In crisis or thinking about suicide? Call or text 988 (US), any time. In danger right now, call 911.

Home / Dementia / Diagnosis & treatment

Dementia guide

Diagnosis & treatment

How an evaluation works, what the new blood tests can and can't do, and today's treatments.

Getting evaluated

Start with a primary care doctor. Bring someone who knows you well, your list of medicines, and your Memory Changes Notebook. An evaluation usually includes:

  1. Your story — what changed, when, and how it affects daily life, often with input from family.
  2. Short memory and thinking tests.
  3. A physical and neurological exam, plus a review of medicines.
  4. Blood tests to rule out treatable causes, such as B12 or thyroid problems.
  5. Brain imaging (CT or MRI) to look for strokes, tumors or fluid.
  6. Sometimes, specialist tests — detailed thinking tests, a PET scan, a spinal fluid test, or one of the new blood tests.

Medicare covers a check of memory and thinking in the yearly wellness visit, and a separate, longer cognitive assessment and care-planning visit if a problem is suspected.

The new blood tests

Since 2025 the FDA has cleared several blood tests that measure Alzheimer's-related proteins (such as p-tau217 or p-tau181). As of September 2026, four have been cleared, and some are designed for use in primary care. They are meant for people who already have symptoms, and results must be interpreted together with a full medical evaluation — a blood test alone does not diagnose Alzheimer's. They are not recommended as a screening test for people without symptoms.

Treatments

Medicines that ease symptoms

Strong evidence · modest benefit

Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and memantine can help memory and thinking for a time in some people. They don't stop the disease. Side effects may include nausea, poor appetite and vivid dreams.

Anti-amyloid treatments: Leqembi (lecanemab) and Kisunla (donanemab)

Strong evidence · slows early Alzheimer's modestly

For people with mild cognitive impairment or mild dementia due to Alzheimer's, with amyloid confirmed by a scan or test. In the main trials they slowed decline by roughly a quarter to a third over 18 months — a real but modest effect. They require regular infusions (Leqembi is also available as an at-home injection) and repeated MRI scans, because they can cause brain swelling or small bleeds (called ARIA). The risk is higher in people who carry two copies of the APOE ε4 gene. Ask whether they fit you, and weigh the benefits and burdens together.

Staying active — body, mind and social life

Moderate evidence

Exercise, social activity and structured group programs like cognitive stimulation therapy can support thinking, mood and quality of life.

Treating everything else

Strong evidence

Controlling blood pressure and diabetes, treating depression, hearing and vision loss, sleep apnea and pain, and stopping medicines that cloud thinking can make a noticeable difference.

About antipsychotic medicines: they carry an FDA boxed warning about increased risk of death in older adults with dementia. They are sometimes necessary for severe distress, but non-drug approaches should come first, and people with Lewy body dementia can react severely. Ask about risks, the lowest dose, and a plan to review or stop.

Questions to ask the doctor

  • What type of dementia do you think this is, and how sure are you?
  • Could any of my medicines or other conditions be contributing?
  • What should we expect in the next year?
  • Are any medicines, including the new ones, right for me?
  • Should I see a specialist or a memory clinic?
  • Is it safe for me to keep driving?
  • What local support and clinical trials are available?

Clinical trials: search Alzheimers.gov.

Sources

Reviewed September 2026. Education only — not medical, legal or financial advice.