I agree that patients over age 65 should be screened for cognitive impairment upon initial assessment and repeatedly thereafter. My Grandmother had Alzheimer’s (she was actually one of the reasons that I became a nurse), and I remember the first sign of cognitive change that she exhibited was the frequent misplacing of her car keys. Some of her health care providers didn’t think anything of it, and thought maybe it was just some short term memory loss related to the natural aging process, but it progressed rapidly and at the end of her life she was completely nonverbal. It was a very challenging time for us, as she was the matriarch of the family and was a kind, generous, lovely mother, grandmother, and friend. One of the many memories I hold near and dear to me, was a time I was visiting with her in her living facility and I was sitting on her bed singing Amazing Grace (that was one of her favorite songs and even as she forgot most of the people around her, she remembered every word to that song), and a nurse asked me if I thought that my Nana knew who I was and so I turned to my Nana (who at this point was almost completely nonverbal) and I said “Nana, what’s my name?” and my Nana, without hesitation, said “Emily.” Needless to say, I was a basket of emotions, the nurses were crying. It was a very emotional and special moment for me, as she hadn’t addressed me by name in several years at that point. It always made me wonder if Alzheimer’s patients know more and are just trapped in their bodies. It is such a debilitating and horrific disease.