Quick answer
Occasionally forgetting names or misplacing objects is normal ageing; repeatedly forgetting recently learned information, getting lost in familiar places, or struggling with everyday tasks needs prompt evaluation. Before blaming a neurodegenerative condition, blood tests exclude fully reversible causes. If tests are normal and impairment persists, Alzheimer's accounts for 60 to 70 percent of dementias.
Blood tests for memory loss
| Test | Why ordered | Treatable if abnormal? |
|---|---|---|
| TSH | Hypothyroidism: cognitive slowing, confusion | Yes: thyroid hormone replacement |
| Vitamin B12 | B12 deficiency dementia: a reversible cause | Yes: B12 injections or supplements |
| Folate | Folate deficiency: cognitive impairment | Yes: folic acid supplements |
| Fasting glucose / HbA1c | Diabetes affects brain function | Yes: blood sugar control |
| FBC | Anaemia: reduces oxygen to the brain | Yes: treat underlying cause |
| Calcium | Hypercalcaemia causes confusion | Yes: treat calcium disorder |
| LFT | Hepatic encephalopathy | Yes: treat liver disease |
| Syphilis serology (RPR/VDRL) | Neurosyphilis: rare but treatable | Yes: antibiotics |
- Normal ageing: occasional lapses with later recall; dementia: repeated, progressive, function-impairing loss.
- Concerning features: forgetting recent information repeatedly, getting lost, difficulty with finances or cooking.
- Blood tests exclude reversible causes first, some profoundly impairing if untreated.
- MMSE and MoCA (below 26 suggests impairment) guide referral but do not diagnose alone.
- Alzheimer's is 60 to 70 percent of dementias; vascular, Lewy body and frontotemporal are the others.
- The page's comparison section lists the key features separating early dementia from normal ageing.
When memory loss is more than normal ageing
Warning signs that need urgent assessment
Normal age-related memory changes include occasionally forgetting names or misplacing objects but remembering them later. Concerning features that need prompt evaluation: forgetting recently learned information repeatedly; getting lost in familiar places; difficulty with everyday tasks (managing finances, cooking); personality or behaviour changes; confusion about time, place or people; repeating the same question multiple times in the same conversation.
Dementia: when blood tests are normal
If all blood tests are normal but significant memory impairment persists, the most common diagnoses are Alzheimer's disease (60–70% of dementias), vascular dementia, Lewy body dementia, or frontotemporal dementia.2 Further investigation may include: cognitive testing (MMSE, MoCA), brain MRI, and in specialist centres, PET scan or cerebrospinal fluid biomarkers (amyloid, tau). Referral to a memory clinic or neurologist is recommended.3
Questions to ask your doctor
- Have reversible blood test causes been ruled out?
- Should I have a formal cognitive assessment?
- Do I need a brain MRI?
- Should I see a memory clinic or neurologist?
Frequently Asked Questions
Is memory loss always a sign of dementia?
What blood tests are done for memory problems?
When should memory loss prompt a doctor's visit?
References
Sources cited on this page. PubMed links open the original abstract.
- Petersen RC, Lopez O, Armstrong MJ, et al. Practice guideline update summary: Mild cognitive impairment. Neurology. 2018;90(3):126–135. PMID 29282327 · doi:10.1212/WNL.0000000000004826
- Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413–446. PMID 32738937 · doi:10.1016/S0140-6736(20)30367-6
- Frisoni GB, Molinuevo JL, Altomare D, et al. Dementia prevention in memory clinics: recommendations from the European task force for brain health services. Lancet Reg Health Eur. 2023;26:100576. PMID 36895446 · doi:10.1016/j.lanepe.2022.100576
Distinguishing normal ageing from early dementia
Some degree of cognitive slowing is part of normal ageing: processing speed decreases, multitasking becomes harder, and occasional "tip of the tongue" experiences increase. This is distinct from dementia. Key distinguishing features of early dementia:
- Progression: Normal ageing memory lapses are stable over years; dementia symptoms progress measurably over months.
- Impact on function: Forgetting where you put your keys is normal ageing; forgetting that you have keys, or being unable to manage finances you previously handled confidently, is not.
- Orientation: Getting lost in a familiar neighbourhood, forgetting the current year, or repeatedly asking the same questions within the same conversation are not features of normal ageing.
- Language: Dementia often causes word-finding difficulties (anomia) that go beyond occasional tip-of-the-tongue phenomena, difficulty naming common objects, substituting wrong words (paraphasias), or reduced conversational complexity.
Cognitive screening tools used in primary care include the Mini-Mental State Examination (MMSE, scored out of 30) and the more sensitive Montreal Cognitive Assessment (MoCA, also scored out of 30, below 26 suggests impairment). Cognitive tests alone do not diagnose dementia but guide referral decisions.
Blood tests that identify reversible causes of memory loss
Before attributing memory loss to a neurodegenerative condition, blood tests exclude fully reversible causes, some of which can cause profound cognitive impairment if untreated:
- TSH (thyroid function): Hypothyroidism is one of the most important reversible causes of cognitive impairment in older adults, causing slowed thinking, depression, and memory difficulty that can closely mimic early Alzheimer's. Fully reversed with thyroxine treatment.
- Vitamin B12: Deficiency causes subacute combined degeneration of the spinal cord and, particularly in older adults, cognitive impairment, personality change, and mood disturbance. B12 below 200 pg/mL is deficient; methylmalonic acid (MMA) is a more sensitive functional marker of deficiency when B12 is borderline (200–300 pg/mL).
- Folate: Deficiency causes megaloblastic anaemia and can contribute to cognitive impairment, particularly in combination with B12 deficiency.
- Fasting glucose / HbA1c: Poorly controlled diabetes, particularly with recurrent hypoglycaemia, impairs cognition. Insulin resistance is also associated with an increased long-term risk of Alzheimer's disease.
- Full blood count: Anaemia causes fatigue and cognitive dulling. The type of anaemia (macrocytic, microcytic) guides further investigation.
- Calcium: Hypercalcaemia (from hyperparathyroidism, malignancy, or vitamin D toxicity) causes confusion, fatigue, and memory impairment, the "moans, groans, stones, and bones" tetrad.
- Syphilis serology and HIV test: Both cause neurocognitive disorders when untreated. Neurosyphilis is rare but fully treatable.
- Liver and renal function: Hepatic encephalopathy and uraemia cause reversible cognitive impairment that can progress to coma if untreated.
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