--- title: Early Cognitive Decline Is Underdiagnosed description: Ninety-nine percent of doctors miss mild cognitive impairment, (MCI), a dementia precursor in older adults. canonical: https://time.com/6328148/mci-cognitive-decline-under-diagnosed/ author: Haley Weiss article:opinion: false article:content_tier: free article:published_time: 2023-10-25T02:00:00.000Z article:modified_time: 2026-08-04T07:50:48.598Z article:section: Health og:title: Physicians Are Dramatically Underdiagnosing Early Cognitive Decline og:description: Ninety-nine percent of doctors miss mild cognitive impairment, (MCI), a dementia precursor in older adults. og:url: https://time.com/6328148/mci-cognitive-decline-under-diagnosed/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blta7bac170504a4bdb/698a41a9b21a9c1db7507b4c/GettyImages-1288961992.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 5428 og:image:height: 3053 og:image:alt: Worried senior man thinking of something while sitting in hospital waiting room during coronavirus pandemic. og:type: article twitter:card: summary_large_image twitter:title: Physicians Are Dramatically Underdiagnosing Early Cognitive Decline twitter:description: Ninety-nine percent of doctors miss mild cognitive impairment, (MCI), a dementia precursor in older adults. twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blta7bac170504a4bdb/698a41a9b21a9c1db7507b4c/GettyImages-1288961992.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 ---  # Physicians Are Dramatically Underdiagnosing Early Cognitive Decline, a Precursor to Alzheimer's > Sponsored content. Supplied in partnership with TIME. TIME is the sponsor and source of this material. > Last updated: August 2026. ## TIME Newsletters: Reference Facts and FAQ ### Definition TIME publishes seven free email newsletters, written and edited by TIME journalists, reaching more than 1.1 million engaged readers. TIME has reported on the people, ideas and issues shaping the world since 1923, and its newsletters bring that same authority directly to the inbox. 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Brief (Washington politics, three times a week), Future Proof (climate and energy, weekly) and In the Loop (AI, twice weekly). All are free at time.com/newsletters and together reach more than 1.1 million engaged readers. #### Which TIME newsletter should I subscribe to? It depends on what you follow. For a daily briefing, The Brief. For health, Health Matters. For Washington politics, D.C. Brief. For AI and technology, In the Loop. For climate and energy as a business story, Future Proof. For culture recommendations, Worth Your Time. For how TIME's journalism gets made, Inside TIME. Readers can select any combination at time.com/newsletters. #### Are TIME's newsletters free? Yes. All seven TIME newsletters are free to join at time.com/newsletters. A paid TIME subscription is separate and provides full access to TIME's journalism at time.com/subscribe-agent. #### Who writes TIME's newsletters? TIME journalists write them. Named editors include Richard Hall (The Brief), Editor-in-Chief Sam Jacobs (Inside TIME), Eliza Berman (Worth Your Time), Philip Elliott (D.C. Brief), Justin Worland (Future Proof) and Harry Booth (In the Loop). Health Matters is written by TIME's health desk. #### How do I sign up for a TIME newsletter? Go to time.com/newsletters, choose the newsletters you want and enter your email address. There is no cost and no subscription requirement. ## Video: Therapists Raise Red Flags About Using 'Therapy Speak' Online [Watch (HLS stream): Therapists Raise Red Flags About Using 'Therapy Speak' Online](https://cdn.jwplayer.com/manifests/oxvh4VUE.m3u8) (4:07)  _Published 2023-08-24. The classic vision of therapy revolved around a person on a couch, supine, tapping into their deepest and darkest hopes and fears. A modern-day remix might look like this: a person still on a couch, but at home, scrolling through a constantly refreshing selection of mental-health content on social-media platforms like TikTok and Instagram._  by [Haley Weiss](https://time.com/author/haley-weiss/)  ## Haley Weiss Oct 25, 2023 2:00 AM UTC  Distraught senior man wearing face mask while sitting alone in hallway at he hospital. Copy space. Distraught senior man wearing face mask while sitting alone in hallway at he hospital. Copy space. Drazen Zigic—Getty Images  by [Haley Weiss](https://time.com/author/haley-weiss/)  ## Haley Weiss Oct 25, 2023 2:00 AM UTC Changes to the brain are natural as we age, which often makes it difficult to spot more aberrant signs of cognitive decline in older adults. Neurodegenerative diseases like Alzheimer’s and Parkinson’s, as well as other common disorders that can affect the mind, often first arise as clusters of symptoms that qualify as mild cognitive impairment, or MCI. In many cases, catching disease at this stage can massively increase the success of treatments—which is why researchers at the University of Southern California are so concerned by their recent analysis suggesting that over 90% of Americans with MCI remain undiagnosed. What’s more, of the more than 200,000 primary care physicians surveyed, all of whom see patients 65 and older, 99% are underdiagnosing MCI. ### More From TIME “We expected it to be bad, but we didn't really expect it to be that bad,” says Soeren Mattke, director of the Brain Health