What Mentage is learning between first concern and clinical clarity
At a LiveWell listening session, a spouse described the period before diagnosis as “quiet terror.” Her concern became harder to dismiss after her daughters raised changes they had noticed during a Thanksgiving gathering. The family did not immediately enter a diagnostic pathway. They watched, compared observations, adjusted around the changes, and tried to determine what the situation required. That was not inaction. Before the healthcare system had formally recognized a problem, the family had already created an informal system for managing one.
I have heard versions of this pattern in expert conversations, community listening, market research, public caregiver discussions, and customer interviews.
Mentage defines the pre-diagnostic interval as the period between a family’s first concern about cognitive change and meaningful clinical clarity. It can include uncertainty about whether a change reflects ordinary aging, stress, medication, illness, personality, or something that warrants a medical conversation.
The hesitation inside this period is sometimes treated as a failure of awareness. That explanation is incomplete.
Research has identified multiple, interacting barriers to seeking help for cognitive concerns, including fear, stigma, uncertainty about symptoms, respect for autonomy, family disagreement, cost, and difficulty accessing care. A systematic review covering 30 years of research found that these barriers rarely operate alone. Families may recognize a change while remaining unsure what it means or what formal action could set in motion. [1]
This does not mean every delay is thoughtful or beneficial. Some people do not recognize changes. Others face denial, limited health literacy, cultural expectations, cost, family conflict, or a shortage of clinicians. A separate review focused on community-dwelling older adults without dementia found that normalizing symptoms, psychosocial explanations, and a perceived lack of benefit from disclosure could also discourage people from seeking help. [2] But hesitation should not automatically be mistaken for passivity. For many families, it also contains observation, adaptation, and protection under uncertainty.
We started too far downstream
Mentage did not begin with this market position.
Our original MICA concept, and the early strategy for MEVA, centered on building a more accessible digital cognitive assessment. We focused on cognitive domains, task performance, clinical workflows, and the possibility of eventual medical device development.
The initial assumption was straightforward: the primary opportunity was a better cognitive test.
Then we studied the market more closely. Established clinical and digital assessment products already occupied that category, including MoCA, SLUMS, Cogstate, and others.
Competing as another assessment product would require Mentage to win on clinical validation, diagnostic accuracy, regulatory clearance, reimbursement, clinician integration, and institutional purchasing. More importantly, it would place MEVA at a point many families had not decided to enter.
The discovery did not show that cognitive testing is unimportant. It showed that we had started too far downstream.
The more distinct unmet need appeared earlier, when families were already noticing and adapting but had no diagnosis, organized record, or agreed next step. Mentage originally explored a cognitive testing model, but narrowed its focus after finding that another stand-alone test would not address the moment families were describing.
That conclusion changed concrete decisions.
First, we stopped positioning MEVA as a replacement for established cognitive tests or as a way to diagnose dementia. MEVA is a general-wellness platform.
Second, the consumer experience moved away from presenting people with a stand-alone clinical-style score.
Third, consent, privacy, dignity, and preparation for future conversations became central requirements. They are not accessories to the product.
Fourth, our research program was staged around reliability, usability, feasibility, and participant experience before any consideration of broader clinical claims.
The commercial thesis narrowed as well. We are investigating how to support families and community or healthcare partners during the period before formal evaluation, rather than attempting to sell another stand-alone cognitive test.
What families are already doing
Our interviews were not the only place this language appeared. Mentage conducted a structured review of public discussions across communities focused on aging, dementia, caregiving, and older adulthood. We treated that review as digital ethnography and language research, not as clinical evidence or a substitute for interviews.
The same questions appeared repeatedly. Is this ordinary aging, stress, or something more concerning? What threshold justifies talking to a doctor? What should I do next?
People described comparing notes with siblings, repeating reminders, checking appointments, watching driving or household safety, and gradually taking over tasks. Some expressed guilt about waiting, even when the waiting contained active observation and protective adaptation. Others wanted a longer-term view but were skeptical that repeatedly taking the same conventional test would provide one.
These discussions helped us identify language and hypotheses to test directly.
I have started to think of the pattern as competent watching. It is not a clinical construct. It is our emerging interpretation of ordinary family behavior: a weekly call functioning as an unspoken wellness check, siblings comparing observations after a holiday, a spouse simplifying routines, or someone quietly noting repeated questions.
Families often #notice earlier than the healthcare record does, but they rarely have a structured way to organize what they are seeing.
What MEVA does with information
MEVA uses structured tablet activities to organize broad patterns of cognitive engagement over time. A single activity or pattern does not establish a medical condition. Instead of giving consumers a diagnostic result or frightening medical score, MEVA presents activity information through plain-language engagement bands. The purpose is to provide a structured longitudinal view of engagement, not a disease-risk score or determination of decline.
Information is encrypted and access-controlled. Mentage’s current privacy policy states that the company does not sell personal information. The individual receives their wellness information first. Sharing is not automatic. A person may choose to share a summary with a family member or healthcare professional to support a more specific conversation.
The intended progression is simple: concern at home, structured activities and observations, understandable patterns over time, and better preparation for a health conversation when the individual chooses to have one.
Discovery before certainty
Mentage was selected to participate in the New York I-Corps Hub, part of the NSF I-Corps network. The program trains scientists and engineers to investigate whether a technical discovery can become a commercially viable product or service with societal benefit.
We are continuing interviews with adults, adult children, spouses, clinicians, primary care leaders, aging services organizations, and potential distribution partners. We are testing which users, buyers, referral sources, and pathways have a strong enough need to adopt the platform.
Mentage is conducting a registered study focused on test-retest reliability, usability, feasibility, and participant experience. The study is registered at ClinicalTrials.gov under NCT07595250.
Our near-term work also includes refining MEVA’s family experience, consent model, plain-language reporting, and appointment-preparation workflow. We will make claims only when the evidence supports them.
Mentage continues to speak with adults 55+, adult children, spouses, primary-care professionals, and aging-services leaders who have lived through or worked through the period between first concern and clinical clarity. If that experience is familiar to you, we would value the opportunity to learn from it. Contact jerin@mentage.com.
Long before a concern reaches the medical record, someone is usually making the calls, comparing what each relative saw, and keeping track without a name for the work.
Jerin Zachariah is the Founder and CEO of Mentage, a cognitive company developing MEVA. Mentage has a commercial interest in the topics discussed in this article.