Many people present to their GP with concerns about cognitive decline. A range of cognitive screening tests are available for use in primary care, but no single test is recommended by guidance across Europe, which leaves the decision to the individual GP. Most tests do not account for educational attainment, were not developed for ethnic minority groups (and are biased towards specific language or cultural knowledge), are less sensitive to early stages of cognitive decline and non-Alzheimer’s disease type dementia. Most GPs do not get formal training specifically on cognitive screening.To equip GPs with increased knowledge of administration and scoring of cognitive screening tests, including different options and the considerations of education, ethnicity and dementia type, drawing on the current evidence.   To understand if/how cognitive screening is used in primary care in different European settings. To explore attendees’ views on proposed changes/improvements to cognitive screening in primary care and to understand where GPs want further training developed.The workshop will use an interactive, mixed-methods teaching approach. Short evidence-informed presentations will introduce key cognitive screening tools, their administration and scoring, and considerations. Case-based learning using primary care scenarios will allow participants to apply this knowledge and compare approaches across different countries. Small-group discussions and whole-group discussion will be used to explore participants’ experiences, views on proposed changes to cognitive screening in primary care, and priorities for future training. Real-time polling and structured feedback activities will be used to capture participant perspectives and encourage shared learning.# Workshop schedule Introduction and presentation (10 minutes) Small group discussions (30 minutes) Open floor discussion (20 minutes)Participants will have increased knowledge and confidence in cognitive screening, understand key limitations and options of tests for specific groups of patients. We will understand from different European contexts if/how cognitive screening is used.This workshop will cover the assessment of cognitive impairment by primary care practitioners, based on the current evidence base and sharing best practice. The interactive workshop will foster collaboration and shared learning about an important, often overlooked, part of primary care.

The concept of MCI has evolved since its first definition in 2003 and is widely used by both researchers and clinicians to define the gray zone between intact cognitive functioning and clinical dementia. It is estimated that about 3–22% of individuals older than 65 years have MCI. It is assumed that 50% of persons with MCI will develop dementia, which represents a significant socioeconomic problem for society. Currently, there are no sufficiently effective diagnostic tools nor an effective cure for dementia. The Montreal Cognitive Assessment (MoCA) test has been validated as a highly sensitive (90%) tool for the early detection of MCI.  The aim of our study was to assess the frequency of cognitive impairment, i.e., to evaluate cognitive status in patients with comorbidities in our medical records in the population aged 50 years and older, to determine the prevalence of MCI, and to analyze the association between cognitive decline and predictors of dementia.We used anamnestic data and laboratory analyses from available medical documentation, and the MoCA test to assess cognitive abilities. We tested 200 patients, including 89 men and 111 women aged 50 years and older, who did not complain of memory problems but were at increased risk of developing dementia. Of these, 130 (65%) participants were aged 65 years or older.Of the 200 examined participants, 138 (69%) had normal findings (MoCA score 26–30), while 62 (31%) had findings consistent with MCI (MoCA score 21–25). The prevalence in the examined group aged 65+ was 26% (52 individuals). Participants most frequently lost points in short-term memory, visuospatial abilities, and language.The results of testing indicate that the prevalence of MCI in our patient registries is slightly higher than expected. Dementia significantly impairs quality of life for both patients and their family members. Therefore, it is necessary to detect MCI using screening methods and to initiate available therapeutic modalities at an early stage.To identify MCI as early as possible, it is essential to test at-risk patients even before the onset of the first clinical symptoms. This is possible only if familly doctors are included in the screening process.

