Most families wait too long. Not out of negligence, but because the early changes are ambiguous, because bringing it up feels like an accusation, and because a fifteen-minute appointment does not feel like enough time to raise something this significant.
The result is that cognitive symptoms frequently go unmentioned for months or years. Research has consistently found that dementia is underdiagnosed and that even when families notice changes, those concerns often do not make it into a clinical conversation until the situation has progressed considerably.
This post covers how to actually have that conversation productively.
Before the Appointment
The single most useful thing you can do is arrive with documentation. Physicians working within a short appointment window rely heavily on what they are told, and a vague report that someone has been forgetful is far less actionable than a specific record.
Write down concrete examples. Not “her memory is getting worse” but “she asked me the same question four times during a single dinner in March,” “he got lost driving to the grocery store he has used for fifteen years,” “she left the stove on twice last month.” Specificity is what allows a clinician to distinguish normal age-related change from something requiring evaluation.
Note when it started and how it has progressed. Was the onset gradual or sudden? Has it been steadily worsening, or does it fluctuate day to day? Sudden onset and significant fluctuation point toward different causes than a slow, steady decline. This is diagnostically meaningful information that only a family member can provide.
Document changes beyond memory. Personality changes, loss of interest in activities they used to enjoy, poor judgment with money, difficulty with familiar tasks, changes in sleep, increased anxiety or suspicion, changes in language. Non-memory symptoms are often the more telling ones, particularly for frontotemporal and Lewy body dementia.
Bring a complete medication list. Include over-the-counter medications and supplements. A number of commonly used drugs, particularly anticholinergics, sleep aids, and certain bladder medications, can produce cognitive symptoms that resolve when the medication is changed.
Note functional changes. This is what clinicians use to distinguish mild cognitive impairment from dementia. Can they still manage their finances, medications, driving, cooking, and appointments independently? Has anything in that list started to slip? Be specific about what has changed rather than what they generally can or cannot do.
Deciding Who Raises It
This is where families get stuck. Bringing up memory concerns in front of the person can feel like a betrayal, and many people with early cognitive changes react defensively, either because they are frightened or because their awareness of their own deficits is genuinely impaired.
A few approaches work.
Frame it as routine. Many people are more willing to accept a cognitive screening presented as a standard part of an annual physical than one presented as a response to specific concerns. Physicians can often incorporate it that way if they know in advance.
Send information ahead of the appointment. Most practices have a patient portal or will accept a letter or fax. Sending your written observations to the physician before the visit allows them to raise the topic themselves, which removes you from the position of having to confront your family member directly. This is a widely used approach and physicians are generally receptive to it.
Attend the appointment. Collateral history from someone who knows the person well is clinically important, because people with cognitive impairment often underreport their own symptoms. If the person is uncomfortable with you being present for the entire visit, ask for a few minutes with the physician separately.
Address it honestly if you can. Some families find that a direct conversation works better than maneuvering around it. Framing it as wanting to rule things out, noting that many causes of memory problems are treatable, and emphasizing that you want to be sure nothing correctable is being missed tends to land better than framing it around dementia.
What to Ask at the Appointment
Going in with specific questions helps ensure the visit produces something actionable.
Can we rule out reversible causes? Thyroid dysfunction, vitamin B12 deficiency, depression, medication effects, sleep apnea, and infections can all produce cognitive symptoms. Blood work and a medication review should be part of any initial workup.
Can we do a cognitive screening today? Brief tools like the MoCA or MMSE can be administered in an office visit and establish a baseline even if the result is normal. A baseline score is valuable because future testing can be compared against it.
Does this warrant a specialist referral? Primary care is an appropriate starting point, but a neurologist, geriatrician, or memory clinic can conduct the detailed neuropsychological testing and imaging that a full evaluation requires. Ask directly whether referral is indicated.
What should prompt me to call back? Establishing a threshold for follow-up prevents the situation where a family waits another year because they are not sure whether what they are seeing is significant.
When should we reassess? Even if the initial evaluation is reassuring, a follow-up interval of six to twelve months allows changes to be detected.
If You Feel Dismissed
This happens, and it is worth knowing how to handle it.
Some physicians attribute cognitive symptoms to normal aging without evaluation, particularly in older patients. A few do so because the symptoms genuinely appear consistent with normal aging. Others do so because a full dementia workup is time-consuming and the visit is short.
If you believe something is being missed, a few things help. Restate the specific functional changes rather than the general concern, because functional decline is what distinguishes pathology from normal aging. Ask directly for the specific tests you want: blood work to rule out reversible causes, a cognitive screening, and a referral for further evaluation. Ask for the reasoning behind a decision not to evaluate, and ask that it be documented.
If you remain concerned after that, requesting a referral to a memory clinic or seeking a second opinion is entirely reasonable. Memory clinics at academic medical centers typically accept self-referrals or referrals from any physician.
A Note on Timing
There is a common belief that pursuing a diagnosis is pointless because nothing can be done. That belief is outdated and it is worth addressing directly.
Several medications have received FDA approval for early Alzheimer’s disease, and eligibility generally requires diagnosis at an early stage with biomarker confirmation. Waiting until symptoms are obvious can close that window. Clinical trial participation similarly requires early-stage diagnosis in most cases.
Beyond treatment, early diagnosis allows the person themselves to participate in decisions about their own care, finances, and future preferences while they still have the capacity to do so. Families who delay often find themselves making those decisions on someone’s behalf without ever having discussed them.
And a meaningful proportion of cognitive complaints turn out to have treatable causes. Pursuing evaluation is not the same as accepting a dementia diagnosis. Frequently it produces a different and more manageable answer.
For a detailed look at what happens after the initial conversation, our post on how dementia is diagnosed walks through the full evaluation process, including neuropsychological testing, brain imaging, and biomarker testing, and what families can expect at each step.
Have questions about memory care for a loved one?
We are happy to talk. Whether you are just starting to research your options or are further along in the process, reach out anytime.
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Sources
- Pirrotta F, et al. Neuropsychological Assessment for Early Detection and Diagnosis of Dementia: Current Knowledge and New Insights. Diagnostics. 2024;14(12):1281.
- Bradford A, Kunik ME, Schulz P, Williams SP, Singh H. Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Disease and Associated Disorders. 2009;23(4):306-314.
- Borson S, et al. Improving dementia care: the role of screening and detection of cognitive impairment. Alzheimer’s & Dementia. 2013;9(2):151-159.
- Livingston G, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet. 2024;404(10452):572-628.
- Alzheimer’s Association. 2025 Alzheimer’s Disease Facts and Figures. Alzheimer’s & Dementia. 2025.