Detecting Cognitive Decline: How Soon Should I Get Tested?
Occasional forgetfulness is a common part of aging, but persistent changes in memory or problem-solving often raise difficult questions for patients and their families.
Historically, cognitive evaluation has been treated as a last resort, something pursued only after significant changes in daily functioning have emerged. However, cognitive evaluations done early can also provide a baseline of a person’s cognitive functioning that guide proactive intervention and identify reversible causes of decline, informing long-term planning before a crisis occurs.
Understanding Cognitive Decline
Cognitive decline exists on a spectrum. In clinical practice, distinguishing between Mild
Cognitive Impairment and Dementia centers primarily on a person’s day-to-day independence:
● Mild Cognitive Impairment (MCI): MCI represents an intermediate stage between
normal age-related cognitive changes and dementia. An individual with MCI experiences
measurable deficits in memory, language, or executive functioning, yet their ability to
function independently in daily life largely remains intact. They are still able to handle
finances, manage medication routines, and take care of household chores, though these
tasks may require more effort or compensatory strategies such as notes or reminders.
There are many reasons why a person might develop MCI, and it is important to note
that not all cases of MCI progress to dementia; in many cases, MCI remains stable or can
even improve if causes are identified and treated (Alzheimer's Association, 2024).
● Dementia: Dementia is not a specific disease, but rather a broad term for a decline in
mental ability severe enough to interfere with daily life. Unlike MCI, dementia is defined
by a loss of functional independence, eventually impacting basic activities of daily living.
Alzheimer's disease is the most common cause of dementia, accounting for 60% to 80%
of all cases, while vascular dementia, which results from strokes or restricted blood flow
to the brain, accounts for 5% to 10% of cases (Alzheimer's Association, 2024). Other less
common forms of dementia exist as well.
Cognitive Decline in the United States
To understand why proactive screening is important, it helps to understand the current
prevalence and future trajectory of dementia in the United States.
Condition | Total U.S. Prevalence (All Ages) | Notes on Population |
Total Mild Cognitive Impairment (MCI) | ~8-10 million Americans | Includes age 65+ estimates (~5–7 million) plus individuals experiencing early-onset MCI in midlife (ages 50–64). |
Total Alzheimer's Dementia | ~7 million Americans | Includes ~6.9 million aged 65+ and an estimated 200,000 individuals under 65 with younger-onset Alzheimer’s. |
Total All-Cause Dementia | ~8-9 million Americans | Encompasses Alzheimer’s alongside vascular, Lewy body, frontotemporal, and mixed dementias across all age groups. |
Sources: Livingston et al. (2024); Alzheimer's Association (2024)
These figures highlight that cognitive decline affects millions of Americans. Yet, observational data collected by Liu and colleagues from Medicare in the United States suggests that up to 90% of expected cases of MCI remain undiagnosed in routine medical care. Because functional independence remains preserved with MCI, early signs are often dismissed as normal aging and are overlooked until significant progression occurs. In the future, research by Fang and colleagues (2025) expect new cases of dementia to increase from 514,000 in 2020 up to 1 million in 2060.
Waiting for clear signs of impairment ensures that care remains reactive; proactive cognitive testing, by contrast, allows patients and their care teams to intervene while the brain is most receptive to treatment and risk-reduction strategies.
Why Cognitive Testing Matters
Psychologists use cognitive testing as a practical roadmap for patients. Assessment serves two distinct purposes:
Prevention
● Establishing a Baseline: Cognitive assessment before significant impairment occurs
helps to establish a person’s baseline cognitive functioning, making it easier for
clinicians to spot changes in functioning as they occur down the road.
● Identifying Risk Factors: It can also help to identify conditions or risk factors that could lead to the development of MCI or look like MCI, but are actually treatable. Risk factors include smoking, high LDL cholesterol, and high blood pressure. Related conditions include depression, anxiety, stress, and sleep problems. If risk factors and related conditions are present and properly identified, treatment can often restore cognitive functioning back to normal.
Diagnosis:
● Providing Clarity: Getting an answer is, of course, the primary reason people arrive for
cognitive assessment. Cognitive testing can be used to spot significant impairments in
functioning and cognitive deficits implicated in MCI or dementia if they exist. The
clinician will use all the data gathered from testing to decide whether the changes are
related to normal aging, MCI or dementia, or other lifestyle or psychological factors.
● Creating a Gameplan: If an evaluation does show real neurological changes, the goal is not to deliver bad news and leave the client to figure things out on their own. The
clinician will work with the client by explaining what the results mean, helping the client
identify next steps, and providing appropriate referrals to medical and mental health
professionals to navigate next steps.
Getting clarity as early as possible helps a client to stay in control of their future. Having an answer allows the client to choose what kind of care they want, set up legal and financial protections, and make other key family and life choices while their mind is clear. Ultimately, cognitive assessment is not about waiting for bad news or confirming worst fears. It is a proactive, empowering step that replaces uncertainty with a flexible roadmap, ensuring that clients and their families have the tools, the support, and the agency they need to protect their quality of life.
Take Control of Your Cognitive Health Today
Don't wait for uncertainty to compromise your peace of mind or future independence. Whether you want to establish a baseline for proactive prevention or are seeking clarity regarding changes in your memory, early evaluation is the key to staying empowered.
Dr. Dalfiume is available to provide comprehensive cognitive testing to help you identify root causes, explore reversible risk factors, and build a personalized roadmap for your care.
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