Memory clinic threshold: consultant, GP, psychiatry or A&E

You have started repeating questions, missed a bill you would never have missed, or watched a parent lose the thread of a familiar kitchen. Search results then offer four doors at once: a private memory clinic, a GP, psychiatry, or A&E. Those are not interchangeable, and picking the wrong door is how a family sits in a booked Harley Street room with a sudden confusion that needed an ambulance, or how they leave a blood form with the same unanswered worry they arrived with.

The memory clinic threshold at Medical Express Clinic is a consultant visit with Prof Arshad Rather at 117a Harley Street. That is not a same-day walk-in, a GP slot, a psychiatry appointment, or an emergency department.

When it is 999 or A&E

Call 999 or go to A&E for a life-threatening emergency.

Which door matches the memory concern.

NHS guidance is plain. For the brain, that includes sudden confusion, stroke symptoms, or any severe illness that makes you think someone is acutely unwell. Face drooping, arm weakness, slurred speech, sudden loss of vision, a seizure, collapse, or a person who was well this morning and cannot now recognise where they are, do not belong on a clinic enquiry form.

If you are reading this while the person in front of you is suddenly confused, stop reading and call 999. Do not drive them yourself if you think it is a stroke.

NHS 111 is the route NHS.uk names when symptoms are urgent but not life-threatening, or when you are not sure whether 999 is required. You can check symptoms online, or call 111. A private memory diary is not a substitute for that public emergency system.

When a GP is the right person

A new memory complaint that is not an emergency often belongs with a GP, especially when a general medical review or routine blood tests would help. NHS.uk says it is a good idea to talk to a GP if you are becoming increasingly forgetful, particularly if you are over 65, and that you should get help if memory loss is affecting daily life or worrying you or someone you know. Stress, tiredness, illness and medicines can all cloud memory. A GP can take that history, examine you, and decide whether bloods, a medicine review, or a specialist referral would help.

This clinic is consultant memory assessment, which is a different appointment from the GP service in the same building. Wanting a specialist does not make a GP the wrong doctor. If nobody has yet looked at a new tablet, an infection, low mood, or a hearing problem that is making conversations harder to follow, a GP is often the person who can do that without you having already decided you need a geriatrician.

A GP can also write the letter you later bring to Prof Rather. If a referral letter already exists, bring it with you. Do not use a memory clinic booking as a way of skipping a GP when the problem is a cough, a fever, or a set of routine bloods that have not been done.

When psychiatry is the better route

If the main concern is low mood, anxiety, psychosis or a psychiatric presentation without clear cognitive decline, a psychiatry consultation may be more suitable than a memory clinic. People lose words when they are depressed, lose sleep when they are anxious, and can look vacant or withdrawn for reasons that are not a dementia syndrome. Those presentations still need a doctor, but they do not automatically need a cognitive assessment.

Personality change, new confusion about place or time, and a partner who says the person is not themselves, can sit inside a dementia picture rather than a purely psychiatric one. The question is which problem is primary. If memory, thinking or confusion is the thread that will not settle, the memory clinic is the door. If mood, anxiety or psychosis is the thread, and thinking is intact, psychiatry is the honest one.

When the memory clinic is the visit

For persistent memory or thinking change that is already affecting daily life, and that you want a consultant geriatrician to hold, the usual visit is a consultation with Prof Arshad Rather, Consultant Geriatrician and General Physician, GMC 6035767, at 117a Harley Street, with cognitive screening as the sister service. He leads this service. You do not need a diagnosis before you enquire.

People come because work, finances, medication or safety at home have started to slip, or because planning, language or decisions have become effortful in a way that is new. Others come because a parent is repeatedly confused about place or time, because personality has shifted out of character, or because a partner, adult child or carer is sure something has moved beyond ordinary ageing.

The person themselves can enquire, and so can a relative. Many families arrive unsure whether the change is ageing, stress, a treatable medical problem, or something that needs longer-term planning. Memory problems are not always dementia, and some causes can be treated, so a structured clinical assessment can help even when the findings are reassuring.

Medical Express Clinic has practised at 117a Harley Street since 1984 and is CQC-registered. Prof Rather sees you in that building. It is not a same-day walk-in. You send an enquiry, or you call, and the clinic contacts you to arrange the visit according to clinical need and current availability, once it understands who the assessment is for and what has already been checked elsewhere.

It is not a guaranteed dementia diagnosis. Further tests are agreed only if they would help answer the clinical question, because no single test tells the whole story on its own, and the assessment is tailored rather than sold as a fixed bundle.

Prof Rather takes a full clinical history, examines you when that is useful, and plans the assessment around your symptoms and background. He reviews the history with you, and with a family member or carer when you agree that would help. When you enquire you can ask for a Memory Assessment Consultation, Cognitive Screening, or Dementia Risk Assessment, matching the reason for contact. Those labels describe why you are getting in touch, and they do not freeze a shopping list of investigations. What further investigation might help, if any, is discussed with you before anything is arranged.

How findings are shared, and how soon follow-up happens, depend on what was done and what those results show. Ongoing review is arranged when it is clinically appropriate. Liaison with your GP can be part of that continuity when it would help.

Alzheimer's is one cause, not the only one

Alzheimer's disease is a type of dementia, and together with vascular dementia it makes up the majority of cases. It is not the only cause. Dementia is a syndrome: a group of related symptoms associated with an ongoing decline of brain functioning. NHS.uk is plain that dementia is not a natural part of ageing, and that people often confuse Alzheimer's disease with dementia.

Accurate assessment looks at the full clinical picture rather than assuming one label from symptoms alone. Memory problems do not necessarily mean Alzheimer's disease, and they do not necessarily mean dementia. Stress, medicines, infection, low mood and other medical problems can all mimic a cognitive decline. That is why the visit starts with history and examination rather than with a name.

What to bring

Bring any referral letter and previous results you already have, a medication list, and a relative's note of what has changed if one exists. If a GP, a hospital discharge or another clinic mentioned a finding, bring that paperwork rather than reconstructing it from memory. You do not need a referral, but a letter that exists should still travel with you.

Tips and tricks

• Decide which of the four doors you are walking through before you enquire.
• Sudden confusion, stroke symptoms or severe illness is 999, not Harley Street.
• Urgent symptoms that are not life-threatening can go to NHS 111.
• A new milder memory complaint, or a problem that still needs a general medical review and routine bloods, often starts with a GP.
• Psychiatry is for when mood, anxiety or psychosis is the primary concern and thinking has not clearly declined.
• The memory clinic is for persistent memory or thinking change that is already affecting daily life, and that you want Prof Rather to assess.
• Put results you already hold in one place.
• Say whether the enquiry is for yourself or for a relative.
• If a family member has seen the change more clearly, ask whether they should sit in the room.

Things to avoid

• Do not sit on sudden confusion, face droop, arm weakness or slurred speech because you have a clinic enquiry in a draft email.
• Do not treat occasional forgotten names as a diagnosis, and do not treat a reassuring GP blood test as a promise that a later decline cannot appear.
• Do not book a memory clinic because you wanted a GP to look at a fever, and do not book psychiatry because you wanted someone to take a cognitive history.
• Do not arrive without letters you already hold.
• Do not assume every further test happens in the same room, or that every enquiry produces a dementia label.
• Further investigation is arranged only if it would help, and a diagnosis is not guaranteed.

If you do want the consultant memory clinic visit, the details sit on the memory clinic page, or you can contact the clinic on 020 7499 1991.

Related guides: choosing between a GP and a psychiatrist and when to see a private GP.