In a primary care setting, how should cognitive impairment in an elderly patient be assessed?

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In primary care, the first step is to screen for cognitive impairment with quick tools and to assess daily functioning. Brief cognitive tests like the Mini-Cog or MOCA detect impairment efficiently, and asking about activities of daily living shows how the symptoms affect real life. It’s essential to distinguish delirium from dementia because delirium is an acute, fluctuating state usually caused by reversible factors such as infection, medications, dehydration, or metabolic problems, and it requires urgent attention. Always look for reversible contributors to cognitive change, including thyroid issues, vitamin deficiencies, depression, polypharmacy, and sensory impairment.

Relying on imaging alone isn’t sufficient for diagnosis, as scans may reveal structural abnormalities but don’t confirm a cognitive syndrome. Focusing only on memory recall misses other cognitive domains and the functional impact. A full neuropsychological battery for every patient is not practical in primary care and is generally reserved for specialist evaluation when screening results are positive or inconclusive.