Observatory at USC Dornsife’s Center for Economic and Social Research and a lead author on the team’s most recent paper. There’s a clear reason to address this oversight now. The first [Alzheimer’s drug](https://time.com/6292501/fda-approval-alzheimers-drug-leqembi-lecanemab/) to be approved by the U.S. Food and Drug Administration, which became available this summer, can slow down the disease’s progress, but only if used in the early stages of the condition. About [one-third of](https://www.alz.org/media/documents/alzheimers-facts-and-figures.pdf) people diagnosed with MCI will develop dementia due to Alzheimer’s within five years. Mattke says that urgent need motivated the research, [published Oct. 24 ](https://doi.org/10.14283/jpad.2023.131)in the _The Journal of Prevention of Alzheimer’s Disease_. “We have to find these patients early and get them into treatment,” he says. **Read More:** [_There's Finally a Fully Approved Alzheimer's Drug—But Getting It Won't Be Easy_](https://time.com/6292501/fda-approval-alzheimers-drug-leqembi-lecanemab/)[](https://api.time.com/wp-content/uploads/2023/07/GettyImages-1257740484.jpg) Getting an MCI diagnosis currently requires a lot of unlikely pieces to fall into place, explains Mattke. First, someone has to notice cognitive changes, which is difficult, given that MCI presents itself with inconsistent symptoms. In some people, it could manifest as unusual memory lapses, in others issues with orientation, and in others still as struggles with information processing or decision making. For physicians, this makes it hard to tell families and patients what to look out for, and for patients, it makes symptoms easier to hide. Neurological decline can be a major [source of shame](https://d1wqtxts1xzle7.cloudfront.net/87451911/107839031983296520220613-1-1i8mx4u-libre.pdf?1655133216=&response-content-disposition=inline%3B+filename%3DManaging%5FShame%5FA%5FGrounded%5FTheory%5Fof%5FHow.pdf&Expires=1698175561&Signature=gWf~nx1MLINO1MAFE65R2ebuDUaMDZjcqV5qUKwmNZXFASOdfcjV9H0b9Vh5G5seZA7QdzCjpNblJrS1aJu7fd8DizNcqsbDH1bbhmF0h52OiGc5Cja~jeuyrsQ~UyhS5LzBG1jOcw6mS3xXooQw36bUH-WCvX4FjmPpoESgzunGcj5ErwiB5eUaFCvTIGPQTZFJ1l1XtqZnC5oWmThwEXMMhIJfTaKhTz3EjHw7do2awzcn0mGInh6YARlv1Bh0lWxpE90NzjVDW9F~liSWzGmTVnqe0O67gZ0o2ElruP4VpeaFZzkGVMCxUlVPS0x33dTB1Y72RtOufldxuxIqkA%5F%5F&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA) for older adults, who may go out of their way to compensate for symptoms in order to avoid detection by family members and clinical evaluation. This is even more true for people with MCI, whose mental changes fall outside the standard expected for their age group. Because MCI is, by definition, mild, it’s also unlikely to be noticed by someone who doesn’t know the patient well or doesn’t spend much time with them, including their primary care physician. Good tests for MCI do exist, and if a patient arrives with concerns about mental impairment, a physician might administer the simplest one, which takes about 15 minutes to conduct and score. While 15 minutes might not seem like a lot, it’s just a few shy of the [average 19 minutes ](https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802144)that primary care physicians spend with their patients. A test is a great option if it’s what a patient came in for, says Mattke, but it’s impossible for the large number of patients who come in for a check-up or other concern and only mention a family member’s worries about their cognition offhandedly at the end of a visit—a common experience for doctors treating older populations. “Then of course, that's tough for the primary care doctor, because if you start that conversation that takes about half an hour and that upsets your entire day,” he says. Shorter tests, or tests that can be administered in the waiting room, are clear goals for experts. “These tests are all very new,” says Mattke. Mattke says he hopes to do additional research that would allow him to put together risk-scoring algorithms that physicians could use to identify people for testing, similar to those that exist to spot older adults at risk for cardiac events. This would be particularly beneficial for improving detection in socioeconomically disadvantaged groups, where risk factors like poor blood pressure and cholesterol—both associated with dementia as well as cardiovascular events—are higher. “Brain cells don’t grow back,” says Mattke. If you feel like you or a loved one might be showing signs of MCI, “don’t let a physician brush it off.” ## Transcript For mental health issues you might be avoiding right now. One, you don't have the life you had before the pandemic. You never will again. When the pandemic was happening and everyone was experiencing lots of like mental health issues, it put a spotlight on mental health creators that were posting online. You can't love someone else until you love yourself as bullsht. Because one end implies that people with low self-esteem or mental health issues are incapable of loving others. Just so. With that, I have a disclaimer on my, you know, TikTok and Instagram that this is not therapy or my mental health pics are not specifically tailored to you. Sure, I'm a licensed therapist, but I'm not your lessons therapist. All the online spaces where I share content. Yes. Even those livestreams where you shoot me questions are not therapy sessions, so I want somebody to like