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Mild cognitive impairment and dementia assessment

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate

Acute or fluctuating confusion, inattention, altered arousal, new focal neurology, fever, head injury, hypoglycaemia or inability to maintain safety is delirium or another acute brain syndrome until proved otherwise. Use urgent ABCDE and cause assessment; do not defer treatment because the person also has chronic memory concerns or a previous dementia diagnosis.

Synopsis

Distinguish mild cognitive impairment from dementia and delirium using collateral functional evidence, adapt cognitive testing to language and sensory needs, identify reversible contributors, and reach a defensible subtype through specialist assessment and imaging.

  • Dementia is acquired progressive cognitive decline severe enough to interfere with independent everyday function; mild cognitive impairment causes objective decline while basic independence is substantially retained.
  • MCI is a risk state, not inevitably early Alzheimer disease: some people progress, some remain stable and some improve when sleep, mood, medicines, sensory loss or illness is addressed.
  • The most diagnostic information is often the change from the person’s previous abilities—money, medication, travel, cooking, technology, work and judgement—not one cross-sectional memory score.

Key red flags

Delirium

Hours-to-days onset, fluctuation, impaired attention and altered arousal in an acutely ill person indicates delirium even when chronic neurodegeneration increases vulnerability.

Investigation priorities

01
Patient and informant functional historyFirst step

Establish decline from baseline, functional consequences and the pattern that suggests a subtype.

Management branches

First assessmentSeparate acute from progressive change

The person or someone close reports new memory or thinking difficulty.

  1. 1. Establish hours, weeks or years of change and screen attention, arousal, observations, acute illness, medication change and focal neurology before cognitive scoring.
  2. 2. If delirium is possible, investigate and treat causes urgently while documenting the pre-illness cognitive baseline from collateral history.

Key medicines

Deprescribing cognitive-burden medicinesReview anticholinergic, sedative, opioid and other contributing medicines one at a time; taper gradually where withdrawal is possible and use current drug-specific and local deprescribing guidance.
No routine cognitive enhancer for isolated MCIDo not start donepezil, another cholinesterase inhibitor or memantine solely for an undifferentiated MCI label; treatment requires an indicated dementia subtype and specialist-informed plan.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom