If an elderly relative suffers progressive memory decline impairing daily functioning, visit a hospital memory clinic or neurology department to rule out reversible causes like depression, sensory deficits, or anticholinergic drugs

Progressive cognitive decline is not simply inevitable "old age." First rule out reversible conditions such as late-life depression, adverse drug side effects, and uncorrected hearing or vision loss. Truly reversible dementias are rare (under 1%), but early diagnosis serves another crucial purpose: while the individual retains decision-making capacity, legally designate future legal guardians and manage asset arrangements.

Low cost. Clinical registration at a hospital memory clinic or neurology outpatient department, cognitive psychometric tests, and routine blood/urine panels take half a day to a full day, covered under standard health insurance. The challenge is overcoming elderly family members' denial or reluctance to undergo cognitive testing.

UK National Institute for Health and Care Excellence (NICE NG97) guidelines mandate that when dementia is suspected, clinicians must take comprehensive histories from both patient and family, perform physical examinations, order laboratory blood/urine tests to rule out reversible etiologies, and conduct validated cognitive testing. NICE guidelines specifically highlight four treatable or modifiable confounders: delirium, depression, sensory impairment (vision and hearing deficits), and high anticholinergic cognitive burden from medications. Once reversible factors are excluded, patients are referred to specialist memory clinics. A classic meta-analysis of 39 clinical studies encompassing 5,620 dementia patients found that 56.3% had Alzheimer's disease and 20.3% had vascular dementia; potentially reversible etiologies represented 9.0%, but actual clinical improvement occurred in only 0.6% (0.29% partial improvement, 0.31% full recovery). NICE guidelines mandate early advance care planning while cognitive capacity remains, including designating lasting powers of attorney for finances and healthcare. National Health Commission 2024 directives call for routine cognitive screening in adults aged 65+ and expansion of dedicated hospital memory clinics.

Graded Evidence Grade B based on clinical consensus guidelines and diagnostic cohort reviews. Benefit is categorized as Low because clinical reversibility is under 1% and no evidence indicates that early screening alters ultimate dementia mortality. Never discontinue medications unilaterally; bring medication boxes to consultation. For acute cognitive decline and gait ataxia following minor head trauma, see Chapter 13, Rule 10 (head CT for chronic subdural hematoma). Hearing aid fitting for cognitive maintenance is covered in Chapter 33, Rule 17. Crucially, while clear-minded, execute written guardianship designations (Chapter 17, Rule 1) and statutory wills (Chapter 17, Rule 2). Judicial declaration of civil incapacity is covered in Chapter 33, Rule 18. Beneficiaries are elderly parents and grandparents.

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). https://www.nice.org.uk/guidance/ng97/chapter/Recommendations；Clarfield AM (2003). The decreasing prevalence of reversible dementias: an updated meta-analysis. Archives of Internal Medicine, 163(18), 2219-2229. https://doi.org/10.1001/archinte.163.18.2219；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）. https://www.gov.cn/zhengce/zhengceku/202501/content_6996231.htm