Screening for Cognitive Impairment in Older Adults

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), dementia (also known as major neurocognitive disorder) is defined by a significant decline in 1 or more cognitive domains that interferes with a person’s independence in daily activities.

The 6 cognitive domains identified in the DSM-5 are complex attention, executive function, learning and memory, language, perceptual motor function, and social cognition.

Dementia affects an estimated 2.4 to 5.5 million persons in the United States, and its prevalence increases with age. Dementia affects an estimated 3.2% of persons aged 65 to 74 years, 9.9% of those aged 75 to 84 years, and 29.3% of those 85 years or older.

Mild cognitive impairment (MCI) differs from dementia in that the impairment is not severe enough to interfere with independent daily functioning. Some persons with MCI may progress to dementia, whereas some do not.

One systematic review found that 32% of persons with MCI develop dementia over 5 years.3 However, studies have also shown that between 10% and 40% of persons with MCI may return to normal cognition over approximately 4 to 5 years.

The prevalence of MCI is difficult to estimate, in part because of differing diagnostic criteria, leading to a wide range of prevalence estimates (3%–42%) in adults 65 years or older. In this recommendation statement, cognitive impairment refers to both dementia and MCI.