[6 MIN READ] 

In this article:

• Learn about what kind of memory changes qualify as dementia and when you should be concerned about someone you love.

• Find out what to expect during the cognitive evaluation process and why it’s best to start with a primary care provider first.

• Get a better understanding of treatment options and find out how caregivers can get support, too.

When memory fades, is it dementia?

If you’ve noticed changes in a loved one’s memory or behavior — maybe they are repeating things, losing items or struggling with daily tasks — it’s normal to worry. But memory loss doesn’t always mean dementia. When it does, early evaluation can make a difference. 

Elif Sozmen, M.D., Ph.D., a neurologist specializing in cognitive and behavioral neurology at the Providence Swedish Center for Healthy Aging, sees patients every day who are navigating these concerns. The center, which focuses on supporting patients’ brain health during aging, provides comprehensive assessments for people referred for cognitive changes, regardless of whether those changes ultimately amount to dementia.

“Not all cognitive changes are results of a neurodegenerative process. At the Center for Healthy Aging and Women’s Brain Health programs, we start with a comprehensive assessment of each patient’s overall health, like sleep apnea, medication interactions, undertreated mood problems, nutritional deficiencies and hormone changes,” Dr. Sozmen says. “That is why a full evaluation is so important in order to provide personalized care.” And if there is an underlying neurodegenerative process, we have state-of-the-art imaging, neuropsychological assessment and laboratory testing at our disposal to better understand the mechanism and develop a care plan.”

What is dementia? 

Dementia is a word that tends to raise alarm bells, but it’s often misunderstood.

Dementia is a general term that describes persistent cognitive decline in memory, reasoning or other cognitive skills that interfere with daily life, including tasks such as managing finances, preparing meals, driving or medication management. Dementia is not a single disease, but a neurocognitive state one can develop because of various neurological disorders, such as vascular dementia, that occurs due to cumulative effects of vascular disease in the brain, Alzheimer’s disease, Lewy body dementia, frontotemporal degeneration and other conditions.  

Before reaching the point of dementia, many people experience a stage of mild cognitive impairment (MCI), when there may be persistent memory or language difficulties, but the person can still function independently.

“The MCI stage is often where we can intervene most effectively,” says Dr. Sozmen. “In addition to personalized care, we also hold shared medical appointments virtually to guide in nutrition, sleep, physical activity, stress management, cognitive rehabilitation and strategies for lasting behavior change for healthy aging. Even if symptoms have progressed into dementia, we have a multi-disciplinary team to provide continuous care. For instance, we regularly assess whether patients are good candidates for the newer anti-Amyloid monoclonal antibody infusion therapies indicated for MCI due to Alzheimer’s disease or mild Alzheimer’s disease. We also assess if certain clinical trials may be a good fit.  We work closely with patient and caregiver support groups and have a team to assist in future planning of care.”

Not all memory problems are dementia

One of the primary goals of the Center for Healthy Aging is to work with patients to differentiate conditions that cause progressive cognitive decline from other causes of cognitive changes. Each new patient visit includes a detailed review of the patient’s medical history, current medications, lifestyle factors and any mood symptoms that have not been addressed. 

“Because cognition can be affected by so many factors, we take a whole-person approach to patient evaluations,” says Dr. Sozmen.

In older adults, side effects from medications — particularly those for sleep and anxiety — are common culprits. Untreated sleep apnea is another condition that causes or worsens cognitive symptoms. If the underlying cause is addressed, cognitive function often improves.

They may not see the signs, but their loved ones often do

People who are still working often take note of their cognitive changes more easily, as their performance may be affected. Tasks may take longer, or mistakes may become more common. This insight may also diminish, however, as cognitive impairment progresses into dementia.

“Decreased ability to recognize one’s own cognitive impairment is a common feature of dementia,” says Dr. Sozmen. “A patient may be unaware of their impaired cognitive state, which can be distressing for loved ones who see the changes.”

This disconnect can lead to anxiety and cause agitation in patients.

“When caregivers understand that diminished insight is part of cognitive decline itself, it can help families navigate dementia with compassion. It is best to redirect, distract and support rather than argue if your loved one is suffering from dementia,” says Dr. Sozmen. 

She adds that caregivers are often the first to recognize when someone’s cognitive changes are out of their baseline. It may be time to seek help if you notice that your loved one begins: 

• Repeating stories or questions during the same conversation.
• Getting lost in familiar places.
• Having difficulty managing medications, finances or household tasks that they normally could.
• Experiencing behavioral or personality changes.

If these signs are present, it is important to ask your primary care doctor for a referral to the Center for Healthy Aging.

