I knew something was really wrong with my grandmother on the day of my grandfather’s funeral. It wasn’t her reaction to this loss that raised a red flag, but what happened when she suffered another big blow that same day: Her beloved cat of many years suddenly died. My grandmother loved her cats like her children, and this one was her very best companion. Yet she didn’t shed a tear or seem to notice. It was like he never existed at all.
She would later be diagnosed with Alzheimer’s disease, and over the next long, agonizing decade, this loving, kind person became angry and suspicious, often lashing out at family members. This kind of trajectory isn’t uncommon with dementia, an umbrella term for a loss of cognitive functioning that impacts a person’s memory, language skills, behavior, mood, and personality. “Changes in how the brain works can make it hard for you to remember things, solve problems, or stay organized,” Baibing Chen, MD, MPH, a neurologist at University of Michigan, tells SELF.
Dementia has a few different causes, including the most common one—Alzheimer’s disease. While there is no cure, early intervention can help people manage symptoms and maybe even slow the progression of the disease. It also helps family members get plans in place—say, setting up medical power of attorney or an advance care directive—with the input of the person who has the diagnosis. “When you diagnose somebody early, they are part of the conversation,” James Noble, MD, a neurologist at NewYork-Presbyterian/Columbia University Irving Medical Center, tells SELF. “They can help make decisions. They can inform what they want care to look like as the disease progresses.”
For those reasons, it’s important to understand what exactly dementia can look like. We asked experts to walk us through some of these lesser-known symptoms of dementia and how to spot them in a loved one.
Surprising signs of dementia people miss
Before reading this list and panicking, it’s important to keep in mind that the name of the game here is whether or not something is happening all the time. “It’s really more of a pattern of consistent problems—say, for example, consistent forgetfulness—not just a once-in-a-while thing,” says Dr. Noble. If your dad forgot the name of the mediocre movie you just saw together, that’s not necessarily an immediate red flag. (Who doesn’t want to forget seeing Death on the Nile?) But if he forgets your name, or needs lots of reminders or help to do basic tasks, that’s worth checking out.
Some cognitive changes can happen as you get older, and that’s completely normal and expected, says Dr. Noble—like being a bit slower to find a word on the tip of your tongue, or having a harder time paying attention. Dr. Chen adds that, before you jump to conclusions, you should also know that some other conditions like thyroid imbalances, vitamin B12 deficiencies, and chronic alcohol misuse can cause similar symptoms. Dementia, on other hand, causes significant changes in a person’s thinking and memory “to the point where they need help,” Dr. Noble says. (And again, there’s often a pattern of consistent troubling changes.)
Here are some potential red flags for dementia that many of us might not know to look for:
1. Issues with driving (like getting more tickets or into more accidents)
“Driving, as I explain it to my patients, is probably one of the more complicated tasks that we do day-to-day,” says Dr. Noble. There are so many cognitive skills associated with being behind the wheel that most of us aren’t even fully aware of, he says, including knowing where you want to go, general awareness of your environment (like noting the weather, who is in your blind spot, or pedestrians about to cross), and the capacity to respond to changes quickly (say, slamming on the brakes to avoid hitting another car).
If one of those skills isn’t at 100%, Dr. Noble says, it “becomes obvious” there’s a problem. That can look like running stop signs, getting more tickets, getting into accidents, or other unsafe driving behavior. Other signs to watch out for, per the National Institute on Aging (NIA), include confusing the gas and brake pedals, sudden lane changes, lots of new dents or scrapes on the car, multiple near misses, and speeding or driving slowly. “When we hear those things in the office, we pay attention to them,” he says.
2. Uncharacteristic money troubles
Financial struggles—late or missed bill payments, bad credit scores, etc.—can be one of the first noticeable signs of dementia. (Some research suggests that these issues can occur up to six years before a person is diagnosed.)
Managing money takes a lot of different executive functioning skills, says Dr. Chen, such as memory (like remembering when bills are due or the PIN for your debit card), judgment (say, being able to tell if you can afford something), and organization. Dementia impacts the brain’s ability to handle those skills, which can cause people to miss payments, spend impulsively, gamble, or be susceptible to scams, he says. Other signs to look out for include having lots of unopened or unpaid bills, excessive spending or new purchases, unexplained money missing from their bank account, and trouble counting change or figuring out the tip.
Caveat: Money troubles might not be the most reliable potential sign of dementia for a person who has always lived paycheck to paycheck or has historically struggled to pay bills on time, says Dr. Noble. But “if somebody was really fastidious with their finances, and all of a sudden they noticed in the last month or two they missed two or three bills, that could be an important indicator to follow,” he says.
3. Unusual sleep behaviors
Changes to how people sleep can be a more “subtle” potential sign of dementia, says Dr. Noble. For example, having very fragmented sleep—meaning a person wakes up a lot during the middle of the night—is associated with an increased risk of Alzheimer’s disease. The same goes for big sleep- cycle changes, such as snoozing all day but then being very awake and agitated at night, adds Dr. Chen.
