Dementia & Memory Concerns
Changes in memory deserve a careful, compassionate evaluation, for the person and the family.
This information is educational and is not a diagnosis. Diagnosis requires a comprehensive psychiatric evaluation.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline) or call 911.
What it is
Dementia is a general term for a decline in memory, thinking or other mental abilities that is significant enough to interfere with daily life. In DSM-5-TR, it is described as a major neurocognitive disorder. A milder level of decline that does not yet affect independence is called mild neurocognitive disorder, often referred to as mild cognitive impairment.
Some forgetfulness can be part of normal aging. Dementia is not. It is caused by diseases or conditions that affect the brain, and some causes of memory problems, such as vitamin deficiencies, thyroid problems, medication side effects, sleep problems or depression, are treatable.
Diagnostic features (DSM-5-TR)
A plain-language summary of key features described in the DSM-5-TR. This is not the official criteria text and is not a self-diagnosis tool.
Major Neurocognitive Disorder
- Significant decline from a previous level in one or more areas: attention, planning and decision-making (executive function), learning and memory, language, perception and coordination, or social understanding.
- The decline is noticed by the person, someone who knows them well, or a clinician, and is confirmed by standardized testing or other clinical assessment.
- It interferes with independence in everyday activities, at least needing help with complex tasks such as paying bills or managing medications.
- It does not occur only during delirium and is not better explained by another condition, such as depression.
Mild Neurocognitive Disorder
- A modest decline in one or more of the same areas, noticed by the person, family or clinician and supported by testing.
- Everyday independence is preserved, though tasks may take more effort or require strategies such as lists and reminders.
Common causes
- Alzheimer's disease, vascular disease (such as strokes), Lewy body disease, frontotemporal degeneration and Parkinson's disease.
- Traumatic brain injury, substance or medication effects, HIV infection, prion disease and Huntington's disease.
- More than one cause can be present at the same time.
Common signs
- Forgetting recent conversations or events
- Repeating questions
- Getting lost in familiar places
- Trouble managing money, bills or medications
- Difficulty finding words or following conversations
- Problems with planning or problem-solving
- Changes in mood, personality or behavior
- Withdrawing from work or social activities
- Seeing things that are not there or acting out dreams (seen in some types)
How it's evaluated
I gather a careful history from the person and, with permission, from a family member or caregiver who has noticed changes. I use standardized cognitive screening tools such as the Montreal Cognitive Assessment (MoCA) and review medications that can affect thinking.
Evaluation includes looking for treatable contributors, with lab work such as vitamin B12 and thyroid testing, and screening for depression, sleep problems, hearing and vision changes and delirium. I coordinate with primary care and neurology for brain imaging or neuropsychological testing when indicated.
Evidence-based treatment options
Medications for cognitive symptoms
Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and memantine are FDA-approved for Alzheimer's disease and may help symptoms for a time.
Newer disease-modifying treatments
Anti-amyloid antibody treatments (lecanemab and donanemab) are FDA-approved for early symptomatic Alzheimer's disease with confirmed amyloid. They require specialist care and MRI monitoring for side effects.
Behavioral and psychological symptoms
Non-medication approaches, such as routine, environment changes and caregiver strategies, are used first. Antipsychotics carry an FDA boxed warning for increased risk of death in older adults with dementia and are used only with great care.
Brain and heart health
Treating blood pressure, diabetes, hearing loss and depression, staying physically and socially active, and protecting sleep support overall brain health.
Caregiver support
Education, planning and respite resources help families care for their loved one and themselves.
How I can help
I provide thoughtful evaluation and family-centered care. I look carefully for treatable causes, address depression, anxiety, sleep problems, agitation and other symptoms that often accompany memory changes, and review medications to reduce those that may worsen thinking.
I partner with families and caregivers, coordinate with primary care and neurology, and help you plan for what lies ahead with clarity and compassion.
Insight
Depression in older adults can cause problems with memory and concentration that look like dementia. A thorough evaluation helps tell the difference, and those symptoms often improve with treatment.
Sources
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
- National Institute on Aging (NIA): Alzheimer's Disease and Related Dementias
- Alzheimer's Association: What Is Dementia?
- Centers for Disease Control and Prevention (CDC): Alzheimer's Disease and Dementia
- NICE guideline NG97: Dementia: assessment, management and support
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