Information
We are often asked to see people with cognitive symptoms, typically memory issues. Many such people are concerned about dementia but have other explanations for their symptoms for which a neurology assessment is not required. We have written this for primary care and patients who are receiving a letter of advice back from neurology rather than an appointment. Typically, this information is about people under the age of 65, although it may also apply to older people.
What types of cognitive symptoms can be managed in primary care without seeing a neurologist?
People who experience cognitive symptoms are often understandably concerned that they may be developing a neurological condition such as dementia or Alzheimer’s disease. However, these conditions only account for a minority of patients seen in memory clinics that focus on younger people and neurology clinics.
There are many common causes of cognitive symptoms which are NOT dementia and cognitive symptoms are very common in the general population (see below). So, any decision about seeing a neurologist needs to consider firstly – is there a cause ALREADY present which may explain the symptoms? and are the symptoms out of the ordinary compared to the general population? Research in Edinburgh shows how common symptoms are, such as forgetting conversations, losing things, or having word finding difficulty in HEALTHY people in their twenties (figure).
What investigations can be done in primary care?
Look for the common causes listed above and some of the ‘red flags’ below. If someone can carry out complex cognitive tasks sometimes but performs badly at others, this often suggests one of the causes above. Some blood tests, including FBC, U&E, Ca, LFTs, TFTs, B12, HIV/Syphilis serology are often reasonable. Cognitive testing has a more limited role (e.g. Montreal Cognitive assessment or 6CIT); if normal, that can be helpful but people with functional cognitive symptoms may score poorly on such tests. A detailed clinical history is usually more helpful than cognitive testing.
If you think your patient has functional cognitive symptoms that are NOT explained by anxiety, low mood or one of the other conditions listed, then consider whether this factsheet available at https://neurosymptoms.org/en/symptoms/fnd-symptoms/functional-cognitive-symptoms/ may be relevant.
Who can refer:
General practitioners
Who to refer:
Patients who are 65 or under where you are concerned about ‘red flags’ such as
• Someone who is NOT concerned about their memory or concentration, but others are.
• Cognitive symptoms that interfere with ability to manage their finances.
• Objective evidence of poor performance at work related to cognitive symptoms.
• Getting lost in familiar places
• Focal neurological symptoms or sign
Who not to refer:
People who are >65 years of age, consider referral to Mental Health (see Cognitive difficulties (Adult) – RefHelp)
How to refer:
SCI gateway: RIE \ Neurology \ LI Basic Sign Referral
If you think your patient has functional cognitive symptoms that are NOT explained by anxiety, low mood or one of the other conditions listed, then consider whether this factsheet available at https://neurosymptoms.org/en/symptoms/fnd-symptoms/functional-cognitive-symptoms/ may be relevant.
