What could be behind your elderly patient’s subjective memory complaints?

Recommendations

There is no consensus regarding the nomenclature applied to reported memory loss and mild cognitive impairment. The Clinical Manual of Geriatric Psychiatry provides definitions that can be used in the clinical setting (TABLE).¹⁸

The US Preventive Services Task Force concludes that evidence is insufficient to recommend for or against routine screening for dementia in older adults (I recommendation).¹⁹ However, the Task Force notes that clinicians should assess cognitive function whenever they suspect impairment or deterioration based on direct observation, patient report, or concerns raised by family members, friends, or care-takers.

The American Geriatrics Society²⁰ and American Academy of Neurology (AAN)²¹ acknowledge the subtle difference between age-associated memory impairment and mild cognitive impairment, and the difficulty of differentiating normal changes of aging from abnormal changes. The AAN’s guidelines for early detection of dementia emphasize the importance of diagnosing mild cognitive impairment or dementia early. However, the guidelines specifically exclude patients with subjective memory loss unaccompanied by objective cognitive deficits and offer no further discussion about these patients.

TABLE
Features of age-associated memory impairment vs mild cognitive impairment