If you’re noticing changes in someone you care about and wondering whether it could be dementia, the most important step is getting them to a doctor for evaluation. Many conditions that look like dementia are actually treatable, and even when the cause is a progressive brain disease, an early diagnosis opens the door to legal planning, safety adjustments, and treatments that work best in the earliest stages. Here’s how to move from concern to action.
Know What You’re Actually Looking For
Dementia doesn’t always start with forgetting names or misplacing keys. Sometimes the first thing to change is the person’s motivation, patience, humor, or mood. A once-social parent who becomes withdrawn, an easygoing spouse who turns irritable for no clear reason, or a friend who starts making impulsive financial decisions can all be showing early signs of cognitive decline.
Clinicians use the term “mild behavioral impairment” to describe new, sustained changes in personality like apathy, irritability, impulsiveness, emotional volatility, loss of empathy, or unusual suspiciousness that persist for six months or more. Different types of dementia tend to announce themselves differently. Alzheimer’s disease often begins with apathy or irritability. Frontotemporal dementia can affect empathy and social judgment first while memory stays perfectly intact. If an older adult becomes uncharacteristically withdrawn, impulsive, or suspicious, and that change sticks around, it deserves clinical attention.
Beyond personality shifts, watch for trouble with tasks that require planning or sequencing: managing bills, following a recipe they’ve made for years, navigating a familiar route, or keeping track of medications. These “executive function” problems often appear before the classic memory lapses people associate with dementia.
Have the Conversation Carefully
Bringing up cognitive concerns with someone you love is one of the hardest conversations you’ll ever have. The person may already sense something is wrong and feel frightened or defensive. A few principles help.
Choose a calm, private moment rather than raising it in front of others or during an argument. Frame your concern around specific observations rather than labels: “I’ve noticed you’ve been having trouble keeping track of your appointments lately, and I’m a little worried” works better than “I think you might have dementia.” Focus on your own feelings and observations using “I” statements. Keep the tone warm and avoid anything that sounds like a confrontation or an accusation.
If the person resists, don’t force the issue in one sitting. You may need to revisit the conversation more than once. Sometimes suggesting a “routine checkup” feels less threatening than naming dementia directly. If you have a good relationship with their primary care doctor, you can also call the office ahead of time to share your observations so the doctor can raise the topic themselves.
Get a Medical Evaluation
A primary care doctor is the right starting point. They’ll likely run blood work and review medications before anything else, because several treatable conditions can mimic dementia convincingly. Depression can make someone seem tired, listless, and withdrawn in ways that look like cognitive decline. Medication interactions, especially common in older adults taking multiple prescriptions, can cause confusion and forgetfulness. Vitamin B-12 deficiency, thyroid problems, infections like urinary tract infections or Lyme disease, heavy alcohol use, poor nutrition, and even heart or lung conditions that reduce oxygen to the brain can all produce dementia-like symptoms that improve or resolve entirely with treatment.
If those causes are ruled out, the doctor will typically administer a brief cognitive screening. Two common tools are the Mini-Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MoCA), both scored on a 30-point scale. The MoCA is generally considered more sensitive to early changes because it tests executive skills like mental flexibility and abstraction that the MMSE doesn’t cover in depth. People in the early stages of decline often score normally on the MMSE but show deficits on the MoCA.
From there, the doctor may refer your loved one to a neurologist for brain imaging, more detailed neuropsychological testing, or both. These steps help identify which type of dementia is involved, which matters because different types progress differently and respond to different treatments.
Address Safety Right Away
You don’t need to wait for a formal diagnosis to start thinking about safety. Two areas deserve immediate attention: driving and the home environment.
Driving
Driving requires alertness, quick decision-making, and the ability to process multiple streams of information at once. Signs that someone should stop driving include new dents or scrapes on the car, confusing the brake and gas pedals, sudden lane changes, getting lost on familiar routes, two or more traffic tickets in a short period, and comments from neighbors or friends about unsafe driving. If you notice any of these, bring it up with their doctor. Some states allow physicians to recommend a formal driving evaluation, and occupational therapists can administer on-road assessments that give an objective answer.
Home Modifications
Falls are one of the biggest risks for someone with cognitive impairment. Small changes can make a significant difference. Mark the edges of stairs with brightly colored tape. Install nightlights and automatic light sensors in hallways and bathrooms. Pad or remove furniture with sharp corners. Place nonskid strips or mats in the tub, shower, and on uncarpeted bathroom floors. Install grab bars near the toilet and in the shower, ideally in a contrasting color so they’re easy to see.
For orientation, use brightly colored signs or simple pictures to label rooms like the bathroom and kitchen. Place decals at eye level on sliding glass doors and large glass panels so the person doesn’t walk into them. Store medications, cleaning supplies, and sharp objects in locked cabinets. A baby monitor or room monitoring device can alert you to sounds of a fall during the night.
Handle Legal and Financial Planning Early
This is the piece families most often regret putting off. Legal documents like powers of attorney must be created while the person still has the legal capacity to make decisions. Once dementia progresses past a certain point, it becomes far more complicated and expensive to establish these protections.
The essential documents to prioritize:
- Durable power of attorney for finances names someone to make financial decisions when the person is no longer able to.
- Durable power of attorney for health care names a proxy to make medical decisions on their behalf.
- A living will spells out the person’s wishes for emergency medical treatment if they become unable to communicate, particularly around end-of-life care.
- A will or living trust specifies how property, money, and other assets will be distributed, and can also address care for dependents.
An elder law attorney can prepare all of these, often in a single session. If cost is a concern, many Area Agencies on Aging offer free or reduced-cost legal assistance for older adults.
Talk to Children and Other Family Members
Dementia affects the whole family, and children in particular may not understand what’s happening. Experts recommend answering kids’ questions simply and honestly. Something like “Grandma has an illness that makes it hard for her to remember things” is enough for a young child. Let them know that feelings of sadness and anger are normal, that no one caused the disease, and that they can always come to you with questions.
For other adult family members, share what you’ve observed, what the doctor has said, and what practical help you need. Dementia caregiving tends to fall disproportionately on one person, and distributing responsibilities early prevents burnout later.
Learn How to Communicate as Things Change
As cognitive decline progresses, the way you interact with the person will need to shift. Don’t correct or argue with them if they make a mistake or forget something. Be patient when they struggle to find the right word. Never use baby talk or a harsh tone. If visitors come by, suggest they introduce themselves with context: “Hi George, I’m John. We used to work together.” These small adjustments preserve the person’s dignity and reduce frustration for everyone.
Connect With Support Resources
You don’t have to figure this out alone. The Alzheimer’s and Related Dementias Education and Referral Center (ADEAR), run by the National Institute on Aging, has information specialists you can reach at 800-438-4380 or [email protected]. The Eldercare Locator, a free service through the Administration for Community Living, connects you to local services like respite care, meal programs, and support groups in your area. Veterans and their families can access the VA Caregiver Support Program for a dedicated support line and coordinator.
Local chapters of the Alzheimer’s Association also run caregiver support groups, both in person and online, where you can talk to people navigating the same challenges. Many caregivers say these groups became their most valuable resource, not just for practical advice but for the emotional relief of being understood.