Maybe your mother has asked the same question three times in one visit. Maybe your father, who balanced the checkbook for 50 years, has a stack of late notices. You tell yourself it's just age. But a small voice keeps asking whether it's something more.
Changes in memory and thinking are common as people get older, and most are a normal part of aging. More serious problems can be caused by mild cognitive impairment, dementia such as Alzheimer's disease, or other conditions1. This guide explains the early signs of dementia, how they differ from normal aging, how to bring up your concerns, and what happens when you see a doctor.
Normal aging or something more?
As people age, many notice they don't remember things as well or as quickly as they once did. They may misplace things or forget to pay a bill now and then. The National Institute on Aging says these are usually signs of mild forgetfulness, not a serious memory problem. What matters is whether the changes make it hard to do everyday things, such as driving, using the phone or finding the way home1.
| Typical with age | Possible sign of dementia |
|---|---|
| Making a bad decision once in a while | Making poor judgments and decisions a lot of the time |
| Missing a monthly payment | Problems taking care of monthly bills |
| Forgetting which day it is and remembering later | Losing track of the date or the season |
| Sometimes forgetting which word to use | Trouble having a conversation |
| Losing things from time to time | Misplacing things often and being unable to find them |
Adapted from the National Institute on Aging.
In other words, it's the pattern and the effect on daily life that matter, not a single forgotten name2. After a diagnosis, ask about Medicare's GUIDE dementia program. After a diagnosis, ask about Alzheimer's medications.
What is mild cognitive impairment?
Between normal aging and dementia is a condition called mild cognitive impairment, or MCI. People with MCI have more memory or thinking problems than others their age, but they can usually still take care of themselves and handle daily tasks1. MCI may be an early sign of Alzheimer's disease, but not everyone with MCI goes on to develop it, and some people stay the same or even improve. Our guide to mild cognitive impairment covers diagnosis and planning.
If your parent is diagnosed with MCI, regular checkups help track any changes over time. It's also a good moment to get legal papers in order and talk about wishes, while your parent can fully take part.
The early signs of dementia
The Alzheimer's Association describes ten early warning signs of Alzheimer's and other dementias3. Most families notice a few of them first, often gradually:
- Memory loss that disrupts daily life. Forgetting recently learned information, asking the same questions over and over, or relying more and more on notes and family for things they used to handle.
- Trouble planning or solving problems. Difficulty following a familiar recipe, keeping track of bills or working with numbers.
- Difficulty with familiar tasks. Getting lost driving to a familiar place, or forgetting the rules of a favorite game.
- Confusion with time or place. Losing track of dates or seasons, or forgetting where they are or how they got there.
- Trouble with images and space. Problems with balance, reading, judging distance or telling colors apart, which can affect driving.
- New problems with words. Stopping in the middle of a conversation, repeating themselves, or calling things by the wrong name.
- Misplacing things. Putting things in unusual places, being unable to retrace steps, and sometimes accusing others of stealing.
- Poor judgment. Giving large amounts of money to telemarketers, or paying less attention to grooming.
- Withdrawing from work or social life. Pulling back from hobbies, social activities or projects.
- Changes in mood or personality. Becoming confused, suspicious, depressed, fearful or anxious, or easily upset outside their comfort zone.
The NIA lists similar signs that it may be time to see a doctor: asking the same questions repeatedly, getting lost in places they know well, having trouble following recipes or directions, becoming more confused about time, people and places, and not taking care of themselves, such as eating poorly, not bathing or behaving unsafely1.
Early signs can differ by type of dementia
Alzheimer's disease is the most common cause of dementia, and memory problems are usually among its first signs. If the terms are confusing, see Alzheimer's vs. dementia. Other types can start differently4:
- Vascular dementia. Often linked to strokes or problems with blood flow. Slowed thinking and trouble with planning and organizing can show up before memory loss.
- Lewy body dementia. Can begin with visual hallucinations, big swings in alertness, acting out dreams during sleep, or movement problems similar to Parkinson's.
