When someone you love begins missing appointments, repeating questions, having difficulty driving or struggling to pay bills, it can be hard to know what those changes mean. Are they part of normal aging, or could they signal something more concerning? And perhaps most importantly, when is it time to seek help?
If concerns arise, families can play an important role in recognizing meaningful changes, documenting what they are seeing and helping someone seek an expert clinical evaluation. There are resources available, and getting help can improve quality of life for everyone involved.
Why Early Evaluation Matters
Waiting until changes are obvious can mean missing options that are only available early.
Some causes are treatable. Medication side effects, sleep problems, depression and anxiety, hearing loss, hormone imbalances, and vitamin deficiencies can all affect memory and thinking skills. Evaluating and treating them early can make a real difference.
Some treatments depend on timing. Newer disease-targeting therapies, such as anti-amyloid therapy for Alzheimer’s disease, are only FDA approved for individuals in the mild cognitive impairment (MCI) or mild dementia stage with biomarker-confirmed evidence of amyloid pathology. Treatment candidacy depends on a number of factors and is decided by specialists. However, because they are only approved for treating early stages of the disease, a timely evaluation keeps the option open for discussion.
Early answers help a person plan on their own terms. Knowing what is happening sooner gives a person time to make their own decisions about legal and financial matters, health care and future care, and to share those wishes with people they trust.
Start With What Has Changed
Rather than focusing on an isolated incident, consider how the person’s abilities have changed over time. Are they managing everyday activities as well as they did a year ago? What about five years ago? Has someone who always managed the household finances begun missing payments? Is a person who was once very organized having difficulty keeping track of appointments? Has a loved one started getting confused on familiar routes or struggling with tasks they have performed for years?
Changes that represent a noticeable difference from a person’s usual abilities, occur repeatedly, become more noticeable over time or begin to interfere with everyday activities deserve attention.
Concerns can be addressed before a person’s memory problems are severe enough that they lose the ability to live independently. Mild cognitive impairment, or MCI, involves noticeable changes in memory or thinking that are greater than expected for normal aging, while a person remains largely independent in everyday activities.
If you are trying to determine whether the changes may be more than normal aging, UCI MIND’s information about mild cognitive impairment (MCI) and dementia can help explain what to look for.
It Is Not Always Memory
Memory loss is a well-known early sign, but it is not the only one. Some conditions show up in other ways, for example there can be changes in:
- Personality and Behavior: new impulsiveness, poor judgment, loss of empathy, apathy, or unusual spending or eating habits.
- Language: trouble finding words, losing track of what common words mean, or speech that becomes halting or hard to follow.
- Vision and Spatial Awareness: difficulty judging distances, reading, recognizing objects or finding things in plain sight, despite normal eyesight.
- Sleep, Movement, Alertness: acting out dreams during sleep, seeing things that are not really there, changes in alertness or confusion that fluctuates, or new or worsening slowed movement, stiffness, or changes in walking.
These changes may be attributable to a number of different causes. However, if someone’s short-term memory seems fine but they no longer seems like themselves, that is still reason to seek an evaluation.
Talk About What You Are Seeing — Not What You Think It Means
Starting the conversation can be one of the most difficult steps. Telling someone, “I think you have dementia,” may immediately create fear or defensiveness. Family members may have more success focusing on specific observations instead. Some people may already have noticed changes in their memory or thinking and may be worried about what those changes mean. Starting with a gentle question gives them an opportunity to share their concerns without feeling confronted. For example, you might ask, “Have you noticed anything different about your memory lately?”
If you wish to raise your concerns more directly, make sure to give clear examples and keep your language concise. For example:
“I noticed you’ve had trouble keeping track of your appointments lately, and I think it would be a good idea to mention it to your doctor.”
Or:
“You’ve gotten turned around a few times recently on roads you know well. I’d feel better if we had that checked out.”
Expect this to potentially take more than one conversation. A first talk that ends in “I’m fine” is common and not a failure; it plants the idea, and the person may be more open when it comes up again. The conversation usually goes better when one trusted person raises the issue privately, rather than several family members at once, which can feel like an ambush. Choose the person your loved one trusts most on health matters. Practical offers can also make it easier to say yes, such as scheduling the appointment, driving them there, or accompanying them to the visit.
