Attention before interpretation #
Cognitive examination begins with whether the person can engage and sustain attention. Poor registration caused by inattention can look like a memory problem. Arousal, distress, hearing, vision, language, literacy, education and fatigue affect performance. Record the conditions and limitations before interpreting a score or an isolated response.
Orientation describes awareness of person, place, time and situation. Intact orientation does not exclude delirium, mild cognitive impairment or another cognitive difficulty. Disorientation is a finding needing explanation rather than a diagnosis in itself.
Separate stages of memory #
| Process | Question | Interpretive issue |
|---|---|---|
| Registration or encoding | Was the information adequately attended to and learned? | Poor attention or comprehension can undermine later recall. |
| Retention | Was information maintained over an interval? | Use a meaningful delay and note interference or altered arousal. |
| Retrieval | Can the person access previously learned information? | Cueing and recognition may clarify the pattern but do not determine cause alone. |
| Working memory | Can information be held and manipulated briefly? | Language, task familiarity and attention affect performance. |
| Remote autobiographical memory | Can personally relevant older events be recalled? | Verify carefully; confident detail is not automatically accurate. |
Recent and remote memory concern the time of the material; anterograde and retrograde impairment concern learning after or recalling before an illness or event. These are different descriptive axes. Specify what was tested and the result instead of writing “memory impaired” without evidence.
Cognition extends beyond recall #
- Language: comprehension, naming, repetition and expression within the person’s language context.
- Executive function: planning, sequencing, flexibility and responding to changing demands.
- Visuospatial ability: spatial relationships, navigation and construction where appropriate.
- Praxis: performance of learned actions, considered with motor and comprehension limitations.
- Social cognition: interpretation of interpersonal information and changes from baseline.
Everyday evidence complements formal tasks. Difficulty managing finances, following medication schedules or navigating familiar places may be important even when basic self-care is preserved. Compare performance with prior responsibilities and available assistance.
Qualitative memory phenomena #
| Phenomenon | Description | Important distinction |
|---|---|---|
| Déjà vu | A feeling of familiarity with a current situation despite recognizing its novelty. | Occasional experience differs from recurrent episodes with altered awareness. |
| Jamais vu | A familiar situation is experienced as unfamiliar. | Clarify recognition, context and associated symptoms. |
| Confabulation | Inaccurate accounts may fill memory gaps without deliberate deception. | Do not infer intention from confidently stated incorrect detail. |
| Mood-related memory bias | Recall or interpretation is influenced by the current emotional state. | This is different from proving that an event never happened. |
| Misidentification | A person or setting is incorrectly identified. | Assess perception, belief, recognition and neurological context. |
Phenomena can occur in different settings and do not identify a single cause. New stereotyped episodes, altered awareness or neurological findings warrant appropriate assessment. Avoid inferring a neurological disorder from an occasional familiar feeling alone.
A clinically useful account #
- Establish the concern, onset, progression, fluctuation and last usual baseline.
- Document sensory, communication and testing limitations.
- Specify domains assessed, tasks used and actual findings.
- Compare function with the person’s previous abilities.
- Review mood, sleep, medicines, substances and physical illness.
- Seek relevant collateral history with appropriate consent.
- Identify unassessed domains and the next information needed.
What a score cannot decide #
A cognitive screen can support detection and follow-up. It does not identify etiology, establish a complete dementia diagnosis, or determine all decisions about independence and capacity. Repeated scores need comparable conditions and consideration of practice effects and intervening illness.