The threshold, stated plainly
Book an appointment if any of these is true:
- It is getting worse rather than holding roughly steady, over a span of months.
- It has started to affect driving, money or managing day to day.
- Somebody else has mentioned it — unprompted, more than once.
- You are forgetting whole events, not details within them.
- You have been lost somewhere familiar.
- You are avoiding things you used to do because they have become difficult to follow.
One of those is enough. You do not need a set.
The reason people delay
Two reasons, usually. Fear of the answer, and a sense that nothing can be done anyway. The second is the more damaging, and it is wrong often enough to be worth challenging directly: a meaningful share of memory complaints presented in primary care have a cause that can be treated.
What gets ruled out first
A first appointment is mostly a search for explanations other than dementia.
- Thyroid function. A blood test. An underactive thyroid is common and produces exactly these symptoms.
- Vitamin B12. Also a blood test. Deficiency is more common with age, with vegetarian diets, and with long-term use of some stomach medications.
- Depression. In older adults it frequently presents as memory and concentration complaints rather than visible sadness.
- Sleep apnoea. If anyone has described you snoring heavily or stopping breathing at night, say so at the appointment.
- Medications. Sedatives, some antihistamines, some bladder and blood-pressure drugs. Bring the actual list, or the boxes.
- Hearing. Untreated hearing loss produces what looks exactly like forgetfulness, because information never clearly received cannot be recalled.
- Alcohol intake, answered honestly.
How to prepare, in ten minutes
Write down, before you go: when you first noticed, specific examples with rough dates, whether it is steady or worsening, your full medication list including anything bought over the counter, and whether anyone in the family had similar problems. Bring somebody who sees you regularly if you can — their account is genuinely part of the assessment, not a courtesy.
What the testing is like
A structured cognitive test, usually on paper, usually ten to thirty minutes. It asks you to recall words, draw a clock, name things, follow instructions. It is not something you can fail in any meaningful sense, and it is not a diagnosis — it is a measurement, to be repeated later and compared.
Blood work, a medication review, and sometimes a referral to a memory clinic. A brain scan is not automatic.
If you are reading this for somebody else
Raising it is uncomfortable and waiting is worse. The approach that tends to work is concrete and unaccusing: name one specific thing you noticed, say you would like to rule out the simple causes, and offer to go with them. “Let's get your thyroid and B12 checked” is a far easier sentence to accept than “I think something is wrong with your memory.”