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Accessible summary • As people get older, many are not able to move as quickly as they used to and many find it harder to think about how to sort their problems. • Sometimes people develop what is called dementia. If someone has dementia then you may notice changes in their memory or how they behave. • There are a few kinds of dementia – one is called Alzheimer’s dementia; another is called vascular dementia; another is called Lewy Body dementia. • If people have these illnesses they find that gradually they are not as able to do the things they used to. They may forget more things like people’s names or how to make their tea. • There are other illnesses that can look a bit like these dementia illnesses and sometimes it is hard to tell if someone has a dementia illness or if they have some other illness instead of or as well as the dementia. • Many of these illnesses can be helped with medicine or with the right sort of support so it is important to sort out just what it is that is making the problem for the person. • If someone really does have a dementia illness then staff members need to know this so they can help the person. Sometimes this means moving into a different house or having different staff members who understand the difficulties. • Sometimes it is hard to find the right place for a person to live. This is because if they have dementia, then as they get older they may need more and more help. • The man in this paper was not able to speak to people but the writer used something called Talking Mats. When there is an important time in their life when they have to choose what they would like to do, Talking Mats is a way to find what a person wants without them speaking, by using pictures. Assessment for a diagnosis of dementia is hard enough under the best possible conditions. There are possible alternative or concomitant diagnoses, such as depression, to consider. However, when the possible dementia concerns a gentleman with severe learning disabilities and with a severe communication disorder then this assessment becomes even more difficult. Still more complications may arise from practical pressures such as general changes in health and hence of support needs; changes in support staff; what housing options are available at the time; and what options are or may be available in anticipation of future needs. This brief case-study highlights the difficulties and competing pressures that complicate further just such a differential diagnosis. [ABSTRACT FROM AUTHOR]