Why early cognitive decline belongs in general practice

With dementia now the leading cause of death in Australia, GPs are increasingly encountering patients who are worried about changes in memory, attention, or thinking, but who do not meet criteria for dementia.
 
These early presentations are not only common; they represent a critical opportunity for intervention.
 
Cognitive decline typically develops along a continuum, beginning with subjective cognitive decline (SCD) and mild cognitive impairment (MCI).
 
SCD refers to a patient’s persistent perception that their cognition is worsening, even when standard cognitive screening tools are normal.
 
MCI involves objective impairment beyond what would be expected for age, while daily functioning remains largely intact.
 
Both are highly prevalent in older Australians and carry an increased risk of progression to dementia.
 
Around one in five Australians aged 70 years and older has MCI, and approximately one in three will progress to dementia within three to five years.
 
Importantly, progression is not inevitable.
 
Some patients remain stable for long periods, and others improve when contributing factors such as depression, sleep disturbance, medication effects, or vascular risk factors are identified and addressed.
 
For GPs, this reinforces the importance of taking early cognitive concerns seriously, even when brief screening tools are reassuring.
 
Patients who are highly educated or cognitively high functioning may remain above diagnostic cut-offs on the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA) despite clear decline from their personal baseline.
 
Where concerns are persistent, particularly when corroborated by family members, ongoing monitoring and follow-up are warranted.
 
The growing evidence base around dementia prevention strengthens the case for early action.
 
Large international studies suggest up to 45% of dementia cases may be attributable to potentially modifiable risk factors.
 
These include physical inactivity, poor diet, hypertension, diabetes, depression, social isolation, sleep problems, and 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 people at increased risk.
 
This places SCD and MCI firmly within the preventive care remit of general practice.
 
Optimising cardiovascular risk management, supporting physical activity, addressing mental health, reviewing medications with anticholinergic or sedative effects, and encouraging cognitive and social engagement are all familiar components of GP care.
 
The challenge is not recognising what should be done, but finding practical, sustainable ways to support patients over time.
 
Research programs that integrate with primary care can help bridge this gap.
 
The CogCoach-Health trial is an Australian study for adults aged 65 years and older who are experiencing changes in memory or thinking, or who have been diagnosed with MCI.
 
It is examining whether a personalised, lifestyle-based intervention can reduce modifiable risk factors and slow cognitive decline in people with SCD and MCI.
 
From a general practice perspective, CogCoach-Health has been designed to be a low-burden referral option that is easy to engage with.
 
The study is conducted entirely online, allowing patients to participate regardless of location and reducing common barriers such as travel or time constraints.
 
Participants receive an evidence-informed e-learning program, alongside personalised input from an exercise physiologist, dietitian, and cognitive engagement practitioner.
 
GPs can direct interested patients to the CogCoach-Health website, where the research team manages eligibility screening, consent, and follow-up assessments.
 
Cognitive function and key medical and behavioural risk factors are assessed at baseline and over 12 months, providing structured monitoring for participants without adding to workload.
 
Dr Marita Long, a GP and medical advisor with Dementia Australia, says she regularly sees patients with subjective cognitive decline or MCI who are motivated to do something proactive.
 
‘CogCoach-Health provides a clear, evidence-informed pathway I can offer them,’ she said.
 
‘I can give patients a brochure, direct them to the website, or complete the digital EOI with them, knowing the research team will manage informed consent, screening, and follow-up without adding to my workload.’
 
Importantly, participation in research such as CogCoach-Health does not replace clinical care.
 
Instead, it offers patients a structured way to act on modifiable risk factors while contributing to the evidence base needed to develop scalable, primary care-ready interventions.
 
If effective, this work may inform future programs that GPs can confidently offer patients presenting with early cognitive concerns.
 
Recently released data from Dementia Australia reveals that the number of Australians living with dementia in 2026 has increased to an estimated 446,500.
 
This figure is projected to more than double to more than one million people by 2065. 
 
As Australia’s population ages, presentations of SCD and MCI will become even more common in general practice.
 
Waiting until dementia is established limits both treatment options and patients’ ability to participate actively in their care.
 
By recognising early cognitive decline, addressing modifiable risks, and supporting patient participation in research, GPs can play a central role in shifting care upstream – towards prevention, early intervention, and better long-term outcomes.
 
GPs can support eligible patients to participate in the CogCoach-Health trial by referring them directly to the study team via the website and EOI form.
 
Further information on GPs’ role in dementia treatment can also be found in the RACGP’s Guidelines for preventive activities in general practice (Red Book).
 
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