Normal Aging vs Dementia vs MCI
| Feature | Normal Aging | MCI | Dementia |
|---|---|---|---|
| Memory lapses | Names, words — recalled later | Noticeable; consistent; forget recent events | Significant impairment; repeated questions |
| ADLs (daily activities) | Intact | Mostly intact; may need prompts | Impaired — can't manage independently |
| Insight | Present | Present | Often reduced |
| Progression | Stable | Possible conversion to dementia | Progressive |
| Language | Normal | Mild word-finding | Significant aphasia (Alzheimer's) |
Reversible Causes to Rule Out First
- Vitamin B12 deficiency — megaloblastic changes affecting brain
- Hypothyroidism — 'myxoedema madness'; reversible with levothyroxine
- Depression — pseudodementia; cognitive testing severely impaired
- Medication side effects — benzodiazepines, anticholinergics, opiates
- Urinary tract infection (especially in elderly) — acute confusion
- Alcohol excess — Wernicke-Korsakoff syndrome (thiamine deficiency)
- Subdural haematoma — head injury (may be minor in elderly); neurosurgical emergency
MMSE and MoCAThe Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are brief 10-minute cognitive screening tools used in primary care. MoCA is more sensitive for MCI. A score <26/30 on MoCA warrants further investigation.
What blood tests should be done for memory problems?
TSH, B12, folate, FBC, CRP, eGFR, glucose, LFTs, calcium. These rule out the most common and treatable causes. If all normal, refer to memory clinic for neuropsychological assessment and MRI brain.
How is Alzheimer's disease diagnosed?
Clinical assessment + cognitive testing + MRI brain (hippocampal atrophy) + (if needed) CSF biomarkers (amyloid β42, tau) or amyloid PET scan. Diagnosis is a clinical judgement — not a simple blood test.
What is the difference between Alzheimer's and vascular dementia?
Alzheimer's: insidious onset, gradual progression, memory loss early. Vascular: stepwise deterioration, executive dysfunction prominent, multiple small strokes or white matter changes on MRI. Many people have mixed dementia.
What helps slow dementia progression?
No drug cures dementia. Cholinesterase inhibitors (donepezil, rivastigmine) slow cognitive decline in Alzheimer's by 6–12 months. Lecanemab (anti-amyloid antibody) is now approved for early Alzheimer's in the US. Social engagement, exercise, and cognitive stimulation help.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.