Why “what to do next” matters
More people are screening positive for cognitive concerns in primary care, hospital settings, and community programs. For individuals and families, the hardest part often begins after the screen: uncertainty about what the results mean and what steps to take next.
A person-centered approach to early identification recognizes that the goal is not simply to label a condition. The goal is to understand what is changing, why it may be changing, and how to support the person’s priorities, function, safety, and relationships.
Clarifying terms: subjective cognitive decline and mild cognitive impairment
Subjective cognitive decline (SCD) refers to self-reported worsening in memory or thinking, even when brief testing may be normal. SCD can be associated with increased future risk of cognitive impairment, but it can also reflect depression, stress, sleep disorders, medication effects, pain, or sensory loss (Centers for Disease Control and Prevention, 2019).
Mild cognitive impairment (MCI) describes measurable changes in cognition greater than expected for age while most day-to-day activities remain intact. MCI is heterogeneous: some people remain stable, some improve (depending on cause), and some progress to dementia over time (Alzheimers.gov, n.d.).
Step 1: Treat a positive screen as a starting point—not a diagnosis
A brief cognitive screen is designed to flag potential concern, not to diagnose a condition. The U.S. Preventive Services Task Force has concluded that evidence is insufficient to recommend routine screening in asymptomatic older adults; however, evaluation of a person with symptoms or concerns is different from screening and is clinically appropriate (U.S. Preventive Services Task Force, 2020; Owens et al., 2020).
A person-centered next step is to validate the concern, ask what changes the person and care partners have noticed, and clarify what the person wants most from evaluation (e.g., answers, safety planning, treatment of reversible causes, or future planning).
Step 2: Conduct a structured clinical evaluation and differential diagnosis
A structured evaluation typically includes history (including timeline of symptoms), functional assessment, mood and sleep screening, medication review, medical history, and an informant interview when possible. The National Institute on Aging outlines practical steps and tools for assessing cognitive impairment in older patients (National Institute on Aging, n.d.).
Common “look-alikes” and contributors include depression, delirium, thyroid dysfunction, vitamin B12 deficiency, medication side effects (e.g., anticholinergics, sedatives), untreated sleep apnea, and hearing/vision loss. Vascular risk factors and cerebrovascular disease can also contribute to cognitive changes and may co-occur with neurodegenerative disease.
Step 3: Confirmatory testing and referral pathways
If concerns persist after initial evaluation, next steps may include more detailed cognitive testing, laboratory workup, and neuroimaging when indicated. Depending on context, referral to neurology, geriatrics, geriatric psychiatry, or neuropsychology may support diagnosis and care planning.
The Alzheimer’s Association Clinical Practice Guideline (DETeCD-ADRD) describes a structured approach for evaluating suspected Alzheimer’s disease and related disorders, including validated clinical instruments and guidance on counseling and disclosure (Dickerson et al., 2025; Atri et al., 2025).
Step 4: Safety planning that preserves autonomy
Early identification creates a window for proactive safety planning—while the person can still participate meaningfully in decisions. Person-centered safety planning should be collaborative and strengths-based.
- Driving and transportation: discuss warning signs, consider formal driving evaluation when appropriate, and plan alternatives.
- Medication management: simplify regimens, use pill organizers or blister packs, and clarify who supports dosing.
- Home safety: reduce fall risks, improve lighting, address wandering risks with environmental supports and routines.
- Financial and legal planning: discuss powers of attorney, advance directives, and trusted contacts for financial institutions.
- Workplace considerations: if the person is employed, consider supports and accommodations early.
Step 5: Care partner supports and navigation
Care partners often carry uncertainty, grief, and practical workload long before a formal diagnosis. Early identification should trigger offers of education, coaching, and connections to community resources. This includes guidance for communication, behavioral support strategies, and respite planning.
A person-centered system also recognizes diverse family structures and cultural contexts. Ask who the person wants involved, how information should be shared, and what supports fit the family’s needs.
Step 6: Lifestyle and risk-factor interventions
Even when a neurodegenerative process is suspected, risk-factor management can protect brain health and functional reserve. The WHO guidelines on risk reduction of cognitive decline and dementia provide evidence-based recommendations related to physical activity, tobacco cessation, nutrition, management of hypertension and diabetes, and other modifiable risks (World Health Organization, 2019).
