It’s not as if I don’t know what’s in store at the far end of Alzheimer’s. For nearly thirty years, most of the Alzheimer’s patients I saw in my practice were already in moderate to advanced stages of the disease when their doctors referred them to me.

One patient – I’ll call her M. – enters my thoughts now as vividly as the moment she arrived for her appointment. M. was in her eighties, a little unsteady on her feet, so I walked her into my office. Her daughter, with whom she lived, followed closely behind. The daughter had brought her mother to see me because M. had been getting increasingly forgetful, repeating herself all the time. She had been living by herself until recently, but her daughter realized that M. couldn’t safely live independently anymore. Her primary care doctor had already ordered a brain MRI scan that showed brain atrophy but no strokes or tumors.