2d • General discussion
I Diagnosed Her. She Had No Idea.
60% of people with dementia never get diagnosed.
I just diagnosed one of them.
Patricia, 71. Came for "stress." Daughter brought her.
First red flag: Patient thinks one thing. Family thinks another.
Her story: "I'm fine. Just forgetful."
Daughter (privately):
"Missed 3 appointments. Repeats questions. Got lost driving to my house. She's lived here 40 years."
This is the diagnostic gap.
My questions:
To Patricia: "How's memory?"
Patricia: "Fine."
To daughter: "Compared to 5 years ago?"
Daughter: "Completely different person."
Testing:
Computerized cognitive assessment.
Deficits: Executive function, visuospatial, delayed recall
Preserved: Language, social skills
The mask:
Seemed fine in conversation. Normal chitchat.
Why she wasn't diagnosed:
PCP never screened (no time, no reimbursement, "seems fine")
Family normalized it ("just getting older")
She denied problems (no insight, blamed others)
Classic pattern. Millions of times.
The diagnosis conversation:
Me: "Testing shows memory problems."
Patricia: "Ridiculous. I'm fine."
Me: "Let me show you the results"
Patricia: "You never told me words."
Daughter crying. Patricia frustrated.
This is why doctors avoid it.
What happened:
Brain MRI: Moderate atrophy in patterns consistent with Alzheimer's
Diagnosis: Probable Alzheimer's, mild-moderate
Treatment: Full Cognitive Care Plan including
↳ Donepezil
↳ Memantine
↳ Vascular risk addressed
↳ Support groups
Family education: What to expect, safety planning, legal prep, resources.
Three years undiagnosed. Three years without treatment. All preventable.
Why 60% undiagnosed:
Patient barriers: Lack insight, fear stigma, don't want bad news
System barriers: No routine screening, time constraints, specialists backlogged
Knowledge barriers: Families normalize, PCPs lack training
The cost:
Patricia missed 3 years of medications that slow progression, safety planning (she was driving!), legal preparation, clinical trials, family adjustment.
Harder for everyone now.
What should happen:
Annual screening age 65+
Earlier if family concerned
Baseline at 50
Would catch 3 years earlier when interventions are much more effective.
The 40% who get diagnosed:
Only because: Got lost publicly, car accident, missed medication, wandered, financial exploitation.
Crisis-driven, not prevention-driven.
Six months later:
Medications helping (modest)
Stopped driving (safely)
Legal documents completed
Family educated
Connected to Alzheimer's Association
Still has dementia. But managed differently. Family understands. Plans in place. Crisis averted.
The message:
If 65+: Ask doctor for cognitive testing
If "you seem fine": Insist on formal testing
If "no time": Find different doctor
If family worried: Get tested regardless
60% undiagnosed isn't statistic. It's millions of Patricias.
⁉️ Has anyone in your family shown memory changes?
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I Diagnosed Her. She Had No Idea.
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