“I can’t remember things like I used to.” “My brain feels foggy.” “I can’t focus on anything.” Cognitive complaints are among the most common reasons adults seek psychiatric evaluation — and they have many possible causes, most of which are treatable.
The challenge is sorting through the possibilities. Cognitive symptoms can reflect depression, anxiety, sleep disorders, ADHD, thyroid dysfunction, vitamin deficiencies, medication effects, or actual cognitive disorders. A thorough psychiatric evaluation distinguishes them — and matters because the treatment differs dramatically based on cause.
What Counts as a Cognitive Symptom
- Memory issues — forgetting recent conversations, appointments, where things are placed
- Attention/focus problems — inability to concentrate, easily distracted, finishing tasks
- Executive dysfunction — trouble planning, organizing, prioritizing, decision-making
- Processing speed — feeling slower, taking longer to do familiar tasks
- Word-finding difficulties — knowing what you want to say but unable to retrieve the word
- “Brain fog” — diffuse sense of mental cloudiness, difficulty thinking clearly
The Major Causes in Adults
Depression
Depression’s effects on cognition are dramatic and frequently underrecognized. “Pseudodementia” — depression-related cognitive impairment that mimics dementia — affects many older adults but also occurs in younger ones. Cognitive symptoms typically improve with depression treatment.
Anxiety
Generalized anxiety produces difficulty concentrating and mental “spinning” that interferes with cognitive function. Treatment of the anxiety often resolves the cognitive symptoms.
Sleep disorders
Sleep apnea, chronic insomnia, and even simple sleep deprivation produce profound cognitive effects. Often the most impactful intervention is sleep evaluation and treatment.
ADHD (often undiagnosed in adults)
Adult ADHD frequently presents with executive function and focus problems — sometimes for the first time as job demands or life complexity overwhelm previously adequate compensation strategies.
Medical causes
Thyroid dysfunction, B12 deficiency, anemia, diabetes, autoimmune conditions, post-viral syndromes (including post-COVID), and certain infections all affect cognition. Workup for cognitive complaints should include medical screening.
Medication effects
Anticholinergic medications, benzodiazepines, certain sleep medications, antihistamines, certain blood pressure medications, and many others affect cognition. Medication review is essential.
Hormonal factors
Perimenopause and menopause produce significant cognitive symptoms in many women. Thyroid changes affect both genders.
Actual cognitive disorders
Mild cognitive impairment and dementia are possibilities — particularly in older adults. They require specific evaluation and management.
Source: Aging & Mental Health journal review data.
When to Seek Evaluation
- Cognitive symptoms are persistent (more than 2-4 weeks)
- They’re interfering with work or daily functioning
- They’re distressing
- They’ve worsened over time
- Family or coworkers have commented on changes
- They’re accompanied by mood, sleep, or anxiety symptoms
- You’re over 60 and noticing decline
What Evaluation Involves
A proper cognitive evaluation includes:
- Detailed history — onset, course, pattern, impact
- Comprehensive psychiatric assessment (depression, anxiety, ADHD)
- Sleep evaluation
- Medication review
- Medical workup including thyroid, B12, possibly other labs
- Cognitive screening (MoCA, MMSE, or detailed neuropsychological testing if indicated)
- Substance use assessment
Premature dementia worry
Adults presenting with cognitive complaints often jump to dementia fears — when most causes are treatable conditions like depression, sleep apnea, or thyroid issues.
Systematic workup
Dr. Farkas evaluates cognitive complaints with thorough psychiatric assessment, attention to medical causes, and appropriate referrals.
Often dramatic improvement
When the underlying cause is identified and treated, cognitive symptoms frequently improve substantially.
Common Questions About Cognitive Symptoms
Am I developing dementia?
In most adults under 65, cognitive complaints are due to depression, anxiety, sleep, ADHD, or medical causes — not dementia. Even in older adults, careful evaluation distinguishes treatable conditions from cognitive disorders.
My doctor said everything is normal — why do I still have symptoms?
Standard medical workup may miss conditions psychiatry evaluates — depression, anxiety, ADHD, complex sleep issues. A psychiatric evaluation can uncover what medical workup didn’t.
Can ADHD develop in adulthood?
ADHD develops in childhood but can become more impairing in adulthood as life demands exceed compensation strategies. Many adults are newly diagnosed when stressors expose long-standing patterns. See our related article on adult ADHD.
What about post-COVID cognitive symptoms?
Post-viral cognitive symptoms are increasingly recognized. They overlap with depression and anxiety effects, but persist in some patients even with mood treatment. Evaluation can distinguish and guide management.