Published .
Memory assessment uncovers an undiagnosed heart condition
A routine ECG, carried out as part of our full memory assessment, picked up a serious heart condition that no one had spotted. The patient was in A&E by the same evening. This is what happened next.
Written by The Dementia Service.
Patient O came to The Dementia Service in the early weeks of 2025. He was in his early seventies, fit and active, still going to the gym several times a week, still sailing and still playing bridge with his wife in the evenings. The concern was language. He had been struggling to find his words for some time. His wife had been noticing it for around two and a half years, and the headaches and nightmares were new. His GP had referred him to the local NHS memory service, where the wait had been quoted as roughly twelve months. He and his wife decided not to wait.
By the time we sat down to review his results in late March, the picture had changed in ways nobody expected.
What the assessment uncovered
Our full assessment combines cognitive testing, blood tests, an ECG and a brain scan: four things that together give a much clearer picture than any of them does alone. We do them this way deliberately. Memory symptoms can have many causes, and some of those causes are treatable. Some of them have nothing to do with memory at all.
In Patient O's case, the 24-hour ECG came back red-rated within days. The findings, which we will not list in detail here, pointed to a serious problem with the electrical signalling in his heart, including overnight pauses of two to three seconds at a time. This was the kind of finding that does not wait.
We rang the family that afternoon. They went to A&E that evening. He was admitted overnight, and a pacemaker was fitted shortly afterwards.
“Thank you once again for alerting us so quickly to the heart condition. I am sure that you have prevented a health situation that we would not have wanted.”
Carrying on with the assessment
Because of the pacemaker, the MRI brain scan we had planned was no longer the right test. We cancelled it the next morning and arranged a private CT scan at a partner centre instead, which took place around ten days later. We confirmed with cardiology that the dementia medication we were considering, an NMDA receptor antagonist, was safe to use alongside a pacemaker. The clinical interview, by video with our consultant old age psychiatrist, took place at the end of March. That was slightly later than we would have liked, because the family already had a trip planned that we did not want to interrupt.
The diagnosis was Alzheimer's disease dementia, mixed type, with cerebrovascular disease. An NMDA receptor antagonist was prescribed in mid-April. At his first medication review a few weeks later, there were no side effects, and the family reported a noticeable improvement in his mood and presentation. He has been on the medication ever since.
What we want other families to know
A case like this one is a useful reminder of why the full assessment matters. A cognitive test on its own would not have found the heart problem. A scan on its own would not have found it either. It was the ECG, sitting quietly alongside the rest of the assessment, that picked it up. We include it because we have seen, more than once, that it earns its place.
From referral to diagnosis took a little under ten weeks, against the twelve-month NHS wait quoted to the family. That is the comparison we are proudest of, although it is not the most important number in this story. The most important number is the one we cannot quote with any certainty: how things might have gone if the heart finding had not been picked up when it was.
What we would do differently
We are open about the parts of a case that did not go as smoothly as we would have liked, because that is how a service improves.
What worked
- The full assessment did the job it is designed to do, picking up an incidental finding that mattered more than the one we were looking for.
- We escalated on the day of the red-flag result, and supported the family from the moment the result came in.
- The pathway adapted around the pacemaker without significant delay, with a private CT scan in place of the cancelled NHS MRI.
- The diagnosis was confirmed about ten weeks after referral, and the medication started smoothly afterwards.
What we are working on
- The gap between the clinical interview and the prescription was longer than it should have been, and the family ended up chasing for an update. We are shortening our internal turnaround for cardiology sign-off and adding a proactive status update, so families do not need to ask.
- The question of what happens when the first private prescription ends, and whether the GP takes on shared care, came up several times. We now set this out in writing when we first prescribe.
- Getting earlier NHS scans took longer than we hoped. We now explain at the start what to expect, and when a new private scan is the quicker route.
Where things stand now
Patient O has since been discharged from our care, with the diagnosis confirmed, the medication settled and a further heart finding identified and acted on during the case. Ongoing prescribing and review now sit with his GP, which is where this kind of care is meant to settle once a private assessment has done its work. We are grateful to the family for letting us share this story, and for their open feedback throughout.