Not every memory complaint means dementia. But it should not be dismissed either, especially when it is new, progressive or noticed by those close to the person.
What they are
Cognitive functions include memory, attention, processing speed, language and executive functions: planning, organising, deciding. Complaints may be subjective, with normal test results, or correspond to a measurable deficit, either mild or enough to interfere with independence.
Possible causes
- depression, anxiety and insomnia, very common and treatable causes;
- medicines (for example, with anticholinergic or sedative effects) and alcohol;
- vitamin B12 deficiency, thyroid disorders and other metabolic causes;
- cerebrovascular disease and uncontrolled vascular risk factors;
- mild neurocognitive disorder and neurodegenerative diseases, such as Alzheimer's disease.
Depression, heart and cognition
Depression can markedly affect attention and memory, sometimes to the point of being mistaken for dementia; in these cases, performance improves when mood is treated. In older people, late-onset depression may also be an early sign of neurodegenerative disease, which justifies follow-up.
Depression, cardiovascular disease and cognitive decline share mechanisms (inflammation, vascular changes, oxidative stress) and risk factors. This is the research field of Pedro Zuzarte.
When to seek an assessment
When difficulties are new or getting worse, are noticed by family or colleagues, interfere with work or everyday tasks, or come with changes in mood, sleep or behaviour.
What the assessment involves
It includes the clinical history, ideally with input from someone close, a review of medication, assessment of mood and sleep, and brief cognitive tests. Depending on the case, a more detailed neuropsychological assessment, blood tests and brain imaging may be requested. When indicated, follow-up is coordinated with neurology.
Treatment and prevention
The first step is to address potentially reversible causes: depression, anxiety, insomnia, vitamin deficiencies, inappropriate medication. Controlling blood pressure, diabetes and cholesterol, physical activity, cognitive and social stimulation and correcting hearing loss all help protect cognitive health. A significant proportion of dementia cases is estimated to be associated with modifiable risk factors. When dementia is present, there are specific drug treatments, and support for carers is an essential part of the plan.
Frequently asked questions
Is forgetfulness normal with age?
Some slowing and occasionally forgetting names or objects are common. Repeatedly forgetting recent events, getting lost in familiar places or having difficulty with previously simple tasks warrants assessment.
Can depression look like dementia?
Yes. Depression can reduce attention, memory and speed of thinking. Telling the two apart, while recognising that they can coexist, is one of the aims of the psychiatric assessment.
What tests are needed?
It depends on the history. They usually include cognitive tests, blood tests (for example vitamin B12 and thyroid function) and, in many cases, brain imaging. A full neuropsychological assessment is requested when brief tests are not enough.
References
- National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers (NG97). 2018.
- Livingston G, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024;404(10452):572–628.
- Petersen RC, et al. Practice guideline update summary: mild cognitive impairment. Neurology. 2018;90(3):126–135.
This page is for information only and does not replace an individual medical assessment. Clinical review: Pedro Zuzarte, psychiatrist · Published and reviewed: .