- Frontotemporal dementia. Often starts at a younger age, with changes in personality and behavior, such as acting impulsively or saying inappropriate things, or with problems using language.
- Mixed dementia. Many older adults have more than one type, so symptoms can overlap.
These differences are one reason a full medical evaluation matters, since the type of dementia affects treatment and planning.
Early signs in women and in men
People often search for early signs of dementia in women or in men. The warning signs themselves are largely the same. What differs is risk and how signs get noticed. Almost two-thirds of Americans living with Alzheimer's are women, according to the Alzheimer's Association, partly because women tend to live longer5.
In practice, early signs may be missed in different ways. A woman who has always managed the household may hide trouble with bills or cooking for a long time. A man who has always handled the finances may hide mistakes until a bill goes to collections. In couples, one spouse often quietly covers for the other, so adult children may not see the changes until a spouse gets sick or dies. Watch for what's changed from your parent's own normal, not from a checklist alone.
Other conditions that can look like dementia
Not every memory problem is dementia. Some causes can be treated or even reversed, which is the best reason not to wait. The NIA notes that memory problems can come from medicine side effects, vitamin B12 deficiency, thyroid, kidney or liver problems, heavy alcohol use, blood clots or tumors in the brain, head injuries, and emotional problems like depression or anxiety4. Our guide to depression in the elderly explains how the two can look alike. Hearing loss can also be mistaken for memory problems; see hearing loss in the elderly.
Sudden confusion is different. If your parent becomes confused over hours or a few days, especially with a fever, a fall or a new medicine, it may be delirium from an infection, such as a urinary tract infection, or another medical problem. Get medical help right away. See sudden confusion in the elderly.
How to bring up your concerns
This is a delicate conversation. Many people fear a dementia diagnosis, and some don't notice their own changes. A few approaches help:
- Write down specific examples, with dates, before you talk.
- Pick a calm, private time, not during a family gathering.
- Focus on health and feeling better, not on mistakes: "I want to make sure nothing's being missed."
- Mention that some causes of memory problems can be treated.
- Suggest a regular checkup or the Medicare Annual Wellness Visit, which includes a check for cognitive impairment6.
- Offer to go along and take notes.
If your parent refuses, don't force it. Try again later, or ask someone they trust, like a doctor or friend, to raise it. Our guide on what to do when an elderly parent refuses help has more ideas.
What happens at the doctor
There's no single test for dementia, though the yearly Medicare Annual Wellness Visit includes a short memory check. A doctor usually starts with a medical history, a review of medicines, a physical exam and short tests of memory, attention and problem-solving. Blood tests can check for other causes. Depending on the results, the doctor may order brain imaging or refer your parent to a specialist such as a neurologist, geriatrician or memory clinic7.
Bring a list of the changes you've noticed, all medicines and supplements, and any family history. Family members often see things the person doesn't, so your notes help. A diagnosis can take more than one visit. Before you leave each appointment, ask the doctor to explain the results in plain language, what the next step is, and who to call with questions. A written summary helps you share the news with siblings accurately.
Why an early diagnosis helps
It's tempting to avoid knowing. But an early diagnosis has real benefits. It can rule out treatable causes. For people with early Alzheimer's, it may open the door to newer treatments that are approved only for the early stage. It gives your parent time to make legal, financial and care decisions while they still can, including naming a power of attorney10. And it helps the family understand what's happening, find support and plan.
Our guide to power of attorney for an elderly parent explains what to put in place, and our guide to the stages of dementia care needs explains what may lie ahead.
Next steps if it is dementia
- Learn about the diagnosis. Ask what type of dementia it is, what stage, and what to expect.
- Get support early. The Alzheimer's Association's free 24/7 Helpline offers information and support11.
- Make the home safer. Simple changes can prevent falls and accidents12.
- Think about driving. Dementia affects driving skills. See when elderly parents should stop driving.
- Plan for care. Many people live at home for years with support. Learn the options before you need them.
When the time comes to think about more support, our guide on signs it's time for memory care can help.
