Very early in my career, long before the advent of donepezil (Aricept) and other medications for treating the cognitive symptoms of Alzheimer’s, a middle-aged woman came to see me for a second opinion.She had mild but troubling symptoms of cognitive impairment and had seen another neurologist who made a diagnosis of Alzheimer’s disease. She had already had all the appropriate testing to exclude treatable mimics of dementia, and those tests were normal. Cognitive testing had shown some very subtle impairment of verbal memory and visual–spatial processing.I told her that she might indeed have very early Alzheimer’s disease, but it was impossible for me to make that diagnosis with certainty. There were no tests to make a firm diagnosis of Alzheimer’s at that time, other than a post-mortem examination of brain tissue. A few months later, I learned that she had taken her own life.