56/100

Attention 11/18

Memory 9/26,

Fluency 6/14,

Language 21/26,

Visuospatial 9/16

BADLS 24/60


Diagnostic Review with Dr E and MH

Caree has experienced a several year history of progressive cognitive impairment now with global impairments (ACE-3) 56/100. Clinical history from GP includes a change in character becoming reclusive and with psycho-motor retardation attributed to depression. The above is occurring on a back ground of ischaemic heart disease. CT scan has shown predominant fronto-temporal changes.

Caree is clearly suffering from a moderately severe dementia, the suspicion is that this is a fronto-temporal dementia; further neuropsychology testing would shed more light on this possibility. Dr E would be comfortable with caree trial an ACI medication but she would need an ECG and he would stop these swiftly if there were any worsening of her symptoms as patients with FTD sometimes do poorly with ACIs.

I have been to visit caree and her husband to deliver a diagnosis of fronto-temporal dementia. I have explained that as a service we could offer further specialist assessment to determine this in more detail however they are happy to leave the diagnosis as it is currently. I have discussed the possibility of caree starting an ACI medication if her ECG allows and it is something they are going to have a think about. I have left it that they will contact the memory clinic when they have made a decision. If they do decided to commence with this I will arrange an ECG and monitor the initiation of this medication for the first 28 days.

In the meanwhile I will refer Caree to a Community Dementia Nurse and a Dementia Adviser who can signpost and offer them support and advice* . I have left Carees with an information pack on Dementia.


Caree to let me know if she wishes to trail sic an ACI medication

Referral made to Community Dementia Nurse

Referral made to dementia Adviser

Yours sincerely,


Memory Assessment Nurse

Cc: Prof and Mrs H


It should be noted that this letter was addressed to caree in handwriting and with no indication of source.

In anticipation of such  inappropriate policy across caree provision, carer had been opening all caree mail for several months. Caree would have been distressed had this not happened.

The 2g care plan is one sentence amounting to keep taking the daily tablet.

" . . they are happy to leave the diagnosis as it is currently. .."  Carer soon after, endeavoured to create dialogue to no useful result.

The diagnosis would have been easier to read had semantic dementia  replaced excessive text at the appropriate point.

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