Dementia – Suspicion in Older Adult

New cognitive impairment is defined by a decline in one or more cognitive domains:
- Learning and memory: Ability to encode, retrieve, store, and make new memories
- Language: Ability to understand and produce language
- Executive function: Ability to reason and problem solve
- Perceptual-motor function: Ability to detect sensations, perform motor skills and copy/produce drawings of objects (construction)
- Complex attention: Ability to focus on relevant information (selective) and sustain attention
- Social cognition: Ability to understand and respond to others’ feelings and social situations.

Cognitive impairment is common in older adults with an estimated prevalence of dementia ~11% (Dementia Prevalence in the United States in 2000 and 2012) in adults aged 65 and older in the United States.
- It is important to note that there are significant disparities by race and ethnicity (2021 Alzheimer’s Disease facts and figures) in the United States.
- Black Americans have 2x the estimated prevalence of dementia, while the Hispanic population has a prevalence of dementia 1.5x of that of non-Hispanic white Americans.
However, dementia has been estimated to be undiagnosed at least 40% of the time, which can lead to reduced quality of life and caregiver burden.
- Several possible reasons for this high percentage exist including: misconceptions about normal aging among the public, failure of healthcare providers to recognize cognitive changes and/or address patients’ concerns, beliefs among providers that pursuing diagnosis would not lead to changes in treatment, among others
Warning signs of possible cognitive impairment:
- Any patient or family concern
- Memory loss or forgetfulness, repeating questions
- Getting lost while driving or getting into car accidents
- New personality changes (depression, impulsivity, apathy, inappropriate behavior, hallucinations, or paranoia)
- Less interest in socialization or work
- Difficulty in completing familiar tasks: managing health care including taking medications, managing finances
- Being a “poor historian”
- Deferring to family member or caregiver to answer questions
- New problem with vocabulary
- Unexplained weight loss
- Vague symptoms
- Inattention to appearance
Link to Alzheimer’s Association “10 Warning Signs of Alzheimer’s” handout, which may be useful to give to patients and families if they ask about warning signs of dementia