Another big red flag is very animated sleep, “like they’re acting out their dreams—even hitting others in the bed or knocking over a lamp on the nightstand,” Dr. Noble says. Those symptoms can be warning signs of specific types of cognitive dysfunction, like Lewy body and Parkinson’s dementia (which some but not all people with Parkinson’s disease can develop). “These changes in sleep can begin well in advance, sometimes many years in advance, of the very first more obvious cognitive, motor, or other symptoms [of dementia],” he says.
4. Substantial personality, behavior, or mood changes
This one is tricky, because everyone has their ups and downs. But with dementia, “people may have a change in personality that other people feel or notice,” Dr. Noble says, such as becoming withdrawn, apathetic, or irritable. With Alzheimer’s disease, for example, a person might be more angry than usual, act paranoid or suspicious of others for no reason, and seem depressed or anxious. (Research suggests these personality changes can happen well before getting diagnosed, too.)
Suddenly losing interest in normal activities or hobbies is also concerning, says Dr. Chen. Does your super outgoing mom no longer want to spend time with her friends? Has dust accumulated on your dad’s often-used toolbox? Just like my grandmother’s lack of interest in her beloved pet was a red flag, these can be signs something else is going on.
5. Stiffness and slowness that can’t be explained by something else
Dr. Noble says that stiffness and slowness—accompanied by cognitive symptoms like the ones on this list—may also be a concern. This is particularly true for Parkinson’s disease and Lewy body dementia, both of which impact a person’s movement. Other possible signs include handwriting changes (like smaller handwriting than normal), tremors or shaking even when resting, and trouble walking (like a very slow or shuffling walk, or balance issues).
Of course, some stiffness and slowness comes naturally with aging thanks to reduced muscle mass and joint mobility. Many older people also have osteoarthritis, which can cause swelling and pain around the joints and make it harder to do certain tasks (like moving from standing to sitting, walking, or even just opening jars). But if your loved one has unusual stiffness along with some other cognitive symptoms, that could be a sign to get things checked out by a doctor.
6. Forgetting basic words or names
Dr. Noble says that certain memory issues are normal with aging and happen to everyone—like walking into a room and temporarily forgetting what you were going to do, or having the name of a book or an actor on the tip of your tongue but not being able to recall it. (I did both of those things just yesterday.) “It’s when well-known words or well-known names of people are forgotten that it starts to stand out,” he says.
This might manifest as repeatedly forgetting names you really should know (the name of your child, spouse, or best friend rather than, say, Meryl Streep’s) or words for really common, everyday things. Dr. Noble says it’s not unusual for people to talk around a common word because they can’t recall it, too. If someone can’t remember the word refrigerator, for example, they might instead go with something more descriptive like “the thing that’s in the kitchen, and it keeps stuff cold, and it’s got ice.”
7. Suddenly forgetting recipes, burning food, or having other issues with cooking
Like money troubles, this potential red flag really depends on a person’s baseline normal. (If your mom has literally never been a good cook, her being bad at it in old age isn’t automatically a troubling sign.) But if the chef in the family starts to forget key elements of their classic recipes or burn things more often, “that’s an indicator to watch,” says Dr. Noble. This makes sense considering how many cognitive skills we use to prepare food, including multitasking (like setting a timer for what’s in the oven while watching something else on the stove), advance planning (picking out what you want to cook and making a shopping list of those ingredients), and remembering techniques and recipe steps.
This isn’t just related to cooking; someone losing the ability to do something they used to do regularly or easily is definitely a troubling sign. “If you’re an engineer, and all of a sudden you can’t do simple math…that’s a big red flag,” says Dr. Chen as an example.
What to do if you’re concerned
If you notice these signs in a loved one, Dr. Noble recommends mentioning it to their doctor. “Primary care physicians are really the best people to start reviewing the types of symptoms and thinking about whether or not a workup ought to be pursued, or a referral to a neurologist,” he says. Not only do they likely have an existing relationship with their patient, and easy access to years of medical history, they are also in a good position to make sure a person’s symptoms aren’t caused by something else, like a thyroid problem or a vitamin deficiency.
Before the visit, Dr. Chen suggests writing down when a symptom started, how often you notice it, and how severe it is. This can help establish a timeline, which may help ensure a quicker (and more accurate) diagnosis. He adds that it’s worth seeking out a dementia specialist or a bigger academic hospital with a dedicated dementia department for more targeted care.
Learning someone has dementia (particularly if that someone is you) can feel like a gut punch. But knowing what you’re up against ensures that you can get the care and support you need, and helps you prioritize an individual’s safety and quality of life. “All these things matter,” says Dr. Noble. So don’t be afraid to take that next step if you feel like it’s time.
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