The 2024 Lancet Commission update highlights that addressing multiple modifiable risk factors across the life course could delay or reduce a substantial proportion of dementia cases (Livingston et al., 2024). For individuals with SCD or MCI, practical steps often include optimizing sleep, treating depression/anxiety, addressing hearing loss, staying physically and socially active, and managing vascular risk.
Step 7: Follow-up and longitudinal re-assessment
Cognitive health is dynamic. Plan follow-up visits to review changes in function, reassess symptoms, update safety plans, and support care partners. A clear timeline for re-evaluation can reduce anxiety and prevent people from falling through the cracks.
How NCCDP can help
Earlier identification only improves outcomes if the next steps are competent, compassionate, and coordinated. NCCDP can help organizations and communities build that readiness by training staff to respond effectively after a positive screen or expressed concern.
- Equip teams to communicate with dignity and clarity: NCCDP’s person-centered care education helps staff discuss concerns without stigma and align care with the person’s goals (National Council of Certified Dementia Practitioners, n.d.-c).
- Build workforce competency with recognized credentials: NCCDP certifications support role-based expectations for dementia care knowledge across settings (National Council of Certified Dementia Practitioners, n.d.-a).
- Scale internal education through CADDCT®: organizations can sustain onboarding and refreshers so “what to do next” is consistent across teams and shifts (National Council of Certified Dementia Practitioners, n.d.-b).
- Strengthen community readiness: NCCDP programs support dementia-capable practice beyond clinical teams by improving how everyday systems interact with people experiencing cognitive change (National Council of Certified Dementia Practitioners, n.d.-a).
Conclusion
SCD and MCI create an opportunity: to identify reversible contributors, plan for safety, support care partners, and reduce long-term risk through lifestyle and vascular health interventions. When systems provide a clear, person-centered pathway after a positive screen, early identification becomes a gateway to support rather than a source of fear.
References
Alzheimers.gov. (n.d.). *What is mild cognitive impairment?* https://www.alzheimers.gov/alzheimers-dementias/mild-cognitive-impairment
Atri, A., et al. (2025). The Alzheimer’s Association clinical practice guideline for the diagnostic evaluation, testing, counseling, and disclosure of suspected Alzheimer’s disease and related disorders (DETeCD-ADRD): Validated clinical assessment instruments. *Alzheimer’s & Dementia.* https://pubmed.ncbi.nlm.nih.gov/39713939/
Centers for Disease Control and Prevention. (2019). *Subjective cognitive decline: A public health issue.* https://stacks.cdc.gov/view/cdc/88752
Dickerson, B. C., et al. (2025). The Alzheimer’s Association clinical practice guideline for the diagnostic evaluation, testing, counseling, and disclosure of suspected Alzheimer’s disease and related disorders (DETeCD-ADRD). *Neurology.* https://www.neurology.org/doi/10.1212/WNL.0000000000212291
Livingston, G., et al. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. *The Lancet, 404*(10452), 572–628. https://doi.org/10.1016/S0140-6736(24)01296-0
National Council of Certified Dementia Practitioners. (n.d.-a). NCCDP: Alzheimer’s disease and dementia care education and certification. https://www.nccdp.org/
National Council of Certified Dementia Practitioners. (n.d.-b). Certified Alzheimer’s Disease and Dementia Care Trainer® (CADDCT®). https://www.nccdp.org/train/
National Council of Certified Dementia Practitioners. (n.d.-c). Understanding person-centered dementia care. https://www.nccdp.org/understanding-person-centered-dementia-care/
National Institute on Aging. (n.d.). *Assessing cognitive impairment in older patients.* https://www.nia.nih.gov/health/health-care-professionals-information/assessing-cognitive-impairment-older-patients
Owens, D. K., et al. (2020). Screening for cognitive impairment in older adults: US Preventive Services Task Force recommendation statement. *JAMA, 323*(8), 757–763. https://doi.org/10.1001/jama.2020.0435
U.S. Preventive Services Task Force. (2020, February 25). *Cognitive impairment in older adults: Screening.* https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cognitive-impairment-in-older-adults-screening
World Health Organization. (2019). *Risk reduction of cognitive decline and dementia: WHO guidelines.* https://iris.who.int/handle/10665/312180
