Getting a Diagnosis When Cognitive Problems Are a Concern

Patients and family members may have to push hard for answers

Jeanne Dorin McDowell

Reviewed by

Orly Avitzur, M.D.

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Published May 27, 2026

Female doctor sharing test results on a tablet with a patient at a clinic

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Key takeaways

Primary care doctors may dismiss cognitive complaints as stress or normal aging.
Brief visits and limited dementia training for primary care physicians make a careful assessment hard to get.
Being persistent, switching doctors or seeking a specialist can help patients and their families get answers.

Joseph Cohen was a kind and gentle man, an intellectual who cherished reading scholarly works in his home library and teaching his students at St. John’s College in Annapolis, Maryland. So at around 80, when Cohen began to fly into volatile rages, his wife of 54 years, Sandy Cohen, knew something was wrong.

“It was dramatic ... He would hyperventilate to the point where his blood pressure would go through the roof,” says Sandy, 85, a retired lawyer. “I was afraid he would stroke out. It was like walking on eggshells.”

When Cohen went to his primary care doctor for guidance, the response was perplexing. “I told him he needed to tell his doctor about these eruptions,” Sandy says. “When he came home, he reported the doctor recommended marriage counseling.”

It wasn’t until about two years later that Cohen finally got an accurate diagnosis and explanation: Alzheimer’s disease. But it came only after he switched to a different primary care doctor, who immediately referred him to a neurologist who was a dementia specialist at Johns Hopkins Hospital.

Looking back at the previous few years, Sandy now realizes that her husband, who died in 2019 at the age of 85, had earlier begun to show some subtle symptoms of dementia that went largely overlooked.

Once, while driving in Washington, D.C., he looked at her “helplessly and confused” when she asked him to read the map for directions. And their children noticed that when he took them out for dinner, he tipped an inappropriately small amount, which was out of character for their father.

Yet Joe’s longtime primary care doctor had never given him a cognitive test or taken his complaints seriously. His explanation of marital woes was nothing short of ridiculous. “When a wife of 50-plus years says something is wrong, you’re at least on notice to investigate,” Sandy says.

Unfortunately, the Cohens’ story is not unusual. For most people, their primary care physician is the first stop when experiencing memory or cognitive issues. But while some 7.4 million Americans age 65 and older now live with Alzheimer’s disease, the most common form of dementia, primary care doctors often lack the skills, time or confidence to accurately diagnose or even assess the symptoms their patients bring to them.

The results can be devastating — from emotional stress and confusion to delayed diagnoses, sometimes for years as the dementia worsens. Since the only medications to slow Alzheimer’s progression are effective when administered in the earliest stages of the disease, patients lose their one chance.

“I hear about these frustrations from patients directly,” says Dr. Suzanne Schindler, a Washington University clinical neurologist and neuroscientist specializing in Alzheimer’s. “They say they have been telling their primary care doctors for two or three years they’re having a problem, and the doctor tells them they are just getting older and it’s normal aging. By the time they decide it’s a major problem and get an appointment with me, the disease has progressed outside the point of treatment.”

Doctors unprepared to diagnose

A 2020 report by the Alzheimer’s Association, “On the Front Lines: Primary Care Physicians and Alzheimer’s Care in America,” found that only 18 percent of primary care physicians surveyed felt “very prepared” to provide dementia care in practice.

Nearly 2 out of 5 said they are “never” or only “sometimes” comfortable personally making an Alzheimer’s or dementia diagnosis. They also lacked the skills: 22 percent of respondents had no residency training in dementia diagnosis and care, and of the 78 percent who did have training, 65 percent said it was “very little.” More recent studies suggest very little has changed.

While these stats speak to the gravity of the situation and the unpreparedness among primary care doctors themselves, in reality, people who are grappling with the possibility of dementia are often left to suffer alone with the terrifying prospect that they are losing themselves or a loved one.

“The person I was supposed to trust with my health care just made me feel hopeless,” says Kerry Dennis, 61, a retired accountant in New Hampshire who was diagnosed with Alzheimer’s three years ago. “I’m not a big crier, but during my darkest times, I was sobbing and terrified. I didn’t know what to do. I had a job, but I was struggling and didn’t have a doctor who took me seriously.”

A successful team leader of several hundred employees, Dennis started noticing changes in her ability to manage tasks and follow through on her agenda. “It got to a point where even writing an email was difficult. At one point, I was working on a major project and couldn’t remember any details.”

When she went to her doctor, he told her, “You’re fine.” He attributed her cognitive issues to work pressure, stress, menopause and normal aging. Because Dennis had a high cognitive reserve — which is the brain’s ability to adapt and function normally despite illness or injury — her Alzheimer’s was masked; She didn’t fit the profile.

“Sometimes, if you don’t fit the Alzheimer’s mold, it appears that you don’t have Alzheimer’s,” says Dennis. “Whether or not it’s intended to be, it’s dismissive and feels a bit like gaslighting. Tell them they’re OK because you don’t want to look any deeper.”

In all fairness, a large part of the problem is time. In today’s health landscape, given insurance realities, the typical primary care appointment doesn’t last much more than 10 to 15 minutes. There is no time for even a basic cognitive assessment, says Dr. Eric Tangalos, a geriatrician and professor emeritus in the Department of Medicine at the Mayo Clinic. His work centers on the need for early detection and diagnosis of mild cognitive impairment (MCI).

