When “Forgetful” Isn’t Just Aging: A Caregiver’s Guide to Early Alzheimer’s Detection, and New Treatments

If you’re the adult child who “handles the appointments,” you may know the uneasy moment: your parent repeats the same story three times, gets lost on a familiar route, or becomes unusually suspicious or irritable. You’re left wondering what’s normal aging, what’s stress, and what might be the start of dementia.

Here’s the new reality—and it’s important: early detection matters more than ever, because there are now disease-modifying medications for early symptomatic Alzheimer’s that can slow decline for some people. That doesn’t make this easy. But it does make it actionable.

Early signs: look for patterns, not one-offs

A single forgotten name is common. What deserves attention is a pattern that interferes with daily life. Examples include:

• Repeating questions, forgetting recent events, or relying heavily on notes

• Trouble managing finances, medications, cooking, or driving

• Word-finding problems that are new and persistent

• Changes in judgment (scams, unsafe decisions)

• Personality or behavior shifts: agitation, apathy, paranoia, social withdrawal

Your advantage as the caregiver is context. You can notice changes that a clinician might not see in a 15-minute visit.  If you are already using an in-home care company, ask their caregiver for input.  

How to start the conversation with a doctor (without triggering defensiveness)

Many parents fear losing independence, so “I think you have dementia” can backfire. Try a practical, shared-goal approach:

• “I’ve noticed a few changes, and I want to make sure nothing medical is driving them—like thyroid issues, B12 deficiency, sleep problems, or medication side effects.”

• “Can we do a memory and thinking check at your next appointment, just like blood pressure?”

Then show up prepared. Bring:

• A short timeline of symptoms (what changed, when, and examples)

• A full medication/supplement list

• Specific safety concerns (driving, falls, missed meds)

Primary care can initiate evaluation, and referrals are common when symptoms are complex or behavioral changes are prominent. The Alzheimer’s Association notes referral may be appropriate for atypical presentations or behavioral/psychiatric symptoms, among other reasons.

What testing typically looks like in 2026

A thorough evaluation usually layers several steps:

1. History + functional assessment
   What’s changed in real life: bills, shopping, navigation, cooking, hygiene.

2. Cognitive screening tests
   Short tools in clinic, and sometimes more detailed neuropsychological testing.

3. Rule-out labs + brain imaging
   Labs can identify reversible contributors; imaging (MRI/CT) looks for strokes, tumors, normal pressure hydrocephalus, and other structural causes. The Alzheimer’s Association describes a comprehensive evaluation as including cognitive testing plus MRI/CT and lab tests, with specialized tests added when clinically warranted.

4. Biomarker testing when Alzheimer’s is suspected
   This is where things have changed quickly. In May 2025, the FDA cleared the first blood test to aid diagnosis: a plasma ratio (pTau217/β-amyloid 1-42) intended for symptomatic adults 55+ in a specialized care setting, interpreted alongside clinical information.
   Depending on the situation, specialists may still use amyloid PET imaging or CSF (spinal fluid) tests, especially when decisions about treatment hinge on high certainty.

New Alzheimer’s medications: what’s available and who might qualify

There are still many supportive treatments (for memory, mood, sleep, and daily function). But the headline shift is anti-amyloid monoclonal antibodies—IV drugs for early symptomatic Alzheimer’s, not late-stage disease.

Two key FDA-approved anti-amyloid options

• Leqembi (lecanemab) received traditional FDA approval (July 2023) for Alzheimer’s disease, with treatment initiated in patients with mild cognitive impairment (MCI) or mild dementia and confirmed amyloid pathology.

• Kisunla (donanemab) was approved in July 2024 for adults with early symptomatic Alzheimer’s (MCI or mild dementia) with confirmed amyloid pathology. 

What caregivers should understand before “asking for the drug”

These therapies require a real partnership with a specialist (neurology, geriatrics, or a memory clinic) because eligibility and monitoring are non-negotiable:

• Amyloid confirmation is required (via appropriate testing). 

• MRI monitoring is part of treatment, because these drugs can cause ARIA (amyloid-related imaging abnormalities)—brain swelling or bleeding that is often asymptomatic but can be serious. 

• For Kisunla, the FDA label states that ApoE ε4 genetic testing should be performed prior to starting to inform ARIA risk, and prescribers should discuss the implications of genetic testing results.

From a caregiver standpoint, your role is to help your parent ask the right questions and to ensure follow-through on monitoring and symptom reporting.

Practical questions to bring to the specialist

• “Do the symptoms fit Alzheimer’s, or could this be another dementia (vascular, Lewy body, medication-related)?”

• “What testing do you recommend to confirm amyloid pathology—blood test, PET, or CSF—and why?” 

• “If eligible for Leqembi or Kisunla, what is the MRI schedule, and what symptoms should prompt urgent evaluation?”

• “How will we measure benefit—what changes should we realistically expect over 6–18 months?”

Coverage note (because someone will ask)

CMS covers FDA-approved anti-amyloid monoclonal antibodies for qualifying patients under Coverage with Evidence Development, generally requiring participation in an approved registry or study. 

Behavior challenges: the part nobody prepares you for

Memory loss is hard. Behavior change can be harder—because it can feel personal.

A few caregiver principles that work surprisingly well:

• Don’t argue with the illness. Correcting details often escalates agitation. Aim for calm and safety, not accuracy.

• Look for the “why” underneath the behavior. Pain, constipation, dehydration, infection, medication side effects, overstimulation, and poor sleep can all worsen confusion.

• Use environmental fixes. Labels on drawers, consistent routines, simpler choices (“tea or water?”), and fewer transitions reduce friction.

• Redirect, then reassure. “You’re safe. I’m here. Let’s have some lunch,” works better than debate.

• Treat safety like a system. Medication management, driving boundaries, door alarms if wandering is a risk—make the environment do the heavy lifting.

If aggression, paranoia, or severe sleep disruption appear, escalate to the clinician promptly. These symptoms can signal a medical trigger—or a different dementia type—where management differs.

A caregiver’s bottom line for the new year

If you do nothing else, do this: move from vague worry to documented observations and a concrete medical plan. Early detection is no longer just about naming the problem—it can open doors to clearer diagnosis, better support, and (for some families) treatment options that weren’t available a few years ago. Very similar to in-home care, starting early can positively impact their quality of life.  

Sources:  

FDA

Medicare

Alzheimers Association