“What really helps is grounding yourself in three things: what change you’re noticing, how different it is from who this person has always been, and whether it’s getting worse over time.” — Dr. Anna Chodos
Are you concerned that your loved one is showing early signs of dementia? Do you find yourself noticing changes but unsure whether they’re significant? You’re not alone in this uncertainty, and there are clear steps you can take to address your concerns.
We are Sue Ryan and Nancy Treaster. As caregivers for our loved ones with Alzheimer’s and other types of dementia, we understand how challenging it can be to recognize early signs of dementia and know what to do next. We’re sharing insights about practical guidance for managing through those early signs of dementia from Dr. Anna Chodos, professor of medicine in geriatrics at the University of California, San Francisco, and executive director of Dementia Care Aware, and Dr. Barry Jacobs, clinical psychologist, family therapist, and co-author of the AARP Caregiver Answer Book.
Let’s explore three essential tips for recognizing early dementia signs — starting difficult conversations with your loved one and communicating effectively with healthcare providers.
Tip 1: Know What Signs to Look For — They’re More Than Just Memory
The first step in addressing potential dementia is understanding what symptoms to watch for. Many people think dementia only affects memory — it’s much more than that. Because the brain controls many functions, symptoms can appear in a variety of ways.
Use This Three-Part Framework to Evaluate Symptoms:
Dr. Chodos recommends three key questions to help determine if concerns are warranted:
- What kind of symptoms are you seeing? Define the specific behavior or change that’s worrying you.
- How serious a change is this from the person’s baseline? Was this previously a strength for them?
- Is it getting worse over time? Are symptoms progressing — for example, barely noticeable last Thanksgiving, even more apparent this year?
Recognize the Full Range of Potential Symptoms:
Dementia can can affect more than just memory, it can affect multiple areas of cognitive function. Look for changes in:
- Language abilities — Difficulty finding words, speaking less, or trouble naming things properly.
- Behavior — Some of these may include acting out of character, or doing things they wouldn’t have done before, or neglecting personal appearance when they were previously impeccable.
- Physical movement — New tremors or increased difficulty walking.
- Repeating behaviors — Telling the same story multiple times within hours with no awareness of the repetition.
Consider Personal Baselines:
Everyone has different strengths and weaknesses. The key is identifying changes in areas that were previously strengths for your loved one. For example, if someone has always struggled with directions, that’s probably not a dementia symptom. But if someone who was excellent at managing finances suddenly can’t balance a checkbook, that’s a significant change worth investigating.
Nancy’s husband had frontotemporal dementia that started with language difficulties — he couldn’t find the right words. It didn’t initially cross her mind that he had dementia because she thought dementia was only about memory. Nancy knew something wasn’t right, so they consulted a neurologist. Nancy’s story highlights why understanding the full range of dementia symptoms is so important.
Tip 2: Start Early and Normalize Health Conversations
Once you’ve identified concerning signs, the next challenge is starting the conversation with your loved one. This can often be the most difficult step because discussing cognitive decline can feel frightening and uncomfortable.
Begin Talking About Health in General, Not Just Cognitive Concerns:
Dr. Jacobs emphasizes the ideal approach is to begin having conversations about health in general long before any problems emerge. “Instead of suddenly confronting your parent with concerns about memory loss, make health discussions a normal part of your relationship.”
Consider asking your loved one questions like:
- “I know you have a primary care visit coming up — are there things you’re going to bring up with your doctor?”
- “How did your appointment go? What did the doctor say?”
- “Did the doctor check your hearing, vision, and memory?”
When cognitive concerns are packaged within overall health conversations, parents can hear them differently. Your approach will immediately alarm them and make them defensive if you begin your conversation by saying something like: “I think you’re really going downhill cognitively and we need to do something about it.”
Use Empathy and Frame Your Concern as Care, Not Control:
Parents are often sensitive about declining function and worried about being a burden to their children. Dr. Jacobs suggests saying something like: “This isn’t a burden to me. I love you, and I want us to talk about what you’re noticing, so we can figure things out together.”
This reassurance may need to happen multiple times because parents need to get used to the idea that their adult child is no longer a child but an adult who can discuss important life issues with them.
Adapt Your Approach Based on Your Family’s Communication Style:
If you have multiple adult children, strategize together about who should raise the topic. Perhaps there’s one child the parent has a better relationship with, or confides in more easily.
Some effective approaches include:
- The straightforward approach: “You offered to help me understand what’s going on with your health. Is now a good time for us talk about some things I’ve noticed?”
- The “for me” approach: “I don’t think this is necessarily a problem for you, but I’m concerned. To help me feel better, would you do this for me?” Parents are accustomed to doing things for their children and may be more willing when framed this way.
