When Forgetfulness Is Really About Mood

The hidden link between mental health and brain health.

By Dr. Jeff Shenfeld, MD, The Brain Health Center

In our community, caring for our parents as they age is not a burden we tolerate — it is a value we hold close. We move them nearby. We bring them to our Shabbos tables. We watch over their health with the same devotion they once gave us. So when a parent begins to repeat questions, misplace familiar things, or seems a step slower than they once were, families act. They want answers. What too often surprises them is how hard those answers are to come by.

Mild cognitive impairment (MCI) and early dementia are among the most under-diagnosed conditions in medicine today — not because the means to detect them don’t exist, but because those means haven’t yet reached most points of care.

When an older patient mentions memory lapses to their primary care physician, the workup is often limited: a brief conversation, reassurance that “some forgetfulness is normal with age,” and perhaps a standard brain MRI. But a routine MRI is designed to rule out tumors, bleeds, and strokes. It says very little about the subtle changes that drive cognitive decline. A scan can read as “unremarkable” while a neurodegenerative process is already well underway.

Meanwhile, the science has moved dramatically. There are now far more sensitive ways to evaluate cognition and to detect the earliest signatures of disease — often years before symptoms become disabling. A proper evaluation today can draw on methods well beyond a routine scan: careful, standardized assessment of memory and thinking; modern laboratory testing capable of detecting biological signs of disease long before they would otherwise be visible; and advanced analysis of brain structure and function that adds dimension a basic image cannot provide. Used together, these approaches can distinguish ordinary aging from something that warrants action — and can often identify the cause, not just confirm the symptom. They can also tell a worried family the most reassuring thing of all: that what they are seeing is, in fact, normal aging and nothing more.

The trouble is that most patients never receive an evaluation at this level. These tools are newer than the everyday workflows of busy general practice, and so they are frequently skipped — not out of negligence, but simply because the field has changed faster than the system around it.

The cost of this gap is real, because early diagnosis is no longer an academic exercise — it changes what we can do for a patient. For families who do seek out a thorough evaluation, another barrier appears: at major academic institutions, the wait for an appointment is often measured in months. And even when these centers offer sophisticated diagnostics, they frequently stop there — handing a family a diagnosis but not the treatment that should follow, leaving them to navigate the next steps alone.

This matters enormously, because disease-modifying therapies are now approved and available — and they work best when started early, in the mild stage. A parent who waits months for an appointment, and then more time for an answer, may move past the window where these treatments offer the most benefit.

Early diagnosis also opens the door to addressing reversible contributors — vascular risk, sleep disorders, medication effects — that can meaningfully change the road ahead.

Diagnosis is only half the picture; what follows matters just as much. At The Brain Health Center, patients who are candidates can receive the newest disease-modifying treatments on-site, with the careful monitoring they require — not referred elsewhere and lost to follow-up. We also recognize that cognitive decline rarely travels alone. Depression, anxiety, and disrupted sleep frequently accompany it. For these conditions we offer non-traditional, drug-free options as well.

None of this reflects a failure of devoted physicians. Primary care doctors carry enormous patient loads, and this field has changed extraordinarily fast. The tools are simply newer than the workflows. Closing the gap requires a place dedicated to cognitive health, equipped with the full range of modern methods, and able to see patients quickly — typically within one to two weeks, not months — and to provide treatment in the same place a patient was diagnosed.

If you’ve noticed changes in a parent’s memory or thinking, you don’t have to wait, and you don’t have to settle for reassurance alone. Honoring our parents includes seeking the best care while it can still make the greatest difference. A thorough, modern evaluation — and real treatment options — is available now, close to home, and without the long delays so many families have come to expect.

TheBrainHealthCenter.com accepts Medicare, Medicare Advantage plans and Fidelis NY.

To schedule a comprehensive cognitive evaluation, please contact either office: Englewood, New Jersey, 401 S. Van Brunt Street, Suite 302, Englewood, NJ 07631, at (201) 947-4777; Suffern, New York,  2 Executive Boulevard, Suite 103, Suffern, NY 10901, at (845) 889-5088.