10 Signs It’s Time for a Cognitive Assessment

By Fran Kritz

Published on July 19, 2024

Fact checked by Nick Blackmer

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Key Takeaways

 Experts say cognitive decline can be challenging to distinguish from normal aging, but can be
assessed by physicians using specific tests.

 Certain symptoms, such as short-term memory loss and difficulty completing familiar tasks,
warrant consulting a doctor.

 Early detection and diagnosis of Alzheimer's and dementia are crucial for accessing FDA-
approved treatments.

Ever since President Joe Biden’s June debate with Donald Trump, many Americans have wondered if his
halting gait, slow responses, and difficulty staying on topic might indicate cognitive decline.

Experts say it can be hard to distinguish cognitive decline from normal slowing due to aging. However,
neurologists and psychologists can help determine this through in-person assessments based on
questions and lab tests.

“It may be nothing at all, it may be a treatable condition such as an infection, or it could be early signs of
dementia or Alzheimer’s disease,” Jason Krellman, PhD, a neuropsychologist at Columbia University
Irving Medical Center in New York, told Verywell.

A condition like urinary tract infection (UTI) or ministroke can also lead to memory impairment or
confusion in older adults, but proper treatment can often resolve these cognitive issues.1

Krellman said it’s important to speak to your doctor if you're worried about cognitive function in yourself
or a loved one. A healthcare provider can conduct a cognitive assessment.

Cognitive Decline Symptoms in Young and Older Adults

What Are the Signs of Cognitive Impairment?

Memory loss that disrupts daily life could be a symptom of dementia or Alzheimer's disease, saidMaria
C. Carrillo, PhD, Alzheimer's Association chief science officer and medical affairs lead.

“Some memory changes can be a normal part of the aging process, but when changes start to interfere
with daily living or stray drastically from the person’s normal behavior, it’s best to get it checked," Carrillo
told Verywell.

These are the 10 warning signs of Alzheimer’s disease or dementia that warrant a discussion with your
doctor, according to the Alzheimer's Association:

1. Short-term memory loss: This can include forgetting recently learned information like important
dates or events, asking the same questions over and over, and increasingly needing to rely on
memory aids like notes.

2. Challenges in planning or solving problems: This could manifest in an inability to follow a

familiar recipe or difficulty keeping track of monthly bills.
 3. Difficulty completing regular daily tasks. Common issues include not remembering how to drive
to a familiar location, inability to organize a grocery list, or forgetting the rules of a favorite
game. Something that used to feel mundane, like recording a TV show, might be confusing.

4. Confusion about time and place. People living with Alzheimer’s or dementia can lose track of
dates, seasons, and the passage of time. They may have trouble understanding something if it is
not happening immediately. Sometimes, they may forget where they are or how they got there.

5. Trouble understanding visual images and spatial relationships. Some people may experience
vision changes, which can lead to difficulty with balance or trouble reading. They may also have
problems judging distance and determining color or contrast, causing issues with driving.

6. New problems with words while speaking or writing. This can include having trouble following
or joining a conversation, stopping in the middle of a conversation, and having no idea how to
continue. There may also be struggles with vocabulary and trouble naming a familiar object or
using the wrong words (e.g., calling a “watch” a “hand-clock”).

7. Misplacing things and losing the ability to retrace steps. This involves putting things in unusual
places or losing things without being able to retrace steps to find them again.

8. Decreased or poor judgment. Individuals living with dementia may experience changes in
judgment or decision-making. For example, they may use poor judgment when dealing with
money or pay less attention to grooming or keeping themselves clean.

9. Withdrawal from work or social activities. A person living with Alzheimer’s or other dementia
may experience changes in the ability to hold or follow a conversation. As a result, they may
withdraw from hobbies, social activities, or other engagements.

10. Changes in mood or personality. Symptoms can include becoming confused, suspicious,
depressed, fearful, or anxious. Someone may also become irritable if a routine is disrupted.

“Now more than ever, early detection and diagnosis of Alzheimer’s and other dementia is critically
important,” Carrillo said. “There are now FDA-approved treatments targeting the early stages of
Alzheimer’s, and more are in development. Early and accurate diagnosis will help determine eligibility for
current and future treatments.”

FDA Approves Eli Lilly's New Drug for Early Alzheimer's

What Cognitive Testing Entails

When it comes to testing for cognitive decline, many people start by contacting their primary care
physician about their memory or thinking concerns, and primary care doctors often oversee the
diagnostic process themselves, Carrillo told Verywell.

Your doctor will evaluate your overall health and identify any conditions that could affect how well your
brain is working. When talking to your primary care physician about cognitive problems, ask how familiar
they are with diagnosing dementia and whether there are circumstances in which they would refer you
to a specialist.
A specialist, such as a neurologist, can evaluate memory and thinking issues and diagnose dementia.
Some people with unclear symptoms, including those under age 65, may require evaluation by two or
more specialists who combine their findings to reach a diagnosis. These might include a psychiatrist,
psychologist, or geriatrician.

Carillo said there is no single test that can determine if a person is living with Alzheimer’s or dementia.
Physicians use physical assessments, diagnostic tools, and medical history to make an assessment. This
can include:2

 A physical examination and review of any current medications

 A depression screen and mood assessment

 A neurological exam. This involves testing reflexes, eye movement, speech, sensation,
coordination, and muscle tone. It may or may not involve brain imaging.

 Cognitive, functional, and behavioral tests to evaluate memory and problem-solving abilities.
These tests vary in length and difficulty. Specific test examples include Ascertain Dementia 8
(AD8), Functional Activities Questionnaire (FAQ), Mini-Cog, Mini-Mental State Exam (MMSE),
Montreal Cognitive Assessment (MoCA) and Neuropsychiatric Inventory Questionnaire (NPI-Q)

 Blood tests and/or cerebrospinal fluid tests to look for abnormal clumps of amyloid and tau
proteins, which may be early indicators of Alzheimer’s

Can Your Job Protect You From Dementia?

What This Means For You

If you or a loved one are experiencing signs of cognitive impairment, such as memory loss or difficulty
completing daily tasks, it’s important to consult a healthcare provider. Early assessment and diagnosis
can lead to better management of symptoms and access to treatments.

2 Sources

By Fran Kritz
Kritz is a healthcare reporter with a focus on health policy. She is a former staff writer for Forbes
Magazine and U.S. News and World Report.