Memory & Cognitive Decline

Some slowing is a normal part of ageing: taking longer to recall a name, or needing to write more things down, while function is entirely preserved. What warrants assessment is a change that other people have noticed too, that has progressed over months, or that is starting to affect everyday tasks such as managing medication, money or navigation. Forgetting where you put your keys is common; forgetting what keys are for is not.

It is one of the most commonly missed contributors. Obstructive sleep apnoea produces daytime cognitive impairment that closely mimics early dementia, and chronic insomnia and circadian disruption do the same to a lesser degree. Because these are treatable, and because this clinic covers both neurology and sleep medicine, sleep is assessed as part of the picture rather than as a separate referral.

A detailed history, ideally with someone who knows you well, because their account of what has changed is often more accurate than your own. A full neurological examination. Formal cognitive testing that gives a measurable baseline rather than an impression. Blood tests to look for treatable contributors. Brain imaging where it is indicated. A review of all your medication, which is one of the more frequently productive parts of the process.

Yes, and it makes a real difference. A partner, adult child or close friend can describe what they have observed and over what timescale, which is information that is genuinely difficult to provide about yourself. It also means two people hear the explanation and the plan, which is worth a great deal when the appointment covers a lot of ground.

MCI describes measurable cognitive change, confirmed on testing, in someone whose day-to-day independence is still intact. It is not dementia. Some people with MCI progress to dementia, some remain stable for years, and some improve, particularly where a treatable contributor such as sleep apnoea, depression or medication is found and addressed. Establishing a formal baseline is what makes it possible to tell later which of those is happening.

That is said clearly rather than avoided, and referral to specialist memory services is arranged, since ongoing dementia care needs a multidisciplinary team rather than a visiting clinic. Earlier diagnosis is still worth having: it allows treatable contributors to be addressed alongside, gives access to support and to treatments where they are appropriate, and gives you and your family time to plan while you are able to be fully part of those decisions.

Almost always a different problem, and rarely neurodegenerative at that age. Poor concentration and mental fatigue in midlife much more often reflect sleep disruption, stress, low mood, perimenopausal change, thyroid disease, anaemia, long COVID or medication. It is still worth assessing, because those causes are identifiable and most are treatable, but the starting assumption is not dementia.