If you’ve noticed memory problems or confusing behavior in someone you care about, the most important first step is scheduling an appointment with their primary care doctor. Many conditions that look like dementia are actually treatable, and even when dementia is the cause, an early diagnosis opens the door to planning, support, and better outcomes. Here’s how to move through this process thoughtfully.
Separating Normal Aging From Warning Signs
Everyone forgets things as they get older. Misplacing car keys, struggling to find a word that comes back to you later, or blanking on an acquaintance’s name are all normal parts of aging. The key distinction is that normal aging leaves your overall memory, reasoning, and language abilities intact. You still remember old experiences, you can follow a conversation, and you can manage daily tasks without help.
Dementia looks different. The signs that should raise real concern include getting lost in a familiar neighborhood, using unusual words for everyday objects (calling a watch a “hand clock,” for example), forgetting the name of a close family member, losing old memories that were once well established, and being unable to complete routine tasks like paying bills or following a recipe they’ve made for years. These aren’t occasional slip-ups. They represent a pattern of decline that disrupts daily life.
If you’re unsure whether what you’re seeing is normal, start keeping a simple written log. Note the date, what happened, and how the person responded. This record becomes invaluable when you eventually speak with a doctor, because cognitive changes that unfold over weeks or months can be hard to describe from memory alone.
How to Bring It Up
This is the part most people dread, and for good reason. Telling someone you’re worried about their thinking or memory can feel like an accusation. A few approaches tend to work better than others.
Frame your concern around specific situations rather than labels. Saying “I noticed you got turned around driving to the grocery store last week, and that seemed to bother you” lands very differently than “I think you might have dementia.” Focus on your worry for their wellbeing, not on what’s wrong with them. Many people with early cognitive changes already sense something is off and feel relieved when someone acknowledges it without judgment.
If the person resists or becomes upset, don’t force the conversation. You can revisit it later, or you can contact their doctor’s office directly. Most physicians will accept a letter or phone call from a concerned family member describing what you’ve observed, even without the patient’s knowledge. The doctor can then raise the topic naturally at the next visit.
Why a Medical Visit Matters So Much
Not everything that looks like dementia is dementia. A significant number of people evaluated for cognitive decline turn out to have a treatable condition instead. Depression is one of the most common mimics, causing concentration problems, memory lapses, and withdrawal that can look remarkably like early dementia. Medication side effects are another frequent culprit, particularly drugs with anticholinergic properties (common in allergy medications, bladder drugs, and some antidepressants).
Thyroid problems, vitamin B12 deficiency, folate deficiency, alcohol use, urinary tract infections in older adults, and even chronic sleep deprivation can all produce cognitive symptoms that reverse with proper treatment. This is exactly why a doctor’s evaluation is essential before assuming the worst. The American Academy of Neurology specifically recommends screening for vitamin B12 deficiency, thyroid dysfunction, and depression as part of any cognitive workup.
What Happens During the Evaluation
A typical evaluation starts with the primary care doctor gathering a detailed history, ideally from both the patient and someone who knows them well. You’ll be asked when the changes started, how they’ve progressed, and what daily activities have been affected. Bring your written log if you have one.
The doctor will likely run a brief cognitive screening test. These are short, structured assessments that check memory, attention, language, and reasoning. One common version asks the person to draw a clock face, recall a short list of words, and answer orientation questions like today’s date. A score of 26 or above out of 30 on the most widely used screening tool is generally considered normal, though education level and other factors are taken into account. These tests take only 10 to 15 minutes and aren’t painful or invasive.
Blood work typically follows to check for those reversible causes: thyroid function, B12 levels, and basic metabolic markers. Depending on the results, the doctor may also order a brain scan, usually a CT or MRI, to look for structural changes like shrinkage in specific brain regions, evidence of a stroke, fluid buildup, or a tumor.
