It starts small. You’re looking for your keys, but they’re in the fridge. Or maybe your dad, who used to be a human calculator, suddenly can’t figure out a 15% tip at dinner. People call these "senior moments." They laugh it off. But honestly, when we talk about the early stages of dementia, it’s rarely about a single "big" moment of forgetting. It’s a slow, quiet drift. It’s a change in the weather of a person’s personality before the storm actually hits.
Most people think dementia is just losing your memory. It isn't. Not exactly.
According to the Alzheimer’s Association, memory loss that disrupts daily life is a big one, sure, but for many, the very first red flag is actually executive dysfunction or subtle mood shifts. You might notice someone getting uncharacteristically angry about a broken toaster, or maybe they just stop caring about their favorite hobby. It’s "apathy," and in the clinical world, it’s one of the most common early symptoms that gets ignored because we just think they’re "getting old and grumpy."
We need to stop doing that.
Why the "Early Stages of Dementia" label is actually kind of tricky
Doctors often use the term "Mild Cognitive Impairment" (MCI) to describe that gray area where someone is struggling but can still mostly take care of themselves. It’s the waiting room. Not everyone with MCI develops dementia, but about 10% to 15% of people with MCI will progress to dementia each year. That’s a heavy statistic from the Mayo Clinic. When we talk about the early stages of dementia, we’re usually looking at the "mild" stage of a progressive disease like Alzheimer’s, Vascular dementia, or Lewy Body dementia.
Every brain is different.
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If it’s Alzheimer’s, the damage usually starts in the hippocampus. That’s the brain’s "save button." If the save button is broken, new memories don't stick. But if it’s Frontotemporal dementia (FTD), the memory might be fine while the "social filter" disappears. I’ve seen cases where a polite, soft-spoken grandmother starts swearing like a sailor or making inappropriate comments to strangers. It’s jarring. Families feel embarrassed. They don’t realize it’s the frontal lobe shrinking, not a moral failing.
The weird signs you probably aren't looking for
Most Google searches for this topic focus on names and dates. Did they forget my birthday? Did they forget where they live? Honestly, by the time those things happen, you’re usually past the earliest phases.
Keep an eye out for "spatial awareness" issues instead. A person in the early stages of dementia might start having trouble judging distances. They might trip more often or have "near misses" while driving. They aren't losing their vision; their brain is just losing the ability to process what the eyes see.
Then there’s the money thing.
Financial slip-ups are often the "canary in the coal mine." A study published in JAMA Internal Medicine found that people with dementia often start missing bill payments or making poor financial choices years before a formal diagnosis. If your mom—who was always frugal—suddenly buys three vacuum cleaners from a telemarketer, pay attention. It’s not just a "silly mistake." It’s a breakdown in the complex reasoning required to sniff out a scam or manage a budget.
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Language starts to "thin out"
Ever had a word on the tip of your tongue? Everyone has. It’s annoying. But in the early stages of dementia, this happens constantly, and the person starts substituting words with "the thing" or "that gadget."
The vocabulary becomes less specific. Instead of saying "I need the spatula," they might say "Give me that flat thing for the eggs." They might also lose the thread of a conversation mid-sentence. They just stop. They look at you, waiting for a prompt, because the track they were on just... ended. It’s called anomia. It’s subtle, but if you’re looking for it, you’ll see it everywhere.
Is it dementia or just "Normal Aging"?
This is the question that keeps people up at night.
- Normal aging: Forgetting where you parked but eventually finding the car.
- Early dementia: Forgetting that you even drove to the store in the first place.
- Normal aging: Forgetting the name of a movie star but remembering it two hours later.
- Early dementia: Forgetting the names of close friends or family members and not "recovering" the info later.
The difference is "retrieval" versus "storage." In normal aging, the data is there; the brain just takes longer to find it. In the early stages of dementia, the data often wasn't stored correctly to begin with.
The Dr. Murali Doraiswamy perspective
Dr. Murali Doraiswamy, a top brain health expert at Duke University, often points out that we need to look at "functional change." If someone has always been disorganized, being disorganized at age 70 isn't necessarily a sign of disease. It's their baseline. We are looking for a departure from that baseline. A lifelong chef who suddenly can't follow a simple recipe is a much bigger concern than a lifelong "bad cook" burning toast.
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What to do if you're worried (The Action Plan)
The worst thing you can do is "wait and see." I know it’s scary. Nobody wants to hear the "A" word. But there are actually things that mimic the early stages of dementia which are totally curable.
Vitamin B12 deficiency can cause brain fog and memory loss. So can urinary tract infections (UTIs) in older adults, which can cause sudden, intense confusion that looks exactly like dementia. Even severe dehydration or thyroid problems can mess with your head. You don't want to assume it's Alzheimer's when it might just be a lack of vitamins or a hidden infection.
- Start a "Behavior Log." Don't just rely on your memory. Write down specific dates and what happened. "Tuesday: Dad couldn't remember how to use the microwave." This is gold for a doctor.
- Book a "Double Appointment." Go to the GP and ask for a cognitive screening, but explicitly ask for blood work to rule out the "mimics" like B12, Thyroid (TSH), and infections.
- Check the Meds. Look at their pill bottles. Are they taking "anticholinergic" drugs? These are common meds for sleep or bladder issues (like Benadryl or Advil PM) that are notorious for causing cognitive decline in seniors. Sometimes, just changing a prescription can "clear the fog."
- The SAGE Test. If you want something to do at home, look up the SAGE test (Schoenbaum Adherence and Generalization Evaluation) from Ohio State University. It’s a pen-and-paper test that can help identify early signs. It’s not a diagnosis, but it’s a great conversation starter for a doctor’s visit.
- Get a Hearing Test. This is huge. There is a massive link between untreated hearing loss and cognitive decline. When the brain has to work 10 times harder just to hear what someone is saying, it has less "power" left for memory and thinking. Sometimes, hearing aids can actually improve cognitive function.
The reality is that while we don't have a "cure" that resets the clock to zero, we do have new treatments like Leqembi (lecanemab) that are specifically designed for the early stages of dementia. These drugs aim to clear amyloid plaques from the brain. They aren't perfect, and they have risks, but they represent a shift: we are finally moving from "just making them comfortable" to actually trying to slow the biology of the disease.
Early detection isn't just about a label; it's about time. It’s about having the chance to plan, to talk about what they want for their future, and to try interventions while the brain is still mostly intact. Don't ignore the "quiet drift."