Getting someone evaluated for dementia starts with their primary care doctor, who can perform an initial cognitive screening and order blood tests to rule out treatable causes of memory loss. The process typically involves multiple visits and sometimes a referral to a specialist, but that first appointment is the critical step. If you’re concerned about a loved one’s thinking or behavior, here’s how to move from worry to answers.
Signs That Warrant an Evaluation
Normal aging causes occasional forgetfulness, like misplacing your keys once in a while. Dementia-related changes are different: they disrupt daily life and get worse over time. The signs worth paying attention to include repeating the same questions within a short period, trouble handling money or paying bills, getting lost in familiar places, taking much longer than usual to complete routine tasks, and poor judgment that leads to uncharacteristic decisions.
Personality and mood shifts also matter. Increased anxiety, new aggression, loss of initiative, or withdrawal from activities the person used to enjoy can all signal cognitive decline. So can difficulty finding common words in conversation, losing track of dates or seasons, and misplacing things in odd places (a wallet in the refrigerator, for example). None of these on their own confirm dementia, but a pattern of several changes over weeks or months is reason enough to schedule an appointment.
How to Bring It Up With a Reluctant Loved One
This is often the hardest part. Many people with cognitive changes don’t recognize them, or they feel frightened and defensive when someone else points them out. A few approaches help. Speak calmly, frame the visit around general health rather than memory specifically (“It’s been a while since your last checkup”), and avoid quizzing them with “Don’t you remember?” Allow them to feel in control of the decision as much as possible. Listening to their concerns and frustrations, rather than arguing with specific examples, keeps the conversation from becoming adversarial.
Starting these discussions early matters. If the person can still participate in decisions about their own care, the entire process goes more smoothly, and they retain a sense of autonomy. If they absolutely refuse, you still have options. Privacy laws allow family members and close friends to share concerns with a doctor even without the patient’s explicit consent. HIPAA permits you to call or write to the physician and describe what you’ve been observing. The doctor can’t share the patient’s medical information back to you without authorization, but they can listen to your concerns and use that information during the next visit.
The First Appointment: What Happens
No single test diagnoses dementia. The evaluation unfolds across several steps, sometimes over multiple visits. At the initial appointment, the doctor reviews the person’s medical history, current medications, and symptoms. They’ll also want to hear from someone close to the patient, a family member or friend who can describe the changes they’ve noticed from the outside. This “independent historian” perspective is a required part of a thorough cognitive assessment.
The doctor will typically perform a brief cognitive screening using a standardized test. The two most common are the Mini-Mental State Exam and the Montreal Cognitive Assessment, both scored out of 30 points. On the MMSE, a score of 24 or above is considered normal. The MoCA, which tests a wider range of thinking skills including executive function and abstract reasoning, uses a cutoff of 26. These screenings take about 10 to 15 minutes and test memory, orientation, attention, language, and problem-solving. A low score doesn’t confirm dementia by itself, but it flags the need for deeper testing.
What to Bring to the Appointment
Preparation makes a significant difference in how useful that first visit is. Before you go, put together:
- A timeline of changes in memory, behavior, language, mood, or daily function, with approximate dates when you first noticed them
- Specific examples of how symptoms affect daily life: trouble with medications, finances, driving, cooking, or safety
- A complete medication list including over-the-counter drugs, vitamins, and supplements
- Names of other doctors involved in the person’s care
- A folder or notebook to keep visit summaries and test results organized going forward
Written notes are especially valuable because the person being evaluated may not accurately report their own symptoms. Your observations fill in gaps the doctor can’t see during a brief office visit.
Ruling Out Treatable Causes
One of the most important reasons to pursue evaluation is that some conditions mimic dementia but are fully reversible. Blood tests check for vitamin B12 deficiency, thyroid problems (both overactive and underactive), liver or kidney dysfunction, and infections. Depression is another common culprit: it can cause concentration problems, forgetfulness, and withdrawal that look remarkably like early dementia. A psychiatric evaluation is often part of the workup for this reason.
Medication side effects, alcohol use, sleep apnea, and even dehydration can also impair cognition. The American Academy of Neurology recommends screening specifically for B12 deficiency, hypothyroidism, and depression as part of any dementia evaluation. If one of these turns out to be the cause, treating it can partially or fully restore cognitive function.
Brain Imaging and Advanced Testing
If the initial screening and blood work point toward a neurological cause, the doctor will typically order brain imaging. An MRI is the most common choice. It shows whether brain regions have shrunk (a hallmark of several types of dementia), and it helps rule out other structural problems like bleeding, fluid buildup, or tumors. A CT scan serves a similar purpose and is used when someone can’t have an MRI, for instance if they have a pacemaker.
PET scans go a step further. An amyloid PET scan detects abnormal protein deposits called amyloid plaques, one of the defining features of Alzheimer’s disease. If the scan shows few or no plaques, Alzheimer’s is unlikely to be the cause. A tau PET scan detects a different protein that forms tangles inside nerve cells in Alzheimer’s and other dementias, though this is less commonly used in routine clinical practice. A third type of PET scan measures how the brain uses energy and may be ordered when frontotemporal dementia is suspected.
Neuropsychological testing is another layer. These are more detailed assessments of thinking skills, sometimes lasting several hours, that map specific strengths and weaknesses across memory, reasoning, language, and attention. The results help pinpoint which type of dementia is involved and how far it has progressed.
Which Specialists to See
Primary care doctors can initiate the evaluation and manage mild cases, but many feel undertrained for complex dementia care. A referral to a specialist is common and often worthwhile. Neurologists focus on the brain’s structure and function, and they’re well equipped to interpret imaging results and distinguish between dementia types. Geriatric psychiatrists bring expertise in the behavioral and mood-related aspects of cognitive decline, including depression screening and managing symptoms like agitation or anxiety. Geriatricians specialize in the overall health of older adults and can coordinate care across multiple conditions.
Current guidelines encourage a multidisciplinary approach, meaning more than one specialist may be involved. Memory clinics at academic medical centers often bundle neurology, psychiatry, neuropsychology, and social work into a single team, which can streamline an otherwise fragmented process.
Insurance and Cost Considerations
Medicare covers cognitive screening as a required part of the Annual Wellness Visit, which is free for beneficiaries. If cognitive impairment is detected during that visit or any other routine appointment, Medicare also covers a separate, more thorough cognitive assessment and care planning visit. This longer visit, typically about 60 minutes, includes a detailed history, functional assessment of daily living skills, medication review, safety evaluation for home and driving, and the creation of a written care plan. Standard Part B coinsurance and deductible apply to this follow-up visit.
Most private insurance plans cover diagnostic testing for dementia as well, including blood work, imaging, and specialist visits, though copays and prior authorization requirements vary. If cost is a barrier, community health centers and university-affiliated memory clinics sometimes offer sliding-scale evaluations.
What Comes After the Evaluation
The evaluation may conclude with a clear diagnosis, a diagnosis of mild cognitive impairment (a stage between normal aging and dementia where daily function is mostly preserved), or a recommendation for follow-up testing in six to twelve months. Mild cognitive impairment doesn’t always progress to dementia, but it does increase the risk, so monitoring matters.
If dementia is diagnosed, the care plan developed during the evaluation becomes a roadmap. It typically addresses cognitive symptoms, behavioral changes, safety concerns like driving and fall prevention, caregiver education, and referrals to community resources such as adult day programs and support groups. Getting the evaluation done early gives your loved one the best chance of benefiting from available treatments and planning for the future while they can still participate in those decisions.