Not all memory loss is dementia, and a meaningful share of it is treatable. The first step is a proper cognitive evaluation rather than reassurance.
Families usually arrive having noticed changes for a year or more before anyone raises it with a doctor. That delay is understandable — and it is also the reason a significant number of treatable causes get missed. Thyroid disease, B12 deficiency, depression, sleep apnoea, and the cumulative effect of several sedating medications all produce cognitive change that improves once addressed.
When the cause is a neurodegenerative condition, an early and specific diagnosis still changes a great deal. It determines which medications help and which make things worse — the distinction between Alzheimer's disease and dementia with Lewy bodies matters enormously here — and it gives families the runway to plan while the patient can still take part in those decisions.
We include family members in the evaluation as a matter of routine. Patients with cognitive change are often the least reliable witnesses to it, and the history from someone who sees them daily is frequently the most valuable piece of information in the room.
Memory or thinking that changes over hours or days — rather than months — is not dementia and needs urgent evaluation. Sudden confusion can signal stroke, infection, medication toxicity or a metabolic crisis. Call 911 or seek emergency care the same day.
“Families often apologise for “over-reacting” when they bring someone in early. Early is exactly when an evaluation is worth the most.”