23, 24 Early in the disease course, dementia often impairs instrumental activities of daily living, such as paying bills, balancing the checkbook, or remembering to take medications. 25, 26 Table 2 outlines diagnostic clues for each cognitive domain. 25, 26 The history should include education level, timeline of symptom presentation, and speed of progression. A history to evaluate for cognitive impairment should include the input of a reliable informant (e.g., family members, close friends, caregivers) because patients of ten have poor insight into their own functional status.

Physicians can recognize signs of worsening cognitive function from aberrant patient behaviors, such as missed appointments or vague answers to questions. Interference with instrumental activities of daily livingĭoes not interfere with instrumental activities of daily living, but they require additional time and effortĬannot occur exclusively during bouts of deliriumĬannot be explained by another mental disorderĬoncerns for early dementia may arise from the patient, the physician, or the patient's loved ones. Modest cognitive decline in at least one cognitive domain as seen in both of the following: Objective neurocognitive testing/assessments Significant cognitive decline in at least one cognitive domain as seen in both of the following:Ĭoncerns expressed by the patient or reliable informant or as seen by the clinician Routine cerebrospinal fluid testing and genetic testing for the apolipoprotein E4 allele are not recommended. Diagnostic testing and secondary evaluation, including screening for depression, appropriate laboratory studies for other conditions that cause cognitive impairment, and magnetic resonance imaging of the brain, should be performed when cognitive impairment is confirmed. If the results are abnormal, further evaluation is warranted using more in-depth screening tools such as the Montreal Cognitive Assessment, Saint Louis University Mental Status Examination, or Mini-Mental State Examination. If dementia is suspected, physicians can use brief screening tests such as Mini-Cog or General Practitioner Assessment of Cognition.

harms of screening for cognitive impairment in older adults. Preventive Services Task Force and the American Academy of Family Physicians have concluded that current evidence is insufficient to assess the benefits vs. Risk factors for dementia include age family history of dementia personal history of cardiovascular disease, cerebrovascular disease, diabetes mellitus, or midlife obesity use of anticholinergic medications apolipoprotein E4 genotype and lower education level. The prevalence of dementia will likely increase in the future because the number of Americans older than 65 years is expected to double by 2060. Dementia is a significant and costly health condition that affects 5 million adults and is the fifth leading cause of death among Americans older than 65 years.

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