Dr. John and Grace Showalter’s Blueprint for Faster Dementia Diagnosis

Dr. John Showalter and registered nurse Grace Showalter run Mindful Integrative Medicine, a dementia-focused primary care clinic in rural central Pennsylvania. 

In this episode, the husband-and-wife team explains how they diagnose Alzheimer’s in a single visit, why so many of their self-referred patients are women navigating perimenopause, and why insurance billing, not clinical capability, remains their biggest obstacle.

In This Episode:

Your Host: Emily Kaplan

Our Guests:

Dr. John Showalter, primary care physician, and Grace Showalter, RN, co-founders of a dementia-specialized primary care clinic in central Pennsylvania 

This Episode Explores:

• How can a primary care clinic diagnose Alzheimer’s in a single visit?
• Why are most of the Showalters’ self-referred patients women?
• What separates perimenopausal brain fog from early Alzheimer’s symptoms?
• Why does insurance billing still block faster dementia diagnosis?
• What financial protections can families put in place for a loved one with cognitive decline?

How Does The Showalter’s Clinic Diagnose Alzheimer’s So Quickly?

John missed the warning signs in his own grandmother. That experience is what drove the Showalters to build a clinic that gets families answers in days, not months. 

Their first visit runs two to two-and-a-half hours and includes digital cognitive testing, a full chart review, and same-day results. Their fastest referral to a neurologist for disease-modifying therapy took 72 hours, compared to a typical wait time of nine to twelve months.

The clinic organizes care around three pillars: prevention, protection, and support — treating Alzheimer’s as a family disease rather than an individual one. In some cases, they can confirm a diagnosis, order blood-based biomarkers, and match the results to cognitive testing in a single visit.

Why Perimenopause Brings So Many Women to Their Clinic [Mindful Integrative Medicine]

Nearly all of the Showalters’ self-referred patients are women, many in their 40s and 50s, and Grace says perimenopausal brain fog can look almost identical to early Alzheimer’s symptoms. That overlap is exactly why testing matters: It can rule out Alzheimer’s as easily as it can catch it early.

One patient came in ready to leave her nursing career over processing-speed problems. Testing, however, showed it wasn’t Alzheimer’s, and after cognitive rehab and better sleep, she chose to remain in her position and even got promoted. 

Grace Showalter also encourages baseline cognitive testing at any age, the same logic behind concussion baseline testing in youth sports: You can’t know what’s changed if you never measured where someone started.

Why Insurance Billing Still Blocks Faster Dementia Care

Pennsylvania requires insurers to cover blood-based Alzheimer’s biomarker tests. However, the billing codes for neuropsychological testing are still built around an outdated, time-based model.

Three years ago, the Centers for Medicare & Medicaid Services (CMS) expanded which care sites could bill these codes, adding primary care to the list. Many insurance plans, however, still decline reimbursement there.

Since cognitive decline can quietly drain accounts long before anyone notices a diagnosis, the Showalters have also started guiding families toward practical financial safeguards, like dual-signature requirements and purchase alerts at local banks.

Watch the full episode to hear the Showalters’ complete approach to dementia care, from rapid diagnosis to protecting patients financially and helping families navigate what comes next.

FAQs About Dementia Diagnosis, Testing, and Financial Protection

What is a digital cognitive assessment?

A digital cognitive assessment is a computer-based test that measures memory, processing speed, and other cognitive functions, similar in concept to the baseline concussion tests used in youth sports. The Showalters’ clinic uses digital testing to complete in about 20 minutes what used to take up to three hours with paper-based testing.

Can perimenopause cause symptoms similar to Alzheimer’s?

Yes. Perimenopausal and menopausal brain fog, often tied to declining estrogen, sleep disruption, and stress, can closely resemble the early symptoms of Alzheimer’s disease. Cognitive testing can help distinguish between the two.

What are reversible causes of cognitive impairment?

Several conditions can cause Alzheimer’s-like symptoms but are treatable, including sleep apnea, chronic sleep deprivation, thyroid problems, and vitamin B12 deficiency. The Showalters say sleep issues, in particular, are often overlooked, and treating them can noticeably improve cognitive function.

How can families protect a loved one with dementia from financial exploitation?

Common safeguards include setting up dual-signature requirements for large checks, purchase alerts or spending limits on debit and credit cards, and working directly with local banks, which can flag unusual account activity. Consulting a financial planner early, while a person can still participate in the decision, is also recommended.

Can lifestyle changes slow or reverse cognitive decline?

A 2024 randomized controlled trial published in Alzheimer’s Research & Therapy found that intensive lifestyle changes, including diet, exercise, stress management, and social support, slowed, stopped, or in some cases reversed the progression of mild cognitive impairment and early dementia over just 20 weeks (Alzheimer’s Research & Therapy). Other research ties consistent exercise and healthy lifestyle habits to a substantially lower long-term risk of dementia overall (PMC).