Dementia is a significant and growing global Public Health challenge. The Lancet Commission on Dementia identified 14 modifiable risk factors, including hypertension, but did not examine the impact of orthostatic blood pressure (BP) changes. Understanding the link between orthostatic BP changes and dementia risk may present an intervention target for dementia prevention given that studies have suggested that different forms of BP dysregulation may be linked to cognitive decline in older adults.This study aimed to assess the associations of orthostatic BP changes with incident dementia in older, community-dwelling adults.Longitudinal analysis of 1605 men aged 71-92 years with no diagnosed dementia followed for an average of 12 years in whom 268 developed dementia. Incident dementia was obtained through general practice medical records. Orthostatic blood pressure changes were defined as orthostatic hypotension (OH) (sitting-to-standing decrease in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg), orthostatic hypertension (sitting-to-standing increase in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg), and orthostatic normotension (neither OH nor orthostatic hypertension). Systolic and diastolic OH was also examined separately. Survival analysis was used to estimate associations of orthostatic BP changes with dementia.Compared to orthostatic normotension isolated diastolic OH (diastolic BP decrease >=10 mmHg) but not isolated systolic OH (systolic BP decrease  >=20 mmHg) was significantly associated with increased risk of dementia after adjustment for possible confounders and incident cardiovascular disease (CVD). The hazard ratio (95% CI) was HR=2.11 (1.39, 3.22) and HR=(0.77, 0.48-1.21) in men with isolated diastolic and isolated systolic OH, respectively. The increased risk associated with isolated diastolic OH was seen for all types of dementia (vascular, Alzheimer’s and others).  No association was seen with orthostatic hypertension [HR=1,04 (0.70,1.54)].Our findings may have practical implications. From a diagnostic standpoint, diastolic OH may be an important clinical marker of dementia risk whereas from a therapeutic standpoint, these results highlight the potential for interventions aimed at stabilising orthostatic BP.In this study of older men, isolated diastolic OH is associated with increased dementia risk. Further prospective studies in diverse cohorts and interventional studies are needed to confirm our findings.

Primary health care plays an important role in maintaining population health and managing comorbidities. In older adults, age-related changes frequently impair cognitive function and mobility, thereby increasing the risk of falls and associated injuries.To investigate whether older adults with subjective cognitive decline (a preclinical self-perceived cognitive decline) exhibit greater mobility impairment than their counterparts who do not report cognitive concerns.Sixty-two community-dwelling older adults (mean age: 67.7 ± 6.0 years) were recruited from primary health care services. The mean MMSE score was 27.7 ± 1.6, and no participant reported falls in the past 12 months. To investigate the relationship between the perception of early cognitive decline and motor dysfunction, participants completed the Geriatric Depression Scale item 10, which asks whether they feel they have more memory problems than most people. Mobility was assessed using the Timed Up and Go (TUG) test combined with a motion analysis system. The variables assessed included TUG time, step length, turn duration, and sit-to-stand time. This study was approved by the Institutional Ethics Committee.Twenty-three participants reported subjective cognitive decline, and thirty-nine did not. Those with cognitive concerns were older (p = 0.027), had lower MMSE scores (p = 0.002), and took longer to complete the sit-to-stand phase of the TUG test (p = 0.024). Age was negatively correlated with MMSE performance (r = –0.343), and lower MMSE scores were associated with longer sit-to-stand duration (r = –0.301).Subjective cognitive decline refers to the self-perceived cognitive difficulties that occur despite the absence of mild cognitive impairment or dementia. This condition may represent an early preclinical stage of cognitive decline and should be carefully considered by primary care professionals.Older adults with subjective cognitive decline exhibit subtle mobility impairments, indicating potential onset of broader motor dysfunction. Implementing effective strategies to monitor cognitive function in primary health care is essential to enable timely intervention, more accurate risk stratification, and enhanced preventive care.

The prevalence of neurocognitive disorders is increasing worldwide. Their accurate and timely detection remains a challenge in primary care since there is no validated strategy to detect them at mild cognitive impairment (MCI) or dementia stages.To assess the accuracy of a standardized approach involving three steps in primary care and taking less than 10 minutes.In this observational prospective multicentric study, 36 French GPs included adult patients aged ≥65 years with cognitive complaints, applied the diagnosis strategy and then systematically referred patients to specialist consultations in 11 tertiary memory clinics (MC). The three assessment steps were as follows: (i) the GP’s clinical judgement; (ii) a functional assessment using part 2 of the General Practitioner Assessment of Cognition (GPCOG) test, then GP’s clinical judgement; (iii) and an assessment of cognitive status using the Six Item Cognitive Impairment Test (6CIT), then GP’s clinical judgement. The statistical performances of this strategy were estimated using the neurocognitive disorder diagnosis established in MC as reference, comparing patients with any neurocognitive disorder to other patients. They were compared to the performances of the Mini-Mental State Examination (MMSE).A total of 165 patients were enrolled and completed the study, including 71 (43.0%) with MCI and 41 (24.8%) with dementia. The highest diagnostic accuracy was achieved after completion of the full diagnostic strategy in primary care, with sensitivity increasing from 69% after step 1 to 83% after step 3, and with consistently good positive predictive values (84–87%) across all steps. The area under the curve (AUC) of this strategy increased from 0.77 at step 1 up to 0.86 at step 3, which was higher than the AUC of the MMSE (0.82).The assessed strategy had good performances to detect neurocognitive disorders in general practice. The in-depth assessment of patients in memory clinics is a strength of this study. This strategy might be combined with the use of blood biomarkers if they are validated in primary care in the future.A short, graduated strategy including functional and cognitive assessments and GP’s clinical impression, proved to be relevant for detecting patients with MCI or dementia in primary care.