The goal is not to persuade someone that they have a particular condition. It is to encourage a medical conversation about a change that has been noticed. When possible, choose a calm time rather than raising the issue immediately after a frustrating incident.
Keep Track of Specific Examples
Before a medical appointment, write down what family members have observed. General statements such as “Dad is getting forgetful” are less useful than specific examples:
- Asked the same question several times within an hour
- Missed two regular bill payments
- Became confused driving to a familiar location
- Had difficulty following a familiar recipe
- Struggled with a specific task that had previously been routine
Include approximately when the changes began, how frequently they happen and whether they seem to be becoming more noticeable. It can also help to make a list of medications and supplements and note any recent changes in sleep, mood, illness or overall health.
Documenting these observations can help healthcare professionals better understand what has changed and determine whether additional evaluation is needed.
Know Where to Start
For many families, a primary care provider is a good starting point. Share the specific changes you have observed and ask whether further testing is appropriate. For people with Medicare, the yearly Annual Wellness Visit often includes a check for changes in memory and thinking skills. This may be a good time to raise concerns. Depending on the situation, the physician may recommend testing or referral to a specialist, such as a neurologist, for a more comprehensive assessment.
An evaluation may include a review of medical history and medications, cognitive testing, laboratory tests, physical and neurological examinations, or brain imaging, depending on the circumstances.
With the person’s permission, having a family member or trusted person attend the appointment is often very helpful. They may offer observations that the person experiencing the changes has not noticed.
The purpose of an evaluation is to better understand whether cognitive changes are present, what may be causing them and what steps should come next. An evaluation does not always lead to a diagnosis. It may find a contributing cause that can be treated or show that memory and thinking skills are within the expected range. An evaluation may also establish a baseline that helps healthcare professionals recognize changes over time.
If you are told it is just normal aging, but you are still worried and the changes you have documented are new, persistent, or affecting daily living skills, it is reasonable to ask more directly: “could we do a brief cognitive screening today?” or “would it be appropriate to make a referral to a memory specialist?” Requesting a more in-depth look is not overreacting.
Know When Not to Wait
Some situations deserve more immediate attention. Contact a healthcare professional promptly if memory or thinking changes begin creating safety concerns, including problems with driving, medication management, cooking or other activities where mistakes could cause harm.
A sudden change is also different from the gradual onset of cognitive difficulties. If someone becomes suddenly confused, disoriented or dramatically different from their usual self, seek immediate medical attention, as this may indicate an acute medical condition requiring emergency evaluation.
What If Your Loved One Does Not Want Help?
Your loved one may not recognize the changes you are seeing, or they may be frightened by what an evaluation could reveal. In some cases, reduced awareness of one’s own cognitive difficulties can itself be a symptom. This does not necessarily mean the person is being stubborn or in denial.
Arguing about whether memory loss is present rarely helps. Instead, focus on specific concerns and your desire to better understand what may be happening.
A routine health visit may provide a natural opportunity to discuss memory and thinking as part of overall health. Concerns about sleep, medications, balance, hearing, blood pressure or another health issue may provide a starting point.
If safety becomes a concern, families may need to address the issue more directly and seek guidance from an appropriate healthcare professional.
Families Do Not Have to Have the Answer
Recognizing memory changes in someone you love can create uncertainty for everyone involved. Families may wonder whether they are overreacting, whether they should wait a little longer or whether bringing up the subject will make things worse.
You do not have to know the diagnosis before asking for help. If something seems meaningfully different, keeps happening or is beginning to affect daily life, that is enough reason to start the conversation.
Sometimes the most helpful first step is simply saying “We’ve noticed a change. Let’s find out what may be causing it.”
Seeking answers early can help clarify what is happening, identify possible causes and connect families with appropriate care and support.
Family members and caregivers need support, too. Resources such as caregiver education, support groups and community services are available even before a diagnosis. Organizations such as Alzheimer’s Orange County and the Alzheimer’s