5 Early Warning Signs of Dementia

Have you joked about your forgetfulness to hide your embarrassment or fear about losing your memory? If you've forgotten things one too many times, you may be wondering whether you have, or are developing, dementia.

Some early warning signs can help you determine whether to see a doctor to be diagnosed for dementia.

Dementia (known more formally as major neurocognitive disorder) is the loss of thinking, remembering and reasoning to the point where it interferes with daily activities and life, according to the National Institute on Aging (NIA) at the National Institutes of Health (NIH).

There are many types of dementia, but the most common form in people age 65 and older is Alzheimer's disease, says Glen Finney, MD, a behavioral neurologist and fellow of the American Academy of Neurology.

The second most common form is vascular dementia, caused by conditions that affect blood vessels in the brain (like stroke), and the third is a brain disorder known as Parkinson's disease dementia or Lewy body dementia, says Dr. Finney.

Although dementia is more common as people get older, it is not a normal part of aging, says the NIA, the leading federal funder of dementia research. In fact, many people live into their 90s and beyond without signs of dementia.

Here are the early signs and symptoms of dementia, along with how to test for the condition and reduce your risk of developing it.

Memory loss is often an early symptom of dementia, according to the Mayo Clinic.

"The first noticeable sign of dementia is usually the loss of episodic memory," says Nicole Purcell, DO, a neurologist and senior director of clinical practice for the Alzheimer's Association. "For instance, a person may remember going on vacation but can't remember where they stayed or what they did."

Episodic memory involves remembering specific information about recent or past events or experiences, according to the UCSF Weil Institute for Neurosciences Memory and Aging Center. Other examples include remembering where you parked your car earlier in the day or where you went for dinner with a friend last week.

Early signs of dementia are not always limited to memory loss, though.

"Sometimes signs include a change in judgment, mood or how people complete projects or tasks," Dr. Purcell says. "People with the condition might not notice the symptoms, but someone else close to them might."

In other words, it's a red flag if a person doesn't notice or complain about their symptoms, but their family members do.

Although anyone can make a poor decision occasionally, people with dementia may experience more frequent changes in judgment or decision-making, according to the Alzheimer's Association.

For example, they may be unable to manage a budget or begin to neglect their hygiene or appearance more regularly.

As people age, they may become more set in their ways and upset when their normal routine is disrupted. Coping with stress can become more challenging with age, and depression in older adults is somewhat common.

People with dementia, however, are sometimes unable to control their emotions or may often become confused, suspicious, depressed, fearful or anxious, according to the Alzheimer's Association. They may be easily upset at home, with friends or when out of their comfort zone.

Many of us may need help learning a new technology or how to use a new appliance.

But people with dementia often find it hard to complete routine tasks they used to be able to do easily, such as driving to a familiar location or creating a grocery list, says the Alzheimer's Association.

Although it's not uncommon to sometimes search for the right word when communicating verbally or in writing, people with dementia have a harder time with language.

For instance, they may have trouble finding words for familiar things or call something by the wrong name, according to the Alzheimer's Association. Or they may frequently repeat themselves or lose track of a conversation.

So, how do you know whether your symptoms are actually a sign of dementia?

"We all walk into a room and forget why we went in there, or struggle to find a word at times. It becomes a problem or concern when it affects your ability to function and perform daily life activities," says Dr. Purcell. "Someone with dementia may not be able to retrace their steps to find where they left their car keys, while someone without it could."

If your memory loss is getting worse and you or others are concerned about it, there are many available tests for dementia.

The Self-Administered Gerocognitive Exam, or SAGE test, can detect early signs of memory and thinking problems. You can take the test at home and share the results with your doctor, who can decide whether you need additional testing and evaluation.

Another test you can take with someone's help is the five-word test, a serial, verbal test to quickly evaluate memory in aging adults. In this test, the examiner reads a list of five words (at a rate of one word per second), then asks the person to repeat back as many words as they can remember, in any order, per the Alzheimer's Association.

"The five-word test is just one example of a simple memory test people can do anywhere to see if they might be struggling with their memory performance," says Dr. Finney.

It's a good idea for people who had problems with the test to speak with their doctor, Dr. Finney says. "Passing it would be reassuring, but not a guarantee that there couldn't be other problems with thinking and behavior."

Any changes in memory, thinking or behavior warrant a doctor visit, according to Dr. Finney.

"Typically, a doctor will start with a short screening of your memory and thinking," he notes.

