When to worry: a symptom checklist
Occasional forgetfulness happens to everyone. What doctors look for, per NHS guidance on dementia symptoms and the Alzheimer's Society's early symptoms guide, is a pattern that is new, gets worse over months and affects daily life:
- Repeating the same question or story within minutes, without realising
- Getting lost or disorientated on a route they have travelled for years
- Withdrawing from hobbies, conversation or social plans they used to enjoy
- Struggling to follow the plot of a TV programme or a conversation with several people
- Difficulty managing money, bills or medication that was previously routine
- Mood or personality changes: new apathy, suspicion, irritability or low mood
- Misplacing items in unusual places, such as keys in the fridge, and being unable to retrace steps
- Word-finding difficulty that goes beyond the occasional tip-of-the-tongue moment
- Family or friends noticing changes before the person does
If two or more of these have been present and worsening for six months or longer, or if a friend or family member has raised it more than once, it is worth booking a GP appointment. Sudden confusion over hours or days is different and usually means an urgent problem such as infection or delirium, not dementia; seek same-day medical advice for that.
How the cognitive screen is scored
Each task maps to a cognitive domain and contributes to a total out of 22, echoing the scoring range used by SAGE. Orientation and serial subtraction sit under attention, the three-word recall task covers memory, animal naming covers language, the clock task covers visuospatial skill, and the similarities task covers executive function and abstraction. A score of 17 or above is in the range most healthy adults score, 15 to 16 is borderline, and 14 or below suggests a conversation with a GP is worthwhile, broadly matching the published SAGE cut-offs.
| Domain | Task | Points |
|---|---|---|
| Attention & orientation | Day, date, month, year, season plus serial subtraction | 10 |
| Memory | Delayed recall of 3 words | 3 |
| Language | Animal naming fluency, 60 seconds | 3 |
| Visuospatial | Clock drawing self-check | 4 |
| Executive / abstraction | Similarities between two pairs of objects | 2 |
The 14 modifiable risk factors, explained
The 2024 Lancet Commission on dementia prevention, intervention and care, led by Professor Gill Livingston, brought together decades of research into a single model of dementia risk across life. Early life factors such as limited education set a baseline of "cognitive reserve". Midlife factors, roughly 45 to 65, do the most damage: untreated hearing loss and high LDL cholesterol are now estimated to be the two single biggest levers, followed by depression, head injury, inactivity, diabetes, smoking, hypertension, obesity and heavy alcohol use. Later in life, social isolation, air pollution and untreated vision loss add further risk. Together the Commission estimates these 14 factors account for up to 45% of dementia cases worldwide, meaning prevention and early treatment, particularly of hearing and vision loss, could delay or prevent a substantial share of cases.
SAGE, Mini-Cog and this tool: how they compare
| Tool | Length | Format | Notes |
|---|---|---|---|
| SAGE (Ohio State) | 10 to 15 min | Pen and paper, self-administered | Validated across four rotating versions; scored out of 22 |
| Mini-Cog | 3 min | Clinician administered | 3-word recall plus a clock drawing test, widely used in primary care |
| MMSE | 10 min | Clinician administered | Scored out of 30; the classic clinical screening tool |
| This tool | 8 to 10 min | Online, self-scored | Inspired by the above; for personal insight only, not clinical use |
A note from us: we built this after a family member's GP used a SAGE-style test at a routine check-up, which felt far less frightening than either of us expected, more like a puzzle than an exam. If you are putting off getting checked because you are scared of the answer, please do not let that stop you. Most memory changes have a treatable cause that has nothing to do with dementia at all.
Frequently asked questions
- Is this online dementia test accurate?
- It is a screening exercise, not a diagnostic test. Even validated tools like SAGE and the Mini-Cog, which this tool is inspired by, are designed to flag who might benefit from a full clinical assessment, not to diagnose dementia on their own. A GP or memory clinic uses a longer assessment, blood tests and often brain imaging to reach an actual diagnosis.
- What is the SAGE dementia test?
- SAGE (Self-Administered Gerocognitive Exam) is a pen-and-paper screening test developed at Ohio State University Wexner Medical Center. It takes 10 to 15 minutes, is scored out of 22, and checks orientation, memory, language, calculation, visuospatial skills and executive function. Scores of 17 or higher are generally considered normal, 15 to 16 borderline, and 14 or below suggest a follow-up conversation with a doctor. This tool borrows that structure and scoring range.
- What is the difference between normal forgetfulness and early dementia signs?
- Misplacing keys occasionally, forgetting a name and remembering it later, or blanking on a word now and again is common at any age. Early dementia signs tend to be a pattern rather than a one-off: repeating the same question within minutes, getting lost on a familiar route, struggling to follow a conversation or a recipe, or a noticeable change that family and friends comment on over months. The 'when to worry' checklist below sets out the pattern doctors look for.
- Can lifestyle changes really reduce dementia risk?
- The 2024 Lancet Commission on dementia prevention, intervention and care (Livingston et al.) estimated that up to 45% of dementia cases worldwide are linked to 14 modifiable risk factors across life, including hearing loss, high LDL cholesterol, depression, physical inactivity, diabetes, smoking, hypertension, obesity, excess alcohol, social isolation, air pollution, untreated vision loss, less education and head injury. That does not mean any one person can guarantee prevention, but the population evidence for action on these factors is strong.
- What should I do if I score in the 'see a GP' range?
- Do not panic and do not self-diagnose. Book a routine GP appointment, mention this screening result, and describe any changes you or people close to you have noticed and how long they have been going on. The GP can rule out common reversible causes such as vitamin B12 or thyroid problems, depression, medication side effects, poor sleep and infections before considering a referral to a memory clinic.
- Who is most at risk of dementia?
- Age is the single biggest risk factor: risk roughly doubles every five years after 65, according to Alzheimer's Society. Family history, certain genes such as APOE4, and the modifiable factors covered in the risk calculator above all add to that baseline. Dementia is not, however, an inevitable part of ageing.
This tool is for general information and self-reflection only and is not medical advice or a diagnostic instrument. It cannot diagnose dementia, Alzheimer's disease or mild cognitive impairment. If you are concerned about your memory or thinking, or someone else has raised concerns about yours, please speak to a GP. Sources: Livingston et al., "Dementia prevention, intervention, and care: 2024 report of the Lancet Commission", The Lancet; Alzheimer's Society; NHS; the Self-Administered Gerocognitive Exam (SAGE), Ohio State University Wexner Medical Center.