Your father was just diagnosed with Alzheimer’s. The first 30 days.

Alzheimer’s is the diagnosis families see coming and are still unprepared for. Partly because it arrives slowly, so there is no clean “before”. Partly because the appointment where it is named often ends with a prescription and a pamphlet and very little about what to actually do. This is the what-to-do.

Alzheimer’s is a clinical diagnosis, made by excluding other causes and observing a pattern. Before accepting it as final, make sure the following have been checked, because several treatable conditions mimic dementia:

• Blood work for thyroid function, vitamin B12, and metabolic problems.
• A medication review. Anticholinergic drugs, sedatives, some bladder and allergy medications and combinations of several drugs can cause confusion that lifts when they are stopped.
• Depression screening. Late-life depression can look exactly like dementia.
• Hearing and vision. Uncorrected hearing loss produces confusion and withdrawal that is easily mistaken for cognitive decline.
• Brain imaging, usually an MRI or CT, to exclude strokes, tumors, bleeding or normal-pressure hydrocephalus.

If any of these were skipped, ask for them. If the diagnosis was made by a primary care doctor, a referral to a neurologist, geriatrician or memory clinic is reasonable and Medicare covers it. Newer tests, including blood biomarkers and amyloid PET scans, are increasingly available and matter if newer treatments are being considered.

This is the step families delay and later wish they had not. While your father can still understand and sign documents, he should complete a durable power of attorney for finances, a healthcare power of attorney, an advance directive or living will, and a HIPAA authorization naming the family members his doctors may speak with. Once capacity is questioned, these become expensive court proceedings instead of an afternoon with a notary.

Medicare covers a dedicated cognitive assessment and care planning visit (CPT 99483). It is a longer appointment in which the doctor evaluates cognition, function, safety, behavior, caregiver needs and medications, and produces a written care plan. Many practices do not offer it unless asked. Ask.

Separately, since July 2024 Medicare has run the GUIDE model, which pays participating practices to provide dementia care navigation, a 24/7 support line, caregiver education and, for eligible patients, respite care. Not every practice participates. Ask your father’s doctor, or ask us to check which practices in your area do.

• Driving. Early dementia does not automatically mean no driving, but it means an evaluation. Ask the doctor to raise it, because a physician’s recommendation is easier to accept than a child’s. Occupational therapists run formal driving assessments in most areas.
• The stove and the smoke alarm. Automatic shut-off devices exist for stoves. Check the alarms.
• Medications. Move to a locked or family-managed system before double doses happen, not after.
• Money. Scams target people with early cognitive change. Set up account alerts, and consider a trusted-contact designation with his bank.
• Wandering. Not usually an early problem, but a door alarm and an ID bracelet are cheap and easier to introduce early.

Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and memantine can modestly help symptoms for some people. They do not stop the disease. Newer anti-amyloid infusions (lecanemab, donanemab) can slow decline in early Alzheimer’s for carefully selected patients and are covered by Medicare with registry participation; they involve regular infusions, MRI monitoring and real risks, and are a decision to make with a specialist. Do not let anyone rush this either way.

Some people want to know everything. Some want the word never spoken. Follow his lead, but do not conspire with denial to the point where planning stops. Language matters: “memory problems” and “keeping you independent as long as possible” open doors that “dementia” and “you can’t” close. What most people fear is losing control. Every decision you can leave with him, leave with him.

Decide in the first month who holds the calendar, who has the medical authorizations, and how the others will be told what is happening. Call the Alzheimer’s Association helpline (800-272-3900, 24/7); it is staffed by people who will talk to you at 2am and know your local resources. Find out what your Area Agency on Aging offers. And read our guide on caregiver burnout before you need it, because you will.