“I believe that most [primary care doctors] could do a good job if they had enough time, the desire and a system in place,” Tangalos says. But “quick appointment times … are not long enough for [older] people to even get settled in their doctor’s office, much less address memory concerns.”

Misdiagnosed with attention deficit

When Scott Berkheiser started noticing short-term memory problems in 2020, he went to his primary care doctor, thinking of his mother’s Alzheimer’s. “It petrified me,” says Berkheiser, 58, who worked in the aerospace defense industry and now lives in Venice, Florida. “I remember thinking, I hope I never get this.”

But Berkheiser’s first primary care doctor sent him for an MRI and came back with the diagnosis of Attention Deficit Disorder (ADD). He prescribed the medication Adderall.

“I knew I didn’t have ADD, but I tried taking it anyway,” says Berkheiser, whose first symptom was a loss of short-term memory. “It gave me energy. I felt like Superman.”

But when his memory didn’t improve, he went through a battery of cognitive tests, including a spinal tap, which revealed he had a biomarker for Alzheimer’s. Months later, he got the diagnosis. The good news was that it was early enough to be prescribed the anti-amyloid drug Leqembi, which he says keeps him fairly stable.

“When someone complains, it is the doctor’s duty to investigate; to pursue symptoms a patient expresses,” Tangalos says. “One of the best ways to do this is at an annual wellness visit, which requires a mental status examination, covered by Medicare. It should be an objective quantitative examination. Even on these simple tests, if a patient scores well, it may not imply they’re normal since they have a concern.”

All too often, physicians bring their own experiences and biases into the examination room. If a doctor is dealing with their own aging parents, they may be resistant to acknowledging cognitive deficits in a patient and prefer to relegate them to normal aging. “If they are in denial, they may be less likely to see an older patient as being impaired,” says New York clinical psychologist Michele Berdy. “But these biases can be very diminishing. Doctors can fall into making attribution based on chronological age, and it’s more the person in front of them that they need to evaluate.”

Early in 2026, Sandy Cohen testified in front of the Maryland State Legislature in support of the creation of the Dementia Services and Brain Health Program in the Department of Health to improve care coordination, caregiver support and early detection of Alzheimer’s. The bill passed and will take effect in October 2026. It includes a clinical tool kit for health care providers and aims to improve early Alzheimer’s diagnosis and caregiver support.

Knowledge can provide relief

For those who are experiencing memory or cognitive problems, a diagnosis of Alzheimer’s or dementia provides an answer and antidote to the terror and frustration they have been experiencing. While it signals the beginning of what is inevitably a long decline in cognitive skills and an eventual loss of self, knowing can also be a relief.

“As dreadful as that diagnosis was, it was instantly curative because at last my husband understood what was going on, and it restored him,” Sandy Cohen says. “In the three-plus years after hearing his diagnosis, he never had volatility, anger, self-pity or complaints.

“He was braver than I knew and cognizant that he was losing his mind. His way of dealing with his disease was a choice of spirit. Although we had difficulty getting the diagnosis, it restored him to the man he had been, and enabled caregiving years to be really sweet with a special intimacy in the marriage. It’s important to have that diagnosis.”

How to Get Your Doctor’s Attention

Your primary care doctor is the first line of defense if you or a loved one is experiencing memory or cognitive symptoms. Here are some suggestions for being proactive if your doctor is unresponsive or dismissive:

Don’t waste time. If you have symptoms that are consistent with Alzheimer’s, you want to move quickly. That means getting a referral from your primary care doctor for a neuropsychologist or neurologist who specializes in memory and cognition. Getting an appointment to see one may take 18 months. According to Duke Han, a professor of psychology at the University of Southern California. He notes that people don’t need a referral for a neuropsychological examination, a two- to five-hour cognitive assessment that primary care doctors can’t perform but licensed neuropsychologists can.
Be prepared. Bring a list of the symptoms and examples of the behaviors that are leading you to believe you or a loved one is having a problem.
Push back. If your doctor tells you forgetfulness or uncharacteristic behaviors are part of ‘normal aging,’ challenge it. “For many of us, acknowledging a serious problem can be frightening,” says Tangalos. “When someone complains, it is the doctor’s duty to investigate. It’s the responsibility of the primary care provider to pursue symptoms a patient expresses. But even on these simple tests, if a patient scores well, it may not imply they’re normal since they have a concern.”
Know that not all symptoms are dementia. While memory and cognitive symptoms are alarming, other treatable conditions, such as depression or a UTI, plus certain medications, can mimic dementia symptoms.
Find another doctor. If your needs aren’t being addressed properly, cut your losses.

_{The key takeaways were created with the assistance of generative AI. An AARP editor reviewed and refined the content for accuracy and clarity.}

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Jeanne Dorin McDowell is a Los Angeles-based journalist who often writes about health and aging for national publications and digital sites.

Dr. Orly Avitzur is a practicing neurologist in Tarrytown, N.Y., and former president of the American Academy of Neurology. She is the former medical director at Consumer Reports and former editor in chief of Brain & Life magazine. She is working on a medical memoir entitled A Very Good Brain.