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

@sunnygardens
That's it! You got it babe💥. The mind is infinite enough to embrace ALL of creation. Even for a few seconds. That's what God , as partners, wants us to see.
Look I made a hat.

Dear Sunnygardens,

I feel for you. You face a very challenging set of interconnected issues. Together, they require abandoning a medium to long range life plan. And the resolution involves making a close friend and yourself very unhappy in the short term. It is natural to feel frozen in this kind of situation; it seems like there must be some other way forward that is easier or less painful than what appears to be required. But as I used to tell my teams at work: "Hope" is not a strategy. There is no cavalry, in our world of dementia. No miracle drug. There are, however, great resources and various paths forward that maximize fulfillment and joy within the changing capabilities of the afflicted person.

I read the exchanges you had above with Karla. She is a fount of great insights. I will second and emphasize a few things she mentioned.
1. You are way down the road. Way past "Am I overreacting?". Believe what you are experiencing. This will give you the strength of conviction needed to start taking action on behalf of each of you asap.
2. Love is your superpower. Take all the affection that led you two to chose to live together, and then add to that whatever love you feel innately for the defenseless or for the ill or those who are afraid. A colleague on a Board of Directors who was collaborating on preparing some tough performance feedback for a senior leader, once said, "It will be fine. You can say anything to anyone, if you say it with Love". That statement changed my life. When people sense that you are acting with loving intent, their defenses fall and positive communication and action flourish.

I would add something that I learned in business. Big important changes do not happen by making incremental changes from the current state: You need to have a clear vision of the end point and then work backwards. If not, you will miss issues and opportunities and you will take twice as long. What that means in this case is this. You may not know exactly what you want to offer him in terms of support, what living arrangement you want a year from now, who will provide his care., what it will cost, etc. That is ok. You do not need to know all the answers now. But make one scenario about what things are like a year and a half from now, with a bunch of assumptions. Use it as the 'straw man" that helps you identify all the things you need to figure out and decide, and in what timeframe, and in what sequence. As you learn more or think through the scenario, things will become clearer and you can change those assumptions. The important thing is to start exerting energy over the whole set of decisions and actions.

Having read your posts, I am sure that you are very well equipped to do so! I wish you all the best. Stay in touch. This is a great group of people!
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P.S. I am usually an advocate of NOT forcing people to acknowledge the fact that they have dementia. In a committed relationship in which one person is prepared to be there for the duration, there is often no good reason to do so. But in your case, you clearly need to get him attention and help. With my husband I used the idea of "just enough"-acknowledgement. I said nothing about it for years, then gently suggested that we go to a center of excellence so that we did not miss out on treatments that might be helpful. That was all he needed to get aligned with the new emphasis that we put on all things related to health (nutrition, exercise, meds, etc.) This allowed us to live largely without acknowledging the disease, but with him being open and trusting me to manage his health and adaptation

I have a similar situation....my husband shows all the behaviors that his mother did and she ended up in memory care. He is trying to "prove" he can remember things. I have afib which is getting worse because of the stress of living with all of his issues.

Many conditions can simulate dementia and might be correctable. An extensive general medical evaluation should be undertaken, looking for correctable conditions. Lab tests are usually targeted towards symptoms and signs. An underactive thyroid could certainly mimick dementia and is correctable, as are many other metabolic abnormalities, drugs in addition to neurodegenerative conditions.

Just had another thought. You mentioned that sometimes he will just stop and stare right in the middle of things. This year I had to learn about seizures. It turns out that there is a kind of seizure that is not uncommon with dementia. They are called "absence seizures" Here's a segment of the Google AI summary:
"A brief, blanking-out episode is medically known as an absence seizure (previously called a petit mal seizure). It involves a sudden, brief loss of consciousness where a person stares blankly into space, typically lasting only 5 to 15 seconds.
- Key Signs & Symptoms:
--Vacant Stare: The person abruptly stops talking, moving, or responding to others, appearing to daydream.
--Subtle Movements: The episode may include fluttering eyelids, slight lip-smacking, or minor chewing motions.
--No Memory: The seizure ends as suddenly as it began, and the person usually resumes their activity with no memory of the blank period."

If this fits your friend's behavior it may be an "in" for you to get him to a neurologist. In other words, you would not be talking about what he considers vague arguable symptoms, but somethign as clear and scary sounding as a seizure. Seizures of all kinds take a toll on the brain every time they happen. This can clearly accelerate the normal decline.

@memoriestomoments I’ve known someone who had what was then called petit mal seizures. It certainly makes sense that these would accelerate dementia. Thx for the thought!

@wctdoc1943 the sufferer still has to recognize and admit there’s something not quite right. This is the problem for me right now. My friend was supposed to book an appointment and bloodwork. He denied ever having the conversation with his NP.

@diane07710 could you move out? Get respite care? Spend time away?

@memoriestomoments thanks for this clear advice. I’ll certainly stay in this forum for the foreseeable future!
I’ve tried a few different ways, with many months in between, to suggest consulting an expert. My friend is absolutely refusing to acknowledge ANYTHING. If I remind him too often about what he just said or recently did, he becomes irritated.

Oh yes. Reminding does boomerang, doesn't it? Your comment reminded me of a tool. You are probably very aware of the attached Compassionate Communication guidelines, but I find them worth sharing often and broadly.