Here's another story about how American healthcare is letting people down. A study in the Journal of General Internal Medicine found that 65% to 81% of older people who have dementia — and their caregivers — don't know they have the condition.

How can that happen?

The researchers say it's likely their doctors never told them they have dementia. Or if they did, that the patient or caregiver didn't understand what was being said.

This is a clear-cut example of how important it is to be an engaged patient.

As new medications for dementia are being developed, you don't want to miss the opportunity to slow (or maybe someday even reverse) the problem.

Right now, cholinesterase inhibitors can be used to help support memory and judgment. Memantine (Namenda) is prescribed to regulate the activity of glutamate, which is involved in learning and memory. And two intravenous infusions — lecanemab (Leqembi) and donanemab (Kisunla) — are approved for people with mild Alzheimer's.

Then there's the treatment that offers the greatest benefit and fewest risks in randomized studies, but isn't covered by insurance: therapeutic plasma exchange. Google "AMBAR" to see the studies.

Don't hesitate to tell your doctors about any cognition problems you experience, or to ask point-blank if they think you may have cognition issues.

And if your doctor says something you don't fully understand, get it clarified. Don't settle for anything less.

Other smart moves include staying engaged in stimulating activities such as the brain game Double Decision, and getting as much aerobic and strength-training exercise as your doctor recommends.