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.