What initial assessments should I perform for a patient presenting with memory loss to differentiate between normal aging and pathological conditions?

Initial assessments for a patient presenting with memory loss to differentiate between normal aging and pathological conditions include:

• Clinical history and brief cognitive testing: Assess memory function and concentration to identify if symptoms are consistent with normal aging or suggest cognitive impairment. For adults under 50, if brief testing shows normal memory and symptoms align with concentration difficulties, routine referral is not required ¹.
• Exclude reversible causes: Investigate and rule out reversible causes of cognitive decline such as delirium, depression, sensory impairments (e.g., hearing or vision loss), and medication effects, especially those with anticholinergic burden ².
• Neurological examination: Perform an appropriate neurological exam to detect any signs suggestive of neurological disease ².
• Use of validated cognitive tests: Include tests of verbal episodic memory (e.g., recalling a list of words or a short story immediately and after a delay) to assess memory more specifically ².
• Consider referral to specialist dementia diagnostic services: If reversible causes have been excluded and dementia is still suspected, refer to memory clinics or community old age psychiatry services for further assessment ².
• Structural brain imaging: Offer CT or MRI to rule out reversible causes and assist with diagnosis unless dementia is well established and subtype is clear ².