Takeaway
Clinicians need to be able to recognize dementia. Diagnosis rests on the patient's history, a cognitive assessment, and collateral input from a care partner.
Lifelong learning in clinical excellence | November 2, 2026 | 3 min read
By Shivani Bhatnagar, DO and Stephanie Nothelle, MD , Johns Hopkins Medicine
I remember sitting with Ms. J on a chilly November afternoon at the Johns Hopkins Memory and Alzheimer’s Treatment Center. Unlike most people who attend a specialist appointment, she wasn’t there of her own accord. Her daughter lived out-of-state and had noticed changes in her mother’s personality and behavior during the prior holiday season that prompted a more in-depth cognitive evaluation. Although Ms. J was appeared well and was conversant, we found on bedside cognitive testing that her Montreal Cognitive Assessment score was 12 out of 30, potentially consistent with moderate cognitive impairment. Her daughter also noted new difficulties in her mother’s activities of daily living, like getting dressed each morning, which led us to discuss something life-changing—a new diagnosis of dementia.
People like Ms. J come into doctor’s offices every day. Globally, about 57 million people have an existing diagnosis of dementia with about 10 million new cases annually. This is expected to rise to about 24 million new cases annually by 2050. At the same time, there are significant wait times in cognitive subspecialty clinics that can lead to diagnostic delays. This means that it’s important that clinicians across all specialties feel comfortable recognizing and even diagnosing dementia.
Diagnosing dementia
Before making the diagnosis, it’s important to clarify the possibilities across the cognitive spectrum that are well illustrated by this figure.
1. Normal aging: Some cognitive changes and slowing can occur with natural aging.
2. Subjective cognitive impairment (SCI): The patient or family report changes in thinking or memory, but the cognitive assessment is normal.
3. Mild cognitive impairment (MCI): A stage where there are deficits on cognitive assessments, but day-to-day function is intact.
4. Dementia: An umbrella term that refers to a syndrome of cognitive decline that’s severe enough to impair day-to-day function, such as new difficulty with activities of daily living.
5. Delirium: A transient syndrome of fluctuating inattention, usually triggered by something like acute illness, hospitalization, or anesthesia.
In addition to obtaining a history of present illness from the patient, the three key pieces to making a diagnosis are:
1. Performing an objective cognitive assessment, like the Montreal Cognitive Assessment, Mini-Mental State Exam, or neuropsychological testing.
2. Obtaining collateral history from a care partner who can speak to the patient’s change over time.
3. Ruling out confounding factors like medication side effects, another illness, or mood disorders, such as depression.
Diagnostics
In recent years, there have been advancements in diagnostics for Alzheimer’s disease, one of the many causes of dementia. These include blood-based biomarkers for amyloid proteins that are thought to cause Alzheimer’s, as well as specialized imaging studies to quantify amyloid burden in the brain. However, these new tests are intended to augment, not replace, the process of gathering history and completing objective cognitive assessment.
Communicating a new diagnosis of dementia
Communicating a new diagnosis or suspicion of dementia can be challenging. When conveying these findings to patients, use clear language and share what about their HPI or cognitive testing indicates SCI, MCI, or dementia. Ensure the diagnosis is conveyed to family or care partners, as patients may not remember the diagnosis or be able to fully recall details. If you’re a specialist, make sure the concerns are shared with the PCP as well.
Two key takeaways
1. MCI, dementia, and delirium are all discrete diagnostic terms.
2. There have been exciting developments in diagnosis and treatment options, but there are many nuances when presenting this information to patients. The initial steps of history taking, cognitive evaluation, and informant collateral are necessary prior to utilizing biomarkers or imaging modalities.
Two practical tips
1. Normal aging and early cognitive impairment can look very similar—do your due diligence and take the extra step to complete a cognitive assessment even if someone’s symptoms sound like normal aging.
2. Identify and involve a care partner—balancing the patient’s perspective with collateral information is key to doing a thorough evaluation.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.