A clearer diagnosis for memory and cognitive change.
Neurologist-led evaluation of memory loss, mild cognitive impairment, and dementia — combining careful history, cognitive assessment, imaging, and biomarkers when they can answer a specific clinical question.
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Start with the syndrome, not with a test.
Tests are most useful when they are selected after the clinical problem is defined. The goal is to understand what has changed, how it affects daily life, and which disease processes may be contributing.
- 01Understand
- Your concerns and timeline, input from a knowledgeable care partner when available, medications, sleep, mood, sensory function, and changes in work or everyday activities.
- 02Characterize
- Neurological examination and standardized cognitive testing define whether the pattern is primarily memory, language, visuospatial, attention, executive, behavioral, or mixed.
- 03Clarify
- MRI, laboratory studies, neuropsychology, and disease biomarkers are chosen when the result can materially improve diagnostic confidence, treatment selection, or safety.
Memory change has more than one possible cause.
Older adults often have more than one contributor at the same time. A useful diagnosis identifies the dominant process, relevant co-pathology, and treatable factors — rather than forcing every presentation into a single label.
Referred with mild cognitive impairment?
MCI means objective cognitive change that does not yet substantially interfere with independent daily life. It is a stage, not a final answer — some MCI remains stable or improves, particularly when reversible contributors are found and treated, and some progresses. The purpose of this evaluation is to determine which of the processes below is responsible, and what can be done about it.
- Alzheimer’s disease
- A progressive disorder associated with amyloid and tau pathology. Biomarker confirmation matters most when the diagnosis is uncertain or disease-modifying treatment is being considered.
- Lewy body disease
- Often involves fluctuating attention, visual hallucinations, dream-enactment sleep behavior, movement changes, and autonomic symptoms.
- Frontotemporal disorders
- May begin with changes in behavior, personality, judgment, speech, or language rather than prominent memory loss.
- Vascular cognitive impairment
- Cognitive change related to stroke or small-vessel disease — often occurring together with a neurodegenerative process.
- LATE & mixed pathology
- An important consideration in older adults with slowly progressive memory decline. No routine clinical test directly confirms TDP-43 pathology, so diagnosis remains probabilistic and often reflects coexisting processes.
- Reversible & other causes
- Sleep apnea, thyroid disease, vitamin deficiency, medication effects, depression, alcohol, and hearing loss can worsen cognition — and normal-pressure hydrocephalus, seizures, autoimmune disease, and other neurological conditions are considered when the picture points there.
A plan built around the diagnosis and the person.
The most appropriate treatment may involve symptom management, disease-specific therapy, modification of contributors, caregiver support, or a combination.
- Symptomatic & contributor-focused care
- Medication review, treatment of sleep and mood disorders, vascular risk management, hearing and vision care, exercise, safety planning, and cognitive or rehabilitative support — these matter across diagnoses.
- Disease-modifying therapy, when appropriate
- Lecanemab (Leqembi) and donanemab (Kisunla) are options for selected patients with mild cognitive impairment or mild dementia due to Alzheimer’s disease and confirmed amyloid pathology. Their average benefit is modest, and ARIA and hemorrhage risks require MRI-based screening and monitoring.
- Longitudinal & family-centered care
- We help patients and families understand prognosis, monitor change, coordinate specialists, address driving and safety when needed, and plan for the next stage — rather than treating one visit as the finish line.