Symptoms of cognitive impairment: what older adults don’t know

May 02 2023

According to our recent survey of 1,000 people, published in the Patient Voices on Alzheimer’s and Other Dementias Report, older adults need more education on the basics of cognitive disorders and signs of potential issues. While campaigns to fight misinformation and drive awareness have made great progress, myths about cognitive impairment and dementia remain persistent; for example, nearly 1 in 5 older adults surveyed still think dementia is a normal part of aging.

When it comes to identifying early cognitive concerns, few older adults surveyed trust their own ability to spot cognitive impairment: 3 out of 4 don’t feel highly confident that they know the early signs of cognitive impairment. And even if they do feel fairly confident, when asked to choose from a list of signs and symptoms of cognitive impairment, respondents’ ability to identify them was mixed. Notably, while neuropsychiatric symptoms are common in those with mild cognitive impairment (present in up to 85% of cases), nearly half of respondents failed to identify personality or mood changes, depression, and anxiety as possible symptoms of cognitive impairment.

The majority of older adults (70% and up of the 1,000 surveyed) are aware that memory problems, trouble doing familiar tasks, confusion about time and place, and misplacing things are signs of cognitive impairment or early dementia. 60% or more reported knowing that trouble writing or speaking, difficulty making plans or solving problems, and making bad or strange decisions are also symptoms. However, less than half recognized that being less social can be a symptom (49%) and only 21% knew that problems with vision and space can also be a sign of cognitive impairment or early dementia.

Implications for Primary Care Providers

Today, cognitive health lacks standardized guidelines for proactive assessment; the approach to Alzheimer's and other dementias testing and diagnosis is largely “reactive when patients raise issues or self-report their cognitive experiences or challenges.” Patients' lack of knowledge about the signs and symptoms of cognitive impairment makes this more concerning, as they can only tell their provider about symptoms they know about. Older adults would benefit from additional education to increase their awareness and help them spot potential issues as soon as possible. Efforts to dispel common myths around dementia, like the idea that it’s a normal part of aging, are also important.

The stakes are high. A lack of symptom awareness combined with low rates of cognitive assessment today (only 23% of survey respondents reported having had cognitive assessment) can result in missed or delayed diagnosis of dementia (estimated up to 62% globally).

With new medications that target early-stage Alzheimer’s disease emerging, PCPs will need to establish new practices for detection, critical to timing a diagnosis with an intervention window that maximizes patient options (e.g., pharmaceutical treatments, clinical trials, lifestyle interventions). PCPs are on the frontlines of patient care, and when it comes to expanding cognitive testing and streamlining diagnosis of Alzheimer’s and other dementias, their role is only going to become more crucial. It’s important to understand the shifting dynamics in cognitive healthcare and get ahead of rising patient demand for dementia testing.