Tackling Early Memory Concerns: GPs at the Forefront of Dementia Prevention
Memory concerns present significant management challenges for general practitioners (GPs). Experts advocate for GPs to integrate cognitive assessment into their practice, even when brief screening tools initially appear normal.
Dementia is a leading cause of death in Australia. GPs are increasingly encountering patients concerned about changes in memory, attention, or thinking who do not yet meet criteria for dementia. These early presentations, including subjective cognitive decline (SCD) and mild cognitive impairment (MCI), represent critical opportunities for intervention.
Understanding Early Cognitive Changes
Subjective Cognitive Decline (SCD) involves a patient's self-perception of worsening cognition despite normal standard screening results.
Mild Cognitive Impairment (MCI) involves objective impairment beyond age-related expectations, with daily functioning largely intact.
Both SCD and MCI are highly prevalent in older Australians and carry an increased risk of dementia progression. Approximately one in five Australians aged 70 and older have MCI, with about one in three progressing to dementia within three to five years.
Progression to dementia is not inevitable. Some patients remain stable, and others improve if contributing factors such as depression, sleep disturbance, medication effects, or vascular risk factors are identified and addressed.
This reinforces the importance for GPs to address early cognitive concerns seriously. Highly educated or cognitively high-functioning patients may score above diagnostic cut-offs on tools like the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA) despite experiencing clear decline from their personal baseline. Persistent concerns, especially when corroborated by family, warrant ongoing monitoring.
The Power of Prevention: Modifiable Risk Factors
Evidence on dementia prevention supports early action. Large international studies suggest up to 45% of dementia cases may be linked to potentially modifiable risk factors. These include:
- Physical inactivity
- Poor diet
- Hypertension
- Diabetes
- Depression
- Social isolation
- Sleep problems
- Low cognitive engagement
Observational research consistently shows healthier lifestyles are associated with slower cognitive decline, while recent multi-domain intervention trials suggest addressing several risk factors simultaneously can slow decline in at-risk individuals.
This positions SCD and MCI firmly within general practice's preventive care scope. GPs commonly manage cardiovascular risk, support physical activity, address mental health, review medications (especially those with anticholinergic or sedative effects), and encourage cognitive and social engagement. The challenge lies in implementing practical, sustainable patient support over time.
Bridging the Gap: The CogCoach-Health Trial
Research programs integrated with primary care can help bridge this gap. The CogCoach-Health trial, an Australian study for adults aged 65 and older experiencing changes in memory or thinking, or diagnosed with MCI, investigates whether a personalized, lifestyle-based intervention can reduce modifiable risk factors and slow cognitive decline in those with SCD and MCI.
Designed as a low-burden referral option for general practice, the study is conducted entirely online, removing geographical and time barriers. Participants receive an evidence-informed e-learning program and personalized input from an exercise physiologist, dietitian, and cognitive engagement practitioner.
GPs can refer patients to the CogCoach-Health website, where the research team manages eligibility screening, consent, and follow-up assessments. Cognitive function and key medical and behavioral risk factors are assessed at baseline and over 12 months, providing structured monitoring without increasing GP workload.
Expert Endorsement and Future Outlook
Dr. Marita Long, a GP and medical advisor with Dementia Australia, notes that CogCoach-Health offers a clear, evidence-informed pathway for patients motivated to be proactive. Participation in such research complements clinical care, offering a structured approach to address modifiable risk factors while contributing to the evidence base for scalable, primary care-ready interventions.
Dementia Australia data indicates an estimated 446,500 Australians will live with dementia in 2026, projected to exceed one million by 2065.
As the population ages, presentations of SCD and MCI will become even more common in general practice. Early recognition, addressing modifiable risks, and supporting research participation enable GPs to shift care towards prevention, early intervention, and improved long-term outcomes.
GPs can refer eligible patients to the CogCoach-Health trial via its website and EOI form. Further information on dementia treatment in general practice is available in the RACGP’s Guidelines for preventive activities in general practice (Red Book).