When a Specialist Is Needed
Primary care doctors are a good starting point, but they often refer patients to a specialist for a definitive diagnosis. The best choices, according to UNC School of Medicine, are a behavioral neurologist, a geriatric psychiatrist, or a geriatrician with a special interest in dementia.
Behavioral neurologists specialize in cognitive problems and are particularly skilled at detecting subtle brain injuries like small strokes or infections that might be causing symptoms. Geriatric psychiatrists focus on the mental and emotional health of older adults, making them especially useful when depression, anxiety, or life stress might be contributing to the picture. Geriatricians handle complex medical conditions in older people and can coordinate care across multiple health issues, though they don’t specialize in brain disorders specifically.
Memory disorder clinics are another option. These centers bring together neurologists, neuropsychologists, and other specialists under one roof, offering comprehensive testing and access to clinical trials. If appointments with superspecialists are unavailable or not covered by insurance, a general neurologist or psychiatrist recommended by the primary doctor is a reasonable alternative.
Making the Home Safer
While the medical evaluation is underway, take a walk through the person’s home with fresh eyes. You’re looking for immediate hazards and opportunities to reduce confusion. The National Institute on Aging recommends going room by room, starting with the most urgent dangers.
Falls are the biggest physical risk. Mark stair edges with brightly colored tape, install nightlights in hallways and bathrooms, and place nonskid mats in the tub and shower. Remove or pad furniture with sharp corners. Make walls a lighter color than the floor to create visual contrast that helps with depth perception.
Kitchen and bathroom safety comes next. Set the water heater to 120°F to prevent scalding. Put signs near the oven, toaster, and iron. Remove small electrical appliances from the bathroom and cover unused outlets. Check the refrigerator regularly and discard expired food. Lock away cleaning products, medications, alcohol, matches, and anything else that could be harmful if used incorrectly. If guns are in the home, secure or remove them.
Simple labeling helps with orientation. Use brightly colored signs or pictures to mark the bathroom, bedroom, and kitchen. Label hot-water faucets red and cold-water faucets blue. Post emergency phone numbers and the home address near every phone. Consider a “No Soliciting” sign for the front door, since people with cognitive decline are vulnerable to scams and aggressive salespeople. Limit mirrors, which can cause confusion or fear if the person doesn’t recognize their own reflection.
Getting Legal and Financial Plans in Place
This is the step families most often wish they’d handled sooner. Legal documents require the person to have decisional capacity at the time of signing, which means the earlier you address this, the better. Once dementia progresses to a certain point, the person may no longer be able to legally execute these documents, and the alternatives (court-appointed guardianship) are expensive and time-consuming.
Three documents matter most. A durable power of attorney for finances allows a trusted person to manage bank accounts, pay bills, and handle financial decisions if the individual becomes unable to do so. A durable power of attorney for health care designates someone to make medical decisions on their behalf. And a living will spells out the person’s wishes for medical treatment in situations where they can’t communicate, such as whether they want life-sustaining measures.
A will or living trust should also be reviewed or created to outline how property and assets will be handled. If the person already has these documents, now is the time to confirm they’re up to date and that copies are accessible to the right people. An elder law attorney can help navigate the specifics, and many offer free initial consultations.
Supporting the Person Through the Process
A dementia evaluation can be frightening for the person going through it. They may feel defensive, embarrassed, or angry. They may insist nothing is wrong. These reactions are normal and don’t mean you should back off from pursuing answers.
Offer to go with them to appointments. Having a familiar face in the room reduces anxiety and ensures the doctor gets an accurate picture, since the person may not reliably report their own symptoms. Between visits, try to maintain their normal routine as much as possible. Familiarity is grounding for someone whose cognitive map of the world is shifting.
If the evaluation does lead to a dementia diagnosis, know that the trajectory varies widely depending on the type and the individual. Some forms progress slowly over many years. Regardless of the diagnosis, the steps you’ve already taken, documenting changes, securing the home, putting legal plans in place, will have given you and your family a meaningful head start on what comes next.