Man Whose Wife Says He Keeps Repeating Himself — Free SCA Practice Case

Character Overview: You are Brian, a 66-year-old security guard. Over the past six months you have become increasingly forgetful — your wife says you keep repeating yourself and forget recent events like what you had for breakfast or family arrangements. It is now affecting your work: recently you forgot to lock the premises, there was a theft, and you are being blamed. You are distressed and suspect dementia because your father had it and started the same way. Your mood is fine and things are otherwise well at home. You still drive without problems, and you do not do the shopping or cooking. You want your memory tested today.

Opening Sentence: "Hello Doctor. My wife's been on at me — she says I keep repeating myself and forgetting things. It's got worse over the last few months, and now it's causing trouble at work. My dad had dementia and started like this, so I'm frightened that's what it is. Can you test my memory?"

History if Asked (Data Gathering Phase)

• ●The memory problem: "Forgetting recent things — conversations, what I've just eaten, arrangements. My wife says I ask the same questions over and over. It's been coming on for about six months and it's getting worse."
• ●Work impact: "It's affecting my job. I forgot to lock up recently, there was a theft, and I'm being blamed. It's really shaken me."
• ●Family history: "My dad had dementia. He started just like this, which is why I'm so worried."
• ●Home/function: "Home's fine, my mood's okay. My wife does the shopping and cooking. I still drive and I've had no problems with that."
• ●What he wants: "I want you to test my memory today and tell me what's going on."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.

• ●Ideas: Brian strongly suspects dementia, because of his father. "I think it's dementia — it's exactly how my dad started."
• ●Concerns: His dominant worry is what dementia would mean — particularly early retirement / losing his job, and the future. "If it's dementia, I'm scared it means the end of my job and early retirement."
• ●Expectations: He expects his memory tested today and to be told what is happening. "I want my memory checked now and to know where I stand."

If Asked — Cognitive, Reversible-Cause, and Safety Screen

The patient answers these only when directly asked.

• ●If asked about onset/progression: "Gradual, over about six months, and steadily getting worse."
• ●If asked about short- vs long-term memory: "It's recent things I forget. Older memories are fine."
• ●If asked about personality/behaviour change: "No real change in my personality — my wife hasn't mentioned that."
• ●If asked about gait, falls, tremor, urinary symptoms (NPH/Parkinson's): "No balance problems, no falls, no shaking, no waterworks problems."
• ●If asked about headaches or visual symptoms: "No headaches, vision's fine."
• ●If asked about mood/depression: "My mood's alright, I'm not depressed — just worried about this."
• ●If asked about impact on daily activities (dressing, eating, medications, finances): "I manage day to day — dressing, washing, taking my tablet. My wife handles the shopping and cooking."
• ●If asked about safety (cooker/gas left on, driving problems): "I've not left the cooker on that I know of. Driving's been fine — no near-misses."
• ●If asked about alcohol, OTC/herbal medicines: "Occasional drink, no other tablets or herbal things."
• ●If a cognitive test is performed: correctly gives the year and month and the approximate time; makes errors counting backwards from 20 and saying the months in reverse; and cannot recall a 5-part name-and-address phrase given earlier. (A pattern suggesting cognitive impairment.)

Responses to Management (The Negotiation Phase)

• ●If the Doctor performs a cognitive screen: "How did I do? Does that mean it's dementia?" (The tested point is performing and interpreting a cognitive screen appropriately.)
• ●If the Doctor explains reversible causes need excluding (bloods): "So there are other things it could be, and you need blood tests first?" (The tested point is screening for reversible/other causes before assuming dementia.)
• ●If the Doctor explains the referral to a memory clinic: "You can't tell me for certain today? I need to see a memory clinic?" (The tested point is that GPs screen and refer; diagnosis is made in secondary care.)
• ●If the Doctor raises driving and work: "What about my driving and my job? Do I have to tell anyone?" (The tested point is sensible, honest advice on driving/DVLA and work.)
• ●If the Doctor offers support: "Is there help for me and my wife while we wait?"