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Feature Article

Forgetfulness, stress or mild dementia? Cognitive assessment of older patients

ANNA TAKÁCS, REBECCA KONCZ, ADITH MOHAN, Perminder Sachdev

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Abstract

Cognitive complaints are common among older people and have many causes, including the normal changes of ageing. A detailed history and cognitive screening are essential for diagnosis, and screening for medical and psychiatric conditions may identify a treatable cause. All older patients presenting with forgetfulness may benefit from neuroprotective advice. Specialist referral should be considered in complex cases or when dementia is suspected.

Key Points

  • Concerns about memory are common in older patients.
  • Cognitive changes are normal for almost all people as they age, and assessment should focus on differentiating the normal changes of ageing from abnormal cognitive functioning.
  • Primary cognitive problems should be differentiated from secondary disorders, such as those caused by a medication, medical condition or psychiatric problem.
  • Assessment and follow up should include use of a cognitive screening tool such as the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) or General Practitioner Assessment of Cognition (GPCOG).
  • The management of mild cognitive impairment includes good medical care and general neuroprotective advice, which is relevant to all older patients presenting with memory concerns.

    Picture credit: © Ivanastar/iStockphoto.com
    
Model used for illustrative purposes only

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