Approach to managing a patient presenting with memory loss who has a history of depression or anxiety:
Initially, assess whether the memory problems are consistent with concentration difficulties rather than true memory impairment, as affective disorders like depression and anxiety can cause concentration and memory problems.
Do not routinely refer adults under 50 with memory problems if brief cognitive testing shows normal memory function and symptoms align with concentration difficulties related to affective disorders or stress.
Investigate and exclude reversible causes of cognitive decline, including depression, sensory impairments, and cognitive impairment from medications with anticholinergic burden.
If memory problems persist after addressing reversible causes and depression or anxiety, or if dementia is still suspected, refer the patient to a specialist dementia diagnostic service (e.g., memory clinic or community old age psychiatry service) for further assessment.
Specialist assessment should include appropriate cognitive testing, neurological examination, and consideration of neuropsychological testing if the diagnosis is unclear.
Consider structural imaging to rule out reversible causes and assist with subtype diagnosis if dementia is suspected.