Diagnosing cognitive decline is more complex than a single test. This review from leading neurologists argues that meaningful assessment must combine objective cognitive performance with real-world functional consequences. The authors advocate for a tiered diagnostic approach: brief screening tools for primary care, followed by targeted referral for full neuropsychological evaluation when needed. They highlight mild cognitive impairment as a critical window for early intervention — sitting between normal aging and dementia. The review also flags a major research problem: inconsistent outcome measures across studies make comparing treatments nearly impossible. The authors call for standardized, patient-relevant endpoints that capture both cognitive performance and daily function, while acknowledging challenges around cultural validity and feasibility in diverse populations.
