Mary has lived on her own for the past 40 years, never seeking out further male relationships following the death of her husband from heart problems in his 50s.

In fact, she has rarely mixed with other people her own age and has few social contacts outside of her immediate family, although is looked on fondly by her neighbours.

Mary has begun to struggle with the names of her ever-expanding family and her stories of past times are increasingly repetitive. Her family are patient, however, and dote on her. Until recently they described her simply as getting ‘muddled’ sometimes, which they attribute to ‘old age’.

She knows her local area very well and has no problem getting to her usual local shops but struggles to remember the recent 90th birthday party thrown in her honour by her family.

As an independent and proud lady, she has never asked for or needed help with personal care and her house has always been spotlessly clean. This situation began to change recently, with family members noticing stained clothes being re-worn and less care taken with grooming.

Mary responded to questions about this with plausible excuses or outright denial.

Over recent weeks her children and friends have noticed her frequently wearing wet clothing from urinary incontinence but still denying any problems as previously. Offers of help from all of her close children were met with sarcasm, annoyance and verbal hostility.

Mary’s resolve that there is no problem is unshakable, even when ‘marched’ to her local GP by one of her daughters, Janine, who has clearly inherited some of Mary’s character. The GP was unable to determine if Mary was unaware of or in denial about her problems. She refuses to submit to investigations or to take medication.

Janine and Mary’s personalities clash, with arguments being frequent between them. Mary states she would rather die than accept help.

Mary appears to have undergone a ‘step change’, a sudden worsening of her condition. This is not uncommon.

It might have been caused by an unnoticed stroke or a fall, factors that can compound problems with the brain and which are difficult to treat.

It might also have been caused by factors that are easier to treat: depression, a physical illness accompanied by feverishness, physical pain of some kind or a urinary tract infection. These are some of the common, everyday problems that can lead to behaviour looking like worsening dementia.

Relationships that were a source of comfort to Mary are now problematic and appear to be causing her some distress. She seems to be finding it difficult to cope with family gatherings: sometimes people living with dementia find coping with large numbers of people overwhelming. Her relationship with Janine is becoming difficult. As described, it does not seem to be helping either of them at the moment.

Was Janine right in insisting on a visit to the GP? It certainly might have proved very useful.

A good GP would recognise and diagnose dementia over time, which would open up various avenues of help for Mary and her family. He would also look for and eliminate any treatable problems that might be worsening dementia.

On the other hand, making Mary feel as if she has been forced to do something she did not want to do has (temporarily at least) made the situation much worse.