When an elder's memory keeps getting worse and daily life starts to slip, take them to a memory clinic or neurology for one check, and first rule out depression, medicines, and poor hearing or vision, causes that can be changed

Memory that keeps getting worse is not necessarily just muddled old age. First check for depression, medicines that do not suit them, and poor hearing or vision, causes that can be changed. Very few cases can actually be cured. Among people with dementia, those who truly improve are under 1%. Checking early has another use: while the elder can still decide for themselves, settle who will manage their money and their medical care later.

Cost

A visit to a memory clinic or neurology, with a cognitive test, a blood draw, and a urine test, takes half a day to a day. Fees follow the local schedule. Yibao (医保 — basic medical insurance) reimburses according to the rules. The hard part is that the elder does not admit they are confused and does not want to go.

Benefit

The UK NICE dementia guideline (NG97) requires that, when dementia is suspected, the history be taken from the person and from family who know them. It also requires a physical exam, blood and urine tests to rule out causes that can be reversed, and a cognitive test. The guideline names four things to check first: delirium (sudden confusion that comes in spells), depression, poor vision or hearing, and medicines with a heavy anticholinergic load. If those are ruled out and dementia is still suspected, refer the person to a specialist service such as a memory clinic for a diagnosis. A 2003 meta-analysis pooled 39 studies, of which 5620 people had a confirmed dementia diagnosis. Alzheimer disease accounted for 56.3%, and vascular disease for 20.3%. Causes that might be reversed accounted for 9%. Those who truly improved were only 0.6%: partial improvement 0.29%, full improvement 0.31%. The same NICE guideline requires an early discussion with the patient and the family about arrangements made in advance. That includes authorizing someone else to manage health and money, and the person's wishes for future care. A 2024 action plan by 15 departments, including the National Health Commission (国家卫健委), calls for pushing a first cognitive screen for people aged 65 and over, and encourages hospitals to set up memory clinics.

Notes

The benefit magnitude is set to small, because very little that is found can truly be reversed, and no study shows that checking early makes a person live longer. The grade is B because the workup comes from a guideline and the figures only show the share that can be reversed. The studies in that meta-analysis run through 2002. The share today may be lower. If a medicine is making the person confused, do not stop it on your own. Take the medicine box and ask the doctor. Becoming sluggish and unsteady on the feet a few weeks after a knock on the head is a different matter: section 13, item 10 (a head CT, computed tomography, after a knock on the head). For hearing loss, fit a hearing aid: section 33, item 17 (hearing aids). While the elder is still lucid, do item 1 (name a future guardian in writing) and item 2 (the will). If they can no longer manage their own affairs, apply to a court for a finding: section 33, item 18 (apply to a court for a finding). The people who benefit are mainly your parents and grandparents.

Sources · 3

1. National Institute for Health and Care Excellence (2018). Dementia: assessment, management and support for people living with dementia and their carers (NG97, recommendations 1.1.12, 1.2.1, 1.2.2, 1.2.6). nice.org.uk/guidance/ng97/chapter/Recommendat…
2. Clarfield AM (2003). The decreasing prevalence of reversible dementias: an updated meta-analysis. Archives of Internal Medicine, 163(18), 2219-2229. doi.org/10.1001/archinte.163.18.2219
3. 国家卫生健康委等 15 部门 (2024). 应对老年期痴呆国家行动计划（2024—2030 年）. gov.cn/zhengce/zhengceku/202501/content_69962…