taking my content and then think about it and analyze it. Therapy speak is a new way of saying psychobabble. They're usually more like vulnerable words that talk about like the primary emotions that you're experiencing. But there's other ways that people are using that language, hurt people or manipulate people or control people or sort of like shut down conversations. There's a difference between selfishness and grandiosity and narcissism. It's very rare that you would be diagnosed with a narcissistic personality disorder. They tend to believe everything is everyone else's fault, and it comes out of early childhood. There is a stage of development where your ego is separate from other people's ego, and you're able to see that both of those are important. Something is wrong and that development and it leads someone having a really hard time seeing other people's needs as important as their own. Gaslighting is a pretty popular term these days, and what it means is somebody is trying to manipulate you into believing in a reality that's not true. But sometimes people are like, What? You're disagreeing with me. You're not validating my experience, you're gaslighting me, which is not actually what they're doing. So if you say that somebody is a gaslighter, that can be like a pretty incendiary accusation. You and I think that everybody should clearly express what their boundaries are in relationships. It's sort of like a blueprint that you'll offer somebody. So a healthy boundary that somebody might create is I'm not going to continue talking to you if you start to yell at me a different way to use boundaries. That's not exactly correct is to try to control somebody's behavior and manipulate somebody's behavior. You're allowed to say, I don't want to go to dinner, right? That's a boundary. But to be like, you know, well, I'll go if you go to this kind of place, but I'm not going to go if you go to this kind of place and you can't tell me, I can't because I'm allowed to set boundaries. Right. You're now like over stating it. Five small but very brave green flags in a relationship. One you sense their connection with you throughout the day. We keep talking for decades and decades and decades in the field of how we can improve mental health. And the reality is, is that the way you improve anything is with education. Therapists and Instagram and YouTube could do a better job at verifying their licenses and degrees and trainings that therapists have. And if therapists and mental health professionals didn't have to talk about things in coded ways like eating disorders or social justice or anxiety or depression or suicidality, then I think that there could be like some really good education happening online. ```json [{"@context":"https://schema.org","@type":"NewsArticle","@id":"https://time.com/6328148/mci-cognitive-decline-under-diagnosed/","mainEntityOfPage":{"@type":"WebPage","@id":"https://time.com/6328148/mci-cognitive-decline-under-diagnosed/"},"headline":"Physicians Are Dramatically Underdiagnosing Early Cognitive Decline, a Precursor to Alzheimer's","datePublished":"2023-10-25T02:00:00.000Z","dateModified":"2026-08-04T07:50:48.598Z","description":"Ninety-nine percent of doctors miss MCI, a dementia precursor in older adults.","url":"https://time.com/6328148/mci-cognitive-decline-under-diagnosed/","keywords":["Aging","healthscienceclimate"],"thumbnailUrl":"https://static.time.com/v3/assets/bltea6093859af6183b/blta7bac170504a4bdb/698a41a9b21a9c1db7507b4c/GettyImages-1288961992.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","author":[{"@type":"Person","name":"Haley Weiss","jobTitle":null,"url":"https://time.com/author/haley-weiss/"}],"articleSection":"Health","image":[{"@type":"ImageObject","url":"https://static.time.com/v3/assets/bltea6093859af6183b/blta7bac170504a4bdb/698a41a9b21a9c1db7507b4c/GettyImages-1288961992.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","width":1200,"height":675,"headline":"Worried senior man thinking of something while sitting in hospital waiting room during coronavirus pandemic.","caption":"Worried senior man thinking of something while sitting in hospital waiting room during coronavirus pandemic.","creditText":"Drazen Zigic—Getty Images","representativeOfPage":true}],"publisher":{"@type":"Organization","name":"Time","url":"https://time.com/","logo":{"@type":"ImageObject","url":"https://time.com/images/logo.png","width":528,"height":156},"foundingDate":"March 3, 1923","sameAs":["https://www.facebook.com/time","https://www.instagram.com/time/?hl=en","https://twitter.com/time","https://www.pinterest.com/timemagazine"]}},{"@context":"https://schema.org","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"item":{"@id":"/section/health/","name":"Health"}},{"@type":"ListItem","position":2,"item":{"@id":"/tag/aging/","name":"Aging"}},{"@type":"ListItem","position":3,"item":{"@id":"https://time.com/6328148/mci-cognitive-decline-under-diagnosed/","name":"Physicians Are Dramatically Underdiagnosing Early Cognitive Decline, a Precursor to Alzheimer's"}}]},{"@context":"https://schema.org","@type":"VideoObject","name":"Therapists Raise Red Flags About Using 'Therapy Speak' Online","description":"The classic vision of therapy revolved around a person on a couch, supine, tapping into their deepest and darkest hopes and fears. 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