When should I consider referring a patient with MCI to a specialist for further evaluation?

Consider referring a patient with mild cognitive impairment to a specialist dementia diagnostic service if:

• Reversible causes of cognitive decline (such as delirium, depression, sensory impairment, or medication effects) have been investigated and dementia is still suspected.
• The cognitive impairment is unclear in nature, or it is uncertain whether the impairment is caused by dementia or another condition.
• There is a need to diagnose a dementia subtype to guide management.
• There is suspicion of rapidly progressive dementia, which requires referral to a neurological service.

Specialist services include memory clinics or community old age psychiatry services staffed by clinicians with expertise in dementia diagnosis and management, such as psychiatrists, geriatricians, neurologists, or specialist nurses.

Initial assessment in primary care should include history, physical examination, cognitive testing with validated instruments, and exclusion of reversible causes before referral.

Referral is appropriate when further specialist assessment is needed to confirm diagnosis, subtype, or to access post-diagnostic support and treatment.

This approach ensures timely and accurate diagnosis and appropriate management planning.

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