Most people will forget a name, misplace their phone, or lose track of a conversation at some point. Usually, those moments pass without much thought. But for many adults, especially as they age, small lapses can trigger a much deeper fear: Is this the beginning of cognitive decline?

As a neurologist, I hear this concern often. And as a researcher, I have learned something important: Worry about cognition and cognitive disease arenot the same thing. Confusing the two can cause unnecessary distress for patients and missed opportunities for care.

Recent media coverage, including a Boston Globe article on how artificial intelligence may help clinicians recognize early signs of cognitive concerns, reflects growing public awareness of this issue. What is often missing from these conversations, however, is the psychology behind cognitive concern itself: why some people worry intensely about their memory while others do not, and what those worries actually mean.

Concern, Mild Cognitive Impairment, and Dementia Are Not the Same

Clinically, we distinguish among three related but very different experiences:

1. Cognitive concern, when a person feels their memory or thinking has changed.
2. Mild cognitive impairment (MCI), when testing shows a measurable decline beyond what’s expected for age, but daily independence remains intact.
3. Dementia, including Alzheimer’s disease and related disorders (ADRD), when cognitive decline interferes with everyday functioning.

These categories matter. They guide diagnosis, counseling, and treatment. But from a patient’s perspective, they often blur together. A person does not wake up thinking, I have subjective cognitive concern. They wake up thinking, Something feels wrong.

That feeling alone does not mean dementia is present or inevitable.

Why Anxiety and Depression Amplify Cognitive Worry

One of the strongest predictors of cognitive concern is not objective cognitive impairment, but mood. Anxiety and depression can profoundly shape how people experience their thinking. Anxiety heightens vigilance to perceived threats. Depression slows processing, concentration, and memory. Together, they can make ordinary cognitive fluctuations feel alarming.

This does not mean the concern is imagined or “all in one’s head.” Psychological distress changes how attention and memory function. It also changes how people interpret uncertainty. A forgotten word becomes evidence. A misplaced bill becomes a warning sign.

Research shows that people with anxiety or depressive symptoms are more likely to report memory problems, even when cognitive testing does not show impairment. The distress is real, even if the diagnosis is not dementia.

The Fear Is About More Than Memory

Cognitive concern is rarely just about forgetting names. It is about identity, independence, and the fear of becoming someone else. Memory anchors our sense of self. When people worry about losing it, they are often grieving a future they fear they may not control.

That fear deserves identification, understanding, and evaluation. Yet, in clinical practice, cognitive concern is often minimized if formal testing is normal or escalated too quickly when it shouldn’t be. Neither response serves patients and healthcare systems well.

Why Early Signals Are So Easy to Miss

Part of the challenge is that early cognitive signals rarely appear as clear diagnoses. They surface indirectly: in a caregiver’s worry, a missed appointment, a vague note in a medical record. These signals may precede formal evaluation by months or years.

Recent research published in a Nature–affiliated journal (npj Digital Medicine) highlights this gap. The study showed that early cognitive concerns are identifiable and often embedded in everyday clinical language long before a diagnosis is made. They are frequently missed by traditional approaches that rely on codes, checklists, or in-person screenings. These findings help explain why patients can feel something is wrong while the healthcare system struggles to address it.

Importantly, this does not mean every concern predicts dementia. It means concern lives in a gray zone: psychologically meaningful, clinically important, and emotionally charged.

When Worry Becomes the Problem

Unchecked cognitive worry can have real consequences. People may withdraw socially, turn to supplements or substances of uncertain benefit marketed as “brain health,” or repeatedly seek reassurance through costly imaging tests that strain both personal and healthcare resources. During prolonged evaluation and uncertainty, confidence in the healthcare system can erode. Ironically, this stress may further impair attention and memory, reinforcing a cycle of fear.

Memory Essential Reads

At the same time, dismissing concern outright can damage trust. Patients understand their own lived experience, and when worries are minimized, they may stop sharing them or seek answers elsewhere. The challenge is not to eliminate cognitive concern but to identify and address it wisely.

What Helps and What Doesn’t

For people worried about their memory, a few principles matter most. Context is key: Occasional lapses are not the same as consistent changes that affect daily life. Mood also matters, as anxiety and depression commonly intensify cognitive concerns and are often treatable. Patterns over time are more informative than a single moment, and functional independence carries far more weight than isolated slips.

A Value-Based Approach to Cognitive Aging

As artificial intelligence begins to support the identification of early cognitive signals, the focus should be on clearer understanding, better conversations, and evidence-guided reassurance or follow-up. Cognitive aging unfolds along a continuum, as do cognitive concerns themselves. The greatest risk remains in leaving people without help to interpret changes in memory and thinking with clarity and compassion.