Navigate the Challenge of Lack of Self-Awareness:
Dr. Chodos explains that some people experiencing cognitive decline are not able to recognize changes in themselves because the parts of the brain responsible for self-awareness are affected by the disease. In these cases, reframe your support around ways to help the person without constantly referring back to the cognitive issue. This isn’t dishonest; it’s actually more compassionate. Your loved one may not be able to understand what’s happening to them.
It Might Not Be Dementia:
There are medical conditions that can mimic dementia symptoms but are treatable. Dr. Chodos notes that common examples include:
- Sleep apnea
- Medications
- Poor sleep hygiene (disrupted routines, staying up all night watching TV)
- Thyroid disease.
This possibility gives you another angle for starting the conversation: “I’m concerned about these signs we’re noticing. Let’s get them checked out because it could be something simple that can be treated.” While symptoms progressing over years are unlikely to be entirely caused by another condition, addressing them as earlier as possible can still help people feel — and function — better, regardless of their baseline.
Tip 3: Plan Ahead for the Doctor’s Appointment
Once you’ve had initial conversations with your loved one, the next step is involving their healthcare provider. This requires preparation and persistence.
Dr. Chodos emphasizes that planning ahead is essential because doctor’s visits are often time-pressured. She suggests:
- Create a prominent list — Bring concerns written on a large yellow legal pad, so it’s very clear you’ve prepared something that needs attention.
- Use the electronic chart — If possible, share your concerns through the patient portal before the appointment.
- Share information with the doctor — You can also provide information to the doctor about your relative without violating privacy rules (the physician won’t be able to share information back without clear permission).
Speak the Doctor’s Language:
Come to the medical appointment with specific information that helps the clinician understand the severity:
- “I’m noticing this specific symptom”
- “This is happening more often”
- “This is quite out of the range for her”
- “I was looking at the Alzheimer’s Association website and noticed these are classic symptoms.”
It’s perfectly appropriate to say: “I would like my mom to have an evaluation that looks into dementia as well as other causes of these symptoms.”
Understand the Evaluation Process:
Dr. Jacobs clarifies what to expect if the conversation takes place during a primary care visit:
- The screening is not a diagnosis — The primary care provider will do a short test (5–10 minutes).
- Below-threshold results trigger referrals — If your relative doesn’t test well, they’ll be referred for more extensive evaluation.
- Further assessment requires specialist visits — The next step involves seeing a neurologist, geriatric psychiatrist, or geriatrician.
You’ve triggered the medical system to pay attention, now you may need to convince your relative to attend the specialist appointment.
Be Persistent with Follow-Up:
Unfortunately, routine dementia screening isn’t yet standard practice everywhere. Dr. Chodos acknowledges that you may encounter a clinician who isn’t ready to jump into evaluation, particularly if symptoms are mild. They may be more focused on other medical issues like diabetes or blood pressure.
If things aren’t moving along, you can follow up with:
- A voice message or a secure online patient portal message (MyChart is an example of this type of patient portal): “It was nice to meet you at the last visit. I’m not sure what the follow-up has been on this. We’re still concerned. Nothing’s really changed — or in fact, it’s getting a little worse. We would still really like more information about this.”
- Keep advocating by giving the clinician tools to realize these are real symptoms and setting the expectation that you want this evaluated.
Emphasize That Early Detection Helps Everyone:
The number one thing for all clinicians is aligning with their patient and doing what’s best for them. Help your loved one understand that early cognitive evaluation is an important part of comprehensive care — it’s just as important as managing diabetes or blood pressure.
Taking Action: You’re Not Alone On This Journey
Recognizing early signs of dementia, and navigating the conversation process with family and healthcare providers, is challenging. By understanding what symptoms to look for, starting health conversations early and compassionately, and preparing strategically for medical appointments, you can advocate effectively for your loved one.
The sooner you engage in these conversations as a family — working together as a team — the more you eliminate your loved one feeling like they’re a burden. When everyone is involved and communicating openly, your loved one can feel more engaged and valued as part of the process — not someone things are being done to without their input.
If you’re concerned about a loved one, trust your instincts. The “furrowed brow” moment of uncertainty is valid. Take that first step:
- Make a list of specific symptoms you’ve noticed.
- Assess whether they represent changes from your loved one’s baseline.
- Consider whether they’re progressing over time.
- Use the conversation strategies and medical advocacy tips shared here to move forward.
You can find more information from our expert guests at:
- Dr. Anna Chodos: DementiaCareAware.org
- Dr. Barry Jacobs: caregiveranswerbook.com
Have you navigated the early signs of dementia with a loved one? What strategies helped you start the conversation or work with healthcare providers? Share your experiences in the comments below or on our Facebook or Instagram pages.
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