memory failure and cognitive deterioration in adults - NICE guidance - suspected neurological conditions - recognition and referral

Last edited 05/2019 and last reviewed 08/2020

Memory failure and cognitive deterioration

Summary points from NICE guidance relating to memory failure and cognitive deterioration in adults are:

Memory problems in adults aged under 50

For adults aged under 50 with memory problems and no other neurological signs:

  • do not routinely refer if brief testing shows memory function to be normal and symptoms are consistent with concentration difficulties

  • be aware that memory problems or concentration difficulties can be caused by:
    • recreational, and some prescription, drugs
    • alcohol
    • affective disorders
    • stress

Memory problems as part of an anxiety disorder or a functional neurological disorder

  • be aware that, for adults who have an anxiety disorder or have been diagnosed with a functional neurological disorder by a specialist, memory problems and concentration difficulties might be part of the disorder and the person might not need re-referral if there are no new neurological signs. New symptoms or signs in adults who have been diagnosed with a functional neurological disorder by a specialist should be assessed.

Concentration difficulties associated with myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome or fibromyalgia

  • do not routinely refer adults for neurological assessment if they have concentration difficulties associated withmyalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome or fibromyalgia

Progressive memory problems

  • if adults with progressive memory problems then assess and manage as possible dementia

Dense amnesia

  • do not routinely refer adults with a single episode of dense amnesia (inability to recall the recent past or form new memories) if:

    • the episode lasts less than 8 hours and

    • there is complete recovery and

    • there are no features suggestive of an epileptic seizure

  • advise the person that they have probably had an episode of transient global amnesia and that the recurrence rate is low

Refer adults with recurrent episodes of dense amnesia to have an assessment for epileptic amnesia.

Reference: