Cognitive Decline in Older Adults

Memory loss is a symptom, not a diagnosis. The first clinical question is whether the change is acute and inattentive, gradually progressive with preserved independence, or sufficiently disabling to interfere with everyday function. Those patterns separate delirium, mild cognitive impairment, and dementia before any biomarker or medication decision is made. For the adult-gerontology primary care nurse practitioner, the work is broader than assigning an Alzheimer's label. It includes obtaining a reliable baseline, identifying reversible or treatable contributors, recognizing a dementia phenotype, staging functional loss, protecting the patient from immediate harm, and helping the patient and care partner make a plan. A normal brief test does not overrule a convincing collateral history, and an abnormal score does not establish an etiology by itself.