The doctor may then screen for issues like anxiety, depression, sleep problems and brain-impairing medications, says Dr. Finney, adding that many common medications can make memory and thinking worse, especially in older people.

"If none of those things turn out to be the problem, a good next step is checking lab tests for reversible causes of cognitive problems like vitamin deficiencies, hormone imbalances and metabolic problems," says Dr. Finney. And "if all of that checks out OK or if, despite fixing those, the problem or concern continues, then it is time for a good picture of the brain, preferably an MRI, and a likely consultation with a memory clinic specialist."

Age is the biggest risk factor for dementia, and that's unfortunately outside of our control. But there ‌are‌ things you can do to reduce your risk of developing the condition, per the National Library of Medicine.

Besides age, risk factors for dementia include the following, Dr. Finney says:

• High blood pressure
• High cholesterol
• High blood sugar
• Smoking
• Excessive alcohol use
• Untreated sleep apnea
• Mid-life depression
• Hearing loss
• Poor diet
• Lack of exercise
• Lack of social interaction

Dr. Purcell recommends following a healthy diet rich in fruits, leafy green vegetables, fish and whole grains.

This is in line with a plant-based diet, which prioritizes whole plant foods (fruits and veggies, whole grains, beans, legumes) and incorporates animal-based foods (meat, eggs, dairy products) sparingly.

The benefits of a plant-based diet are many, including a link to lower blood pressure and cholesterol as well as a lower risk of diabetes (high blood sugar) and stroke — all of which can help lower your risk of dementia.

Although it's important to treat any vitamin or nutrient deficiencies, "mega-dosing" on supplements doesn't necessarily help, according to Dr. Finney.

"If you don't have a diet rich in omega-3 fatty acids, taking that as a supplement makes sense, and recent research suggests that a multivitamin is good for brain health as well," he says.

Indeed, a July 2023 randomized clinical trial in ‌The American Journal of Clinical Nutrition‌ found that older adults who took a daily multivitamin had improved memory after a year.

Just make sure to talk to your doctor before you start taking any supplement, as they can interact with certain medications or underlying conditions.

Follow the federal government's Physical Activity Guidelines for Americans, which encourages 30 minutes of activity at least five days a week. That is, aim for at least 150 minutes per week total of exercise like brisk walking, biking or swimming.

The guidelines also say adults should do at least two sessions per week of full-body strengthening exercises.

The benefits of regular exercise include a lower risk of dementia, weight management, better heart health, a lower risk of diabetes and more.

Studies have found an association between hearing loss and dementia in older adults, according to the NIH. Research also suggests hearing aids may slow the development of cognitive problems.

However, possible links between hearing loss treatment and improved cognition were not tested in a large, randomized study, the NIH says.

If you're having trouble hearing, get your hearing checked as soon as possible. Although more research is needed on the link between dementia and hearing loss and treatment, a loss of hearing may indicate other medical problems.

Research shows activities that challenge the brain stimulate new connections between nerve cells and may even help the brain create new cells, according to Harvard Health Publishing.

Activities that stimulate the brain may delay the onset of dementia and decrease the effects, according to the Alzheimer's Association. Staying mentally healthy can also benefit your physical health.

Try activities such as crossword puzzles, learning a new language or instrument, taking a course in a topic that interests you and reading to stay mentally alert and healthy.

Connecting with other people and engaging in social activities can prevent social isolation and loneliness, which are linked to higher risks for cognitive decline and Alzheimer's disease, according to the Alzheimer's Association.

Spending time with others can also boost your mood and reduce your stress, says the Mayo Clinic. These social connections benefit your physical health as well and can help reduce the risk of high blood pressure and other health problems, according to the Mayo Clinic.

Take a walk with a neighbor, ask a coworker to lunch, volunteer, join a book club and keep in touch with family members and friends, both near and far.

Drinking large quantities of alcohol can cause changes in the brain, and studies have linked alcohol use disorders to an increased risk of dementia, according to the Mayo Clinic.

In addition, too much alcohol can cause falls and other accidents, and worsen health problems such as diabetes, high blood pressure, stroke, memory loss and mood disorders, says the Alzheimer's Association.

Aim for no more than one or two drinks each day, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health.

Some studies have shown that smoking in middle age and later may increase the risk of dementia and blood vessel conditions, says the Mayo Clinic.

Quitting smoking can reduce your risk, though, as well as your risk for other health conditions such as heart disease and cancer.