Nov 17 • General discussion
What have you stopped doing?
I teach medical students one question that catches dementia earlier than most screening tests.
"What have you stopped doing that you used to enjoy?"
Not "how's your memory?" Not "what's today's date?"
This question reveals functional decline.
Here's why it works:
People with early dementia don't usually complain about memory loss. They know something's wrong, but they can't articulate it.
So they stop doing things. Quietly. Gradually.
They stop managing finances because it's "too stressful"
They stop cooking because they're "not hungry"
They stop driving to new places because they "prefer familiar routes"
They stop hosting friends because they're "too tired"
Each excuse seems reasonable. But together they paint a picture of someone avoiding tasks they can no longer handle.
I had a patient, Maria, who came in for annual checkup. Age 68. No memory complaints.
I asked my question: "What have you stopped doing?"
She paused. Then said "I used to love crossword puzzles. Haven't done one in months. They just frustrate me now."
That can be early cognitive decline. Not the puzzles themselves. The frustration when something that used to be easy becomes hard.
We did cognitive testing. Mild cognitive impairment. Early enough to intervene. Early enough to plan.
Three patterns that signal early dementia:
1. Withdrawal from complex tasks
2. Managing money, cooking elaborate meals, planning travel. These require executive function that declines first.
3. Reduced social engagement
Not because they're depressed. Because social situations demand cognitive effort they can no longer sustain.
Preference for routine
New situations require learning and adaptation. People with early dementia stick to routines because routines don't challenge their declining cognition.
Standard screening tests miss this.
The Mini-Mental State Exam asks "what's the date?" and "spell WORLD backwards."
Patients with early functional decline can pass those tests easily.
But they can't manage their checkbook anymore. They've stopped organizing family gatherings. They've given up hobbies that require concentration.
That's dementia. Before the tests show it. Before families recognize it.
Why this matters:
Early intervention works better. Medications work better. Lifestyle changes work better.
Families have time to plan.
But we miss the early window because we're asking the wrong questions.
A patient who scores 28/30 on cognitive tests but stopped managing their life? That's suspicious.
A patient who scores 24/30 but still runs their business? That might just be lifelong low cognition.
Context matters. Function matters. Pattern of decline matters.
⁉️ What question do you use to screen for early cognitive decline?
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What have you stopped doing?
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