Normal cognitive aging or dementia? Know the signs and when to refer

Providers should be aware of the latest diagnostic tools to distinguish between normal cognitive aging and early stages of dementia.

Distinguishing normal aging from early dementia can be difficult, but there are clues that can help.

Neurologist Gregory E. Cooper, M.D., Ph.D., chief of adult neurology and director of the Norton Neuroscience Institute Memory Center, answers the most commonly asked questions.

What are the differences between normal cognitive aging, mild cognitive impairment and dementia?
According to Dr. Cooper, it’s helpful to think of aging and cognition as a spectrum:

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Ideal aging: No cognitive change
Normal aging: Some subtle changes in cognition
Mild cognitive impairment: Mild impairments in memory and language (forgetting details or conversations; repeating themselves; losing items) but can still function independently
Dementia: Cannot handle functions of daily living independently

“I have patients who’ll come in and give a very detailed account of all of the things they couldn’t remember. But when they can recount those details, it’s most likely not a sign of a developing dementia. But if their family is concerned about their forgetfulness, then that raises a red flag,” Dr. Cooper said.

It is also important to note the differences between issues of memory compared with attention. If someone is busy, stressed or distracted, they may forget why they entered a room or miss a turn while driving, which would point to attention issues.

Signs of a memory disorder would involve a person missing their turn and getting lost while driving, or not being able to recognize familiar environments.

Are there screenings that you recommend for primary care?

Neurology providers use the Mini-Mental State Examination or the Montreal Cognitive Assessment. If the level of suspicion remains high, then the patient would be referred for neuropsychological testing.

For primary care providers, Dr. Cooper recommends questionnaires for the patient’s family. The AD8 Dementia Screening Interview or the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) will provide a short series of questions to measure a patient’s cognitive decline and determine whether it is a condition that requires further examination.

“You have limited time in the office, and if you’re addressing five or six other issues, you don’t really have time to do a long screen. I know it would be easy enough to refer off to the neurologist, but it might be reasonable to begin with a screening questionnaire,” Dr. Cooper said during a recent episode of the MedChat podcast.

When should primary care refer to neurology?

If a primary care provider has evaluated a patient, including with a questionnaire, and a concern remains, then it is reasonable to refer to neurology.

Many patients with dementia are very well cared for by a primary care provider, according to Dr. Cooper, a referral can sometimes help with peace of mind for provider or family.

“I think to some degree it depends on the family,” Dr. Cooper said. “There are situations where I’ve seen patients and I’ve assured them that their primary care provider did everything right, but they just feel better seeing a specialist. I don’t think there’s any problem with that.”

MedChat is produced by Norton Healthcare's Center for Continuing Medical Education to provide evidence-based information with continuing medical education credit.


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