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Recognizing Cognitive Impairements

Recognizing early cognitive impairments is one the earliest and most important steps one can take in proactively addressing the growing threat of Alzheimer’s disease and other forms of dementia.

Early diagnosis can lead to early treatment as well as possible inclusion in advanced clinical trials. Early diagnosis can also help with one’s overall financial and health management planning – as they are still lucid enough to express their desires and wishes.

Common Symptoms

Here are some guidelines on behaviors, actions, and responses that might suggest early cognitive impairments.

Subtle Short-Term Memory Changes

Trouble with memory can be an early sign of dementia. The changes are often subtle and tend to involve short-term memory. Your elderly relative may be able to remember years past, but not what they had for breakfast.

Other signs of changes in short-term memory include forgetting where they left something, struggling to remember why they went into a particular room, or forgetting what they were supposed to do on any given day.

Difficulty Finding the Right Words

Another early sign of dementia is struggling to communicate thoughts the way you want to. This may mean that a person can’t seem to explain things. They may reach for the right words, but just can’t seem to grasp them.

Conversations with an elderly parent who has dementia can become difficult and take longer than usual to conclude.

Changes in Mood

Changes in mood are also common with dementia. It isn’t always easy to recognize this aspect of dementia in yourself, but it’s easy to notice in a loved one. Depression, for instance, is typical of early dementia.

Along with mood changes, you might also see a shift in personality. One typical type of personality change seen with dementia is a shift from being shy to outgoing. This is because judgment is often affected.


A common symptom of early dementia is a listlessness or apathy. You might notice that your elderly loved one is starting to lose interest in hobbies or activities. They may not want to go out anymore or to do anything fun. They may be losing interest in spending time with friends and family and may seem emotionally flat.

Difficulty Doing Normal Tasks

A subtle shift in the ability to complete normal tasks may indicate an early sign of dementia. This usually starts with difficulty doing more complex things like balancing the checkbook or playing games that have a lot of rules.

Along with the struggle to complete familiar tasks, you may notice your loved one struggling to learn how to do new things or follow new routines.


Someone in the early stages of dementia may often show signs of confusion. When memory, thinking, or judgment lapses, confusion arises as your loved one can no longer remember faces, find the right words, or interact with people normally.

Confusion can occur for a number of reasons. For example, missing car keys, forgetting what comes next in the day, or trying to remember who someone is.

Difficulty Following Storylines

If you notice that your elderly loved one has a hard time following storylines, it may be due to early dementia.

Just as finding and using the right words becomes difficult, people with dementia also sometimes forget the meanings of words they hear. Struggling to follow along with conversations or TV programs is a classic early warning sign.

A Failing Sense of Direction

Sense of direction and spatial orientation is a common function of thinking that starts to deteriorate with the onset of dementia. This can mean not recognizing once-familiar landmarks and forgetting regularly used directions.

It also becomes more difficult to follow series of directions and step-by-step instructions.

Being Repetitive

Repetition is common in dementia because of memory loss and general behavioral changes. You might notice your elderly parent or loved one repeat daily tasks like shaving or collecting items obsessively.

They also may repeat the same questions in a conversation after you’ve already answered them.

Struggling to Adapt to Change

For someone in the early stages of dementia, the experience is frightening. Suddenly they can’t remember people they know or follow what others are saying. They can’t remember why they went to the store and get lost on the way home.

Because of this, they might crave routine and not want to try new things. Having difficulty adapting to changes is a typical sign of early dementia.

Medical Tests

There are numerous medical tests that can help provide a clearer picture of a loved one’s mental capacity. The following outline the series of medical test that should be considered.

Physical Exam

During your loved one’s medical workup, you may ask the physician to look for symptoms of cognitive impairments. You can expect the physician to:

Ask about diet, nutrition and use of alcohol.

Review all medications. (Bring a list or the containers of all medicines currently being taken, including over-the-counter drugs and supplements.)

  • Check blood pressure, temperature and pulse.

  • Listen to the heart and lungs.

  • Perform other procedures to assess overall health.

  • Collect blood or urine samples for laboratory testing.

Be prepared for the doctor to ask:

  • What kind of symptoms have you noticed?

  • When did they begin?

  • How often do they happen?

  • Have they gotten worse?

Co-attending the physical exam and providing input can be helpful.

Information from a physical exam and laboratory tests can help identify health issues that can cause symptoms of dementia. Conditions other than Alzheimer's that may cause confused thinking, trouble focusing or memory problems include anemia, depression, infection, diabetes, kidney disease, liver disease, certain vitamin deficiencies, thyroid abnormalities, and problems with the heart, blood vessels and lungs.

Neurological Exam

During a neurological exam, the physician will closely evaluate the person for problems that may signal brain disorders other than Alzheimer's. The doctor will look for signs of small or large strokes, Parkinson's disease, brain tumors, fluid accumulation on the brain, and other illnesses that may impair memory or thinking.

The physician will test:

  • Reflexes

  • Coordination, muscle tone and strength

  • Eye movement

  • Speech

  • Sensation

Mental Status Tests

Mental status testing evaluates memory, ability to solve simple problems and other thinking skills. Such tests give an overall sense of whether a person:

  • Is aware of symptoms

  • Knows the date, time, and where he or she is

  • Can remember a short list of words, follow instructions and do simple calculations

The mini-mental state exam and the mini-cog test are two commonly used tests.

Mini-mental state exam (MMSE)

During the MMSE, a health professional asks a patient a series of questions designed to test a range of everyday mental skills.

The maximum MMSE score is 30 points. A score of 20 to 24 suggests mild dementia, 13 to 20 suggests moderate dementia, and less than 12 indicates severe dementia. On average, the MMSE score of a person with Alzheimer's declines about two to four points each year.


During the mini-cog, a person is asked to complete two tasks:

  • Remember and a few minutes later repeat the names of three common objects

  • Draw a face of a clock showing all 12 numbers in the right places and a time specified by the examiner

The results of this brief test can help a physician determine if further evaluation is needed.


Disclosures – Important – Please Review

This material does not constitute the rendering of investment, legal, tax or insurance advice or services. It is intended for informational use only and is not a substitute for investment, legal, tax, and insurance advice.

State, national and international laws vary, as do individual circumstances; so always consult a qualified investment advisor, attorney, CPA, or insurance agent on all investment, legal, tax, or insurance matters.

The effectiveness of any of the strategies described will depend on your individual situation and on a number of other factors. After reviewing your personal situation, we may recommend that you not use any strategy in this document but instead consider various other strategies available through our practice.

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