When a parent's memory is changing, the right first step is a structured evaluation, not reassurance and not a guess. I start by ruling out treatable causes that can mimic or worsen memory loss, such as thyroid disease, low vitamin B12, medication side effects, sleep apnea, depression, and hearing loss. Then I measure cognition objectively, review prior records, and add blood biomarkers and brain MRI where indicated. Family members are part of the history, and visits take place by secure video.
Not every memory change is Alzheimer's disease. Several common conditions affect memory and attention, and they often improve with treatment. Looking for them is the first job of any memory evaluation, before a pattern is called a neurodegenerative disease.
An underactive thyroid and low vitamin B12 can both slow thinking and memory. Each is checked with a routine blood test.
Some sleep aids, bladder medications, antihistamines, and other common drugs can impair memory, especially in combination. A full medication review is part of every evaluation.
Untreated obstructive sleep apnea fragments sleep and is linked to poorer attention and memory. A partner's or family member's observations often raise the question first.
Mood disorders can look like memory loss, and early cognitive decline can also lead to withdrawal. Separating the two takes a careful history.
A parent who cannot hear a conversation clearly cannot remember it well. Untreated hearing loss can make memory problems look worse than they are.
Heavy alcohol use, blood count and metabolic problems, and other medical conditions are reviewed alongside the cognitive picture.
The evaluation is built on the same components as my brain health assessment. It begins with a two-hour intake covering your parent's health history, family history, medications, and a typical day mapped hour by hour: sleep, activity, nutrition, and routine. I administer neurocognitive testing personally, starting with the MoCA and extending to a broader battery, so the result is an objective measurement rather than an impression. Depending on the findings, testing can include blood biomarkers for Alzheimer's pathology such as p-tau217, a vascular risk workup, APOE genetic testing with counseling, a sleep evaluation, and volumetric brain MRI where indicated. Blood draws and imaging are arranged at facilities near your parent and reviewed together by video. The evaluation ends with a clear explanation of what is and is not going on, and a prioritized plan.
If you are still deciding whether what you are seeing is normal aging, the article on early signs of Alzheimer's vs. normal aging explains the difference and when an evaluation is worth doing.
Memory changes are often noticed first by family. Your observations are part of the clinical history: when the changes started, whether they are getting worse, and how they affect daily life, such as managing bills, medications, driving, or appointments. With your parent's agreement, you can join the video visit, whether you are in the same room or connecting from another city. Before the visit, it helps to write down specific examples, list every medication and supplement, and gather any prior test results.
Telehealth care is governed by where the patient is physically located at the time of each visit, not by a home address. Your parent needs to be in one of the 16 states where I hold an active medical license when the appointment takes place: California, Florida, Idaho, Indiana, Kentucky, Maryland, Massachusetts, Montana, Nevada, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Virginia, and Wisconsin. The rule applies to your parent's location, so family members can join from wherever they are. The telehealth page has details for each state. In-person appointments are available on a select basis.
If your parent has already been evaluated, the earlier work is not wasted. Prior cognitive test scores, lab results, and MRI reports and images are gathered and reviewed before the evaluation, so it builds on what has been done instead of repeating it. If your parent already has a diagnosis, or a result you do not understand, such as a positive p-tau217 blood test or white matter hyperintensities on an MRI report, a careful second look can clarify what it means and what is still worth acting on.
The practice is direct-pay. If your parent has Medicare or other insurance, ask about coverage on your complimentary discovery call, before any commitment. The call is also the place to describe what you are noticing and decide together whether an evaluation is the right next step.
A complimentary discovery call is the first step: describe what you are noticing, ask your questions, and decide together whether an evaluation is the right next step.
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