“We always encourage early evaluation,” Dr. Sozmen says. “If we see someone during that early MCI stage or mild dementia, there’s more we can do, including newer infusions for Alzheimer’s disease to slow down the progression. Our support for patients continues during later stages as well. We provide symptom management by medication, provide education for caregivers and resources for community support.”

Primary care providers offer initial screenings and referrals

For most people, the first step to getting answers about their cognitive health is to visit a primary care provider. Basic screenings and lab work can help rule out conditions such as thyroid issues or identify vitamin deficiencies that may be contributing to cognitive problems.

“If concerns remain after these screenings, the patient’s primary care doctor can provide a referral to the Center for Healthy Aging for further evaluation,” Dr. Sozmen says.

She adds that while there’s growing public interest in serum biomarker testing for Alzheimer’s disease, these tools are appropriate in the context of an accurate MCI diagnosis with a neurologist for useful interpretation of the biomarker result. In addition to biomarker tests, patients are also understandably eager to have genetic testing done for the APOE gene if there is a family history of dementia.  

“APOE ε4 isoform is the strongest late-onset Alzheimer’s susceptibility gene we know,” says Dr. Sozmen. “Susceptibility is not destiny to develop Alzheimer’s, however. Most patients carrying one copy of the APOE ε4 isoform do not develop dementia. At the Center for Healthy Aging, we focus on mitigating risk by improving factors shown to be important in preventing dementia in older age,” she says.

Family members are key to memory evaluations 

Dr. Sozmen encourages patients to bring a family member or friend with them to their initial appointment, to provide an added perspective on their loved one's history.

The evaluation covers the patient’s:

• Medical and mental health history
• Daily functioning and safety concerns, such as balance problems, changes in mobility
• Sleep habits and quality
• Mood and stressors
• Review of medications
• Lifestyle habits

A neuropsychological test may be recommended to evaluate cognitive functions in more detail following an initial screen in the clinic or by a primary care doctor. Brain imaging may also be ordered to detect signs of vascular damage or other structural abnormalities that could impact cognition. It also provides a baseline for later evaluations and treatment.

“Imaging is rarely diagnostic by itself, but it is an essential component,” Dr. Sozmen says. “It gives us clues as to what the underlying neurological problem may be.” 

Treatment is available, but most dementia cannot be reversed

Dr. Sozmen and the providers at the Center for Healthy Aging collaborate closely with specialists in movement disorders, epilepsy, stroke, neurology, psychiatry, physical therapy, speech therapy and geriatrics to provide interdisciplinary care to patients diagnosed with cognitive impairment or dementia.

If the clinical picture suggests Alzheimer’s disease, we have a newer class of infusion therapies that can delay the disease progression. For patients with more advanced presentation, symptom management by behavioral strategies and medications becomes our priority. There are no medications that can reverse neurological conditions causing dementia yet. “Our hope is to have additional novel therapies to address the growing need in our aging population,” says Dr. Sozmen. 

Caregivers need support, too

Caregivers play a crucial role in the wellbeing of dementia patients, and their health matters just as much.

“Caregivers are at high risk for burnout,” Dr. Sozmen says. “It can be hard to ask for help, but don’t try to do it alone. We are here to connect you to available resources and support you along the way.”

The Center for Healthy Aging’s social work team helps families find support groups, counseling, legal advice and respite care options. Our social worker can also help families understand their options, especially as the disease progresses. This includes education on long-term care, safety concerns, palliative care or memory care placement options.

Making the case for assisted can take time

At some point, cognitive decline may render it unsafe for someone to live independently. Warning signs that memory care might be necessary include: 

• Wandering or getting lost
• Combativeness
• Difficulty with hygiene
• Incontinence
• Safety concerns, such as leaving appliances on
• Not recognizing familiar people or places
• Inability to keep track of their medications

Memory care facilities may be limited in capacity. Finding a new long term care option can be an emotional and complex journey for patients and caregivers.

Dr. Sozmen says that one thing families can do to help themselves through the process is to complete legal documents (such as a power of attorney and an advance directive) early, when the patient is still able to participate.

Learn more and find a physician or advanced practice clinician (APC) 

Recognizing cognitive changes in someone you love can be distressing, but it also opens the door to understanding, support and care. Whether the cause is cognitive impairment or something else entirely, early evaluation offers the best chance to preserve independence, dignity and connection. 

If you or someone you love is experiencing symptoms of cognitive impairment or dementia, help is available. Dr. Sozmen and her colleagues at the Providence Swedish Center for Healthy Aging can help. Whether you require an in-person visit or want to consult a doctor virtually, you have options. 

You can also contact Providence Swedish Primary Care to schedule an appointment with a primary care physician. And with Providence Swedish ExpressCare Virtual you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections, and more. You can use our provider directory to find a specialist or primary care physician near you.

Information for patients and visitors

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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