Decision-making capacity is foundational to autonomy and legal personhood. In contexts of cognitive decline—such as dementia, intellectual disability, or psychiatric illness—healthcare professionals must assess capacity to consent, often within complex ethical and legal frameworks.To review existing literature on decision-making capacity and autonomy in cognitively impaired individuals, with emphasis on neuroethical, legal, and clinical dimensions, and how these are addressed in the European Union (EU), particularly in Portugal and France.A narrative literature review was conducted using PubMed, Scopus, and legal databases. Sources included peer-reviewed bioethics and legal journals, EU case law (ECtHR), and grey literature such as reports from the Council of Europe and the UN Committee on the Rights of Persons with Disabilities (CRPD). National legislation in Portugal and France was analyzed to identify reforms and alignments with CRPD principles.Findings highlight a shift from paternalistic substituted decision-making models to supported decision-making, especially under the CRPD. Portugal’s 2018 reform replaced guardianship with individualized support measures, emphasizing will and preferences. France has partially reformed its tutelle system but retains substitute decision-making. Ethical frameworks are evolving to include relational autonomy, recognizing the role of social support in preserving agency. Clinically, tools such as the MacCAT-T assess capacity, yet are inconsistently applied across settings. Jurisprudence from the European Court of Human Rights increasingly protects autonomy, requiring proportional, reviewable restrictions.Despite progress, many systems remain structurally paternalistic. Neuroethical debates around cognitive enhancement, involuntary treatment, and advance directives underscore tensions between autonomy and protection. The interplay of national laws and international human rights obligations reveals inconsistencies in implementation, particularly regarding informed consent and legal capacity.There is a growing consensus in EU health law and ethics toward capacity maximization and autonomy support. Legal reforms, especially in Portugal, offer promising models. Further research is needed to evaluate implementation and develop interdisciplinary frameworks that balance autonomy, capacity, and care.

The rapid digitalization of financial services challenges older adults, whose ability to manage digital money depends on multiple cognitive domains such as memory, calculation, planning, and executive function. Cognitive impairment may compromise financial autonomy and increase vulnerability to digital fraud. This study analyzes alterations in monetary calculation and explores whether digital money management may be beneficial or risky for older adults with cognitive decline..To identify cognitive differences by age, sex, education, and COVID-19 history using the SAGE test; and to assess, through a SWOT–CAME analysis, the implications of digital money management for individuals with cognitive impairment.A cross-sectional observational study was conducted between 2024 and 2025 at XXXXXX. The Self-Administered Gerocognitive Examination (SAGE) was administered to 380 patients aged ≥14 years. Sociodemographic variables and COVID-19 history were analyzed. A score <17 indicated probable cognitive impairment. Statistical tests included chi-square and Student’s t-test (p<0.05). Subsequently, a SWOT–CAME analysis examined strengths, weaknesses, opportunities, and threats of digital financial management in older adults with cognitive decline.Of the 380 participants, 59.2% were women (mean age 54.9 ± 20.3 years). Educational levels were 40.0% secondary, 27.6% university, and 32.4% primary. The global prevalence of SAGE ≤17 was 48.7%, and 38.2% among those aged ≥60. Calculation impairments affected 58.8% (money1: 33.5%; money2: 25.3%), sequencing 20.6%, and recent memory 43.5% (p<0.05 for ≥60 vs. <60). Even participants ≥60 with normal SAGE scores showed calculation/planning deficits (28.6%), and 47.3% had at least one banking-related topic altered.Cognitive decline in domains related to calculation and planning appears early, even before global impairment, suggesting a specific vulnerability to digital financial management. Digital literacy may act as “technological reserve,” preserving cognitive function and autonomy, but lack of training, interface complexity, and fraud exposure remain major risks. Primary Care can play a pivotal role in prevention and digital inclusion.Early dysfunctions in calculation and planning indicate increased susceptibility to digital financial challenges. Digital money management may support autonomy and healthy aging if protective frameworks—technological, legal, and educational—are ensured. Primary Care should serve as a sentinel system promoting safe digital participation among vulnerable populations.