Recognising Mild Cognitive Impairment and Early Alzheimer's Disease in General and Psychiatric Practice: Clinical Clues and Appropriate Referral

Early cognitive decline may become evident through changes in daily activities or behaviour before it is apparent in a brief consultation. This selective narrative review supports case-finding and appropriate referral in general and psychiatric practice. Four actions organise the review: identify decline in previously mastered instrumental activities of daily living; recognise new apathy or sustained behavioural change; use a cognitive screen sensitive to mild impairment, such as the Montreal Cognitive Assessment; and refer when clinically meaningful concern remains. Functional and behavioural findings require interpretation alongside medical, psychiatric and social factors. Mild behavioural impairment has reported associations with both amyloid and tau, varying across populations. Depression, medication exposure or a reassuring screening score should not end the assessment of otherwise unexplained decline. Collateral information strengthens the assessment but living alone and lacking a reliable informant are distinct circumstances. Municipal and care services may contribute observations without resolving every gap. Dementia disease medical centres should coordinate assessment and support with referring clinicians and community services.