Evaluation of Cognitive Impairment in Older Adults

Cognitive complaints are common in older persons. With the shifting demographic pattern toward more aged individuals, more physicians will be needed who have competency in the differential diagnosis for cognitive impairment because there are not enough geriatric subspecialists. Psychiatrists who can evaluate patients for mood and different cognitive disorders will be key societal contributors in caring for the growing elderly population. We describe major differential diagnostic categories for cognitive impairment and characterize their examination, cognitive, laboratory, and neuroimaging findings. We discuss the 3 D’s (depression, delirium, dementia) as common conditions for which older persons are at risk, as well as key differential diagnostic features for the common causes of dementing disorders. Because these disorders may be comorbid, the practitioner needs to carefully evaluate and interpret a range of signs and symptoms indicative of their underlying conditions and manage those accordingly, including referring to subspecialists when necessary. Psychiatrists and neurologists are well positioned to diagnose older patients who have cognitive impairment or dementia. The coauthors leverage their geriatric psychiatry and cognitive-behavioral neurology expertise in addressing this topic for practitioners and cite guidelines and tools that have application in clinical practice.