How should I approach the management of a patient with memory loss who has a history of depression or anxiety?

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.