Cognitive symptoms

People who experience cognitive symptoms are often concerned that they may be developing a type of dementia such as Alzheimer’s disease. However, these conditions only account for a small number of patients seen in memory clinics for younger people, and neurology clinics.

Cognitive symptoms are very common in the general population. For example, research from the University of Edinburgh found that even healthy people in their twenties often forget conversations, lose things or struggle to find the right word (see figure below). These symptoms alone do not usually suggest dementia.

Before referring to neurology, consider:

• Is there an existing condition that could explain the symptoms?
• Are the symptoms unusual compared to the general population?

Start by considering the common causes of cognitive symptoms, as well as any red flags (see below). If someone can carry out complex cognitive tasks sometimes but struggles at other times, this often suggests a non-dementia cause such as stress or fatigue, as listed above.

It may be appropriate to carry out some initial investigations in Primary Care. These can include blood tests to rule out common underlying causes of cognitive symptoms:

• Full blood count (FBC)
• Urea and electrolytes (U&E)
• Calcium (Ca)
• Liver function tests (LFTs)
• Thyroid function tests (TFTs)
• Vitamin B12
• HIV and syphilis serology

Cognitive testing, such as the Montreal Cognitive assessment (MoCA) or the 6-item Cognitive Impairment Test (6CIT) may also be helpful. A normal test result can be reassuring, however, it’s important to note that people with functional cognitive symptoms may score poorly on such tests and a detailed clinical history is usually the most valuable assessment tool

If cause is found, treat this where possible. This might include:

• Managing anxiety, depression, post-traumatic stress disorder (PTSD), sleep apnoea
• Reducing or reviewing sedating medication (especially opiates and gabapentinoids)
• Sharing helpful resources with the patient if they have functional cognitive symptoms or cognitive symptoms after head injury (see below)

Consider referral for people aged 65 or under if any of the following red flags are present:

• The person is NOT concerned about their memory or concentration, but family or others are
• Cognitive symptoms are affecting their ability to manage their finances or work
• Objective evidence of poor performance at work related to cognitive symptoms
• Getting lost in familiar places
• There are focal neurological symptoms or signs
• There is a family history of early onset dementia or motor neurone disease (MND)

For patients with symptoms following a mild traumatic brain injury: headinjurysymptoms.org