Claire Schooley tried for several years to get doctors to diagnose what was going on with her husband, David, now 57.
He would ask her the same questions again and again, never remembering the answers. He would grow confused. Two years ago, on a trip to San Jose, Calif., with their kids, now ages 6 and 12, he drove 60 miles in the wrong direction from their hotel, insisting the whole time he knew where he was going.
Maybe his memory loss was the result of depression over two job losses, most recently in 2009, doctors told the Sacramento, Calif., couple. Maybe it was stress.
"I'd see him sitting in front of the TV at home," said Claire Schooley, 45, a network engineer. "He'd say he was taking a break, but he'd forgotten what he was doing or what room he was in.
"He never was like this before. I knew in my heart there was something wrong."
Two days before Thanksgiving 2012 -- almost two years after he sought help from his primary care physician -- David Schooley finally was diagnosed with Alzheimer's disease. For people with the degenerative brain disease, delays in diagnosis can exact a steep cost.
"Honestly, it's a routine thing that families in general try to get the person seen by a knowledgeable physician for more than a year, even a couple of years," said neurologist Dr. Charles DeCarli, director of the UC Davis Alzheimer's Disease Center.
Without timely diagnosis, people with Alzheimer's lose valuable months when medications can most effectively slow their memory loss. The delay in diagnosis robs families of the chance to enjoy their time together and make financial and legal plans for the future.
Alzheimer's is now the nation's sixth-leading cause of death, with 5.4 million people affected. Even so, physicians can be slow to identify the disease in the elderly, despite the fact that old age is the greatest risk factor. And doctors can be even more reluctant to diagnose people below the age of 65 who suffer from the rare, early-onset form of the illness.
The U.S. Centers for Disease Control and Prevention estimates that only 4 percent of Americans with the disease are younger than 65. But with the aging of the baby boomer generation -- and the coming Alzheimer's epidemic, projected at 14 million cases by 2050 -- the hard numbers behind that younger-onset percentage continue to rise.
Typically, experts say, families end up frustrated in seeking help, because primary care physicians aren't looking for dementia in people still in the prime of life.
"Many providers find it hard to believe that someone so young could have dementia or Alzheimer's," said Elizabeth Edgerly, the Alzheimer's Association of Northern California's chief program officer.
For many patients, diagnosis is delayed because a comprehensive assessment of dementia requires a detailed clinical history and neurological exam, said DeCarli. Most primary care physicians, who can see up to 40 patients a day in their practices, don't have the time.
"It's a challenge for primary care physicians," he said. "I tend to see them adapting a number of strategies. When someone has memory complaints, they get a brain scan and get the patient on memory-enhancing drugs.
"The other strategy is to minimize the complaint until the situation gets more severe."
Complicating the picture is the fact that dementia has other causes beyond Alzheimer's: Pain medications, vitamin B12 deficiency, thyroid conditions, chemotherapy and some infections also can cause memory loss. So can diabetes and vascular problems.
The average person with dementia comes into contact with the health care system four times more frequently than patients without dementia, said DeCarli.
Beyond the health consequences and frustration, families of people with early onset Alzheimer's also deal with the fact that delayed diagnosis forestalls the process of applying for Social Security disability payments.
After long delays finally gave way to a referral to a neurologist, Claire Schooley hoped for a diagnosis for her husband. By that time, she suspected he might have Alzheimer's.
She insisted on a follow-up test, a positron emission tomography scan, which showed decreased brain cell activity.
Her husband of 13 years -- the former telecom technician who once could fix anything, the man who made the dean's list when he retrained in HVAC school a half-dozen years ago -- definitely had Alzheimer's. The news came as both a shock and a relief.
"David doesn't talk much anymore," said Schooley. "He's forgotten about things he can't do. I'm worried about my kids. My son asks, 'Is he going to forget who I am?' Chances are, he will.
"But we're trying to make memories for our kids, so later that's the part they'll remember.'"