How can I deal with undiagnosed, unrecognized, likely dementia ?

Definitely a difficult situation. I don't envy you.

Can you bring someone in under a different pretext to observe your roommate? Maybe:
"I'm thinking of getting new carpet and someone's coming to see the space."
"A friend's son/daughter wants to talk with me about this-or-that."

Would that work?

@sunnygardens Welcome to Mayo Clinic Connect! And you have asked a very good question do we’ll see what other members say. On this site there are no medical professionals so we can’t really figure out medical things and give diagnoses or prescribe medicines. Everyone shares their own experiences and what worked and what didn’t. I think you will really like it!

@scottrl , thanks. I will ask his friends if they’ve noticed a change, at some point. I’d be surprised if a stranger (unless they were a professional in mental health) would notice.
But perhaps I could use this pretext to have him interact with one of the social workers who do this sort of thing.

Welcome to the "in limbo" called the disease of ambiguity, and the challenge with any early diagnosis of memory loss, delayed thinking, they are in denial and don't believe it. I'm not sure what you can do, I only know what I did in my given situation. For me, I noticed things.... my husband denied anything was wrong. So I reached out to our primary care, sent a note on the portal about what I was noticing and booked an appointment under the pretext of a 6 month visit. When we got there, I didn't mention alzheimers or dementia, but did mention that since we were care partners for one another, I was concerned since we had both been in a house with mold, which I had read could cause confusion and memory loss. She gave him a basic test in the office and then suggested when he couldn't remember the words and/or sequencing things that she wanted him to see a neurologist. You may not have access to your roommates' doctor, but all you can do is tee up the problem, to either the doctor if you have access and/or your roommate in an ongoing loving, non-defensive way. Tap into Dr. Natali, Careblazers on UTUBE, and see if there are any videos on how to have the dialogue with a loved one, about what you are seeing, so you can make them more aware, and it resonates, and they reach out for help - so key for early on treatment. I am still reluctant to say anything to my husband's friends as once they hear "something could be wrong, they "talk" through the community and walk away." I saw it happen with my neighbor; sad but true. I did talk to one of my husband's sons, after my husband started lequembe infusions for early memory loss. Believe me, I practiced a lot in how I talked to my husband early on, which led him finally to the doctors, and then what I said to the doctor once we got there to try to make the conversation positive, loving, and handled in the most dignified way. I just notice the words I pick with my husband regarding his memory loss are key - even to this day with him on the infusions - so it doesn't put him on the defense, and it looks more like we're working on "aging" together. Hope this helps in some small way. Best, Karla

Such a tough situation to be in, especially for one with the screen name of sunnygardens.
From what you've posted, it appears to be your intention to find help for your friend, support/caregivers, etc., then go the rest of the way on your own. If that is the case I'd suggest you review your living arrangements that you have with your friend. You may need to seek legal advice. Are you living in a state, or country, that recognizes common law marriage, or do you have any written agreement, such as a cohabitation agreement. How about a lease agreement, have you both signed such a document, or any other financial documents.

Not to make you situation seem any worse, but it may profit you to be prepared if you do decide to leave, after securing the basic support for your friend. Because if it does turn out that he is suffering from. or is in the early stages of Alzheimer's disease, or some other dementia - that would be possibly a very long journey, and believe me, it is not fun. Please, prior to making any decision - seek legal advice. Stay safe and be strong, you will get to see that sunny garden again.

Greetings and welcome.
After reading your description it sounds like your friend may have Anosognosia, meaning, no self awareness. My husband has this and has no idea he has dementia, so any steps I take are challenging since he sees no point (e.g., taking away his debit/credit cards after financial abuse, having him surrender his license after he nearly killed us and another driver).
It's tough and challenging, more so for you since you are not married (making any legal intervention tricky).
I just had to yell and scream and cry to get my husband to listen to me, and he still didn't know what all the fuss was about.
It's hard to know how to support you, but we will all try. You may want to join a dementia support group, and perhaps take some caregiver classes if you are going to continue living with your friend.
All the best. 🌺

@kjc48 thanks so much, Karla! You’re the first person to ever tell me they recognized early signs. Because of having no confirmation except a few remarks from my own counselors, it’s too easy to wonder if I’m losing my mind! You’re the first person to say there IS a” limbo “ stage. I do have access to his Nurse Practitioner and she’s very good. I’m sure she would find a way to recommend testing. I’m considering bringing it up with her soon, as she’s seen my friend recently. I do try to spite him respect and give affirmation (he’s actually very immature and has needed phenomenal amounts of affirmation since I met him), but I feel more and more like a caregiver. He’s commented that sometimes I treat him like he’s an old man. Afterwards while I had to tell him that I have concerns about his health. After the conversation, within hours it’s as if it never took place. I’m SURE he blames my concerns and comments on my MDD, even though I’ve been doing well. So if course then I wonder if he’s right! So I talk to a counselor and she tells me I’m doing well. She tells me that some of his changes are not normal adding. So the circle of uncertainty goes round and round.
I will reread your comment often and take your suggestions about how to see a doctor with him. (Although when I asked this time if he wanted me to come along, as a listener, he said no. 🤷🏻‍♀️

I am going through the same with my ex spouse who’s 80 years old. Took her to her primary physician and gave him a note explaining her symptoms of memory loss; he then referred her to a neurologist, and it took me a couple of months getting her to go, when she finally did, I gave the same note to the neurologist who did a very superficial exam, mostly testing for neurological symptoms such es gait, coordination, etc… but didn’t even do a MMS ( Mini Mental Status) test. Instead he ordered a EEG (electroencephalogram) which I found out is a test primarily to rule out epilepsy; she has never had a seizure nor tremors, so I am back to square one, waiting in tenterhooks, as you wrote. Hopefully you will have a better outcome if you can entice him to go see a doctor. I suggest you take him to his primary for a consultation unrelated to his memory issues, and take a note describing his symptoms and casually give it to the doctor prior to or as he is entereing the office. Good luck!!

@fred1 a thanks for the reminder, Fred. I’ve cared for Alzheimer and demented clients, and seen the terrible destruction, and toll on family and friendships.
We aren’t in a common law relationship but we do own the property together. It’s a somewhat remote rural location so getting any sort of help isn’t easy. I was able to have a realtor friend give us an evaluation.
I certainly don’t want to abandon him but I certainly do not want to be his live-in caregiver. I have two aging parents to assist when the time comes, who live in the other side of the country. I’ve already chosen to leave a job and home to relocate out there when my dad (now passed on) and my stepdad were both very sick.
Perhaps it would be a good idea to ask about selling if he is demented. As far as I know, his Power of Attorney would make his decisions but I don’t want to be living with him by that point.
I won’t forget your reminder though.
And thanks for the cheery remark. It was the name of my own little gardening company years ago. 🌻

@judimahoney thanks for sharing, Judi! I’ve done some yelling and crying too, trying to break through the obtuseness. I’ll do a bit more research about Anosognosia.
I suppose it’s possible my friend might go in in this state for years. Except I don’t really trust that thought because I’ve seen changes happen so quickly already.