The first and second questions ask about concerns that individuals may have, whereas the second and third questions ask about changes they may have noticed. Both topics are important, and asking one question about each topic may be the preferred option. 

The focus on memory in all three questions reflects the way many people speak about changes in their cognition, even though other cognitive functions, such as ability to sustain attention, executive function, language, and spatial orientation, can also decline. Some clinicians report asking about “memory and thinking” yields increased disclosure of patient concerns, particularly with racially diverse populations. Members of the care team may opt to ask about memory and at least one other cognition-related function (e.g., following a familiar recipe or getting lost in a familiar place). A question such as “Have you experienced issues with paying household bills, managing your inbox, or coordinating appointments?” may provide the care team with important insights into cognition and function.

Listen for and respond to people’s concerns about memory and cognition.

Listen for and acknowledge people’s concerns about memory and cognition. Thoughtful responses to tentatively expressed concerns can help to overcome reluctance to talk about the issue. 

As an example, the short video Assessing Cognition and Recommending Follow-Up shows a staged interaction in which a physician responds to a patient’s very tentative expression of concern about her memory. In a friendly, conversational tone, the physician acknowledges the concern and encourages the patient to share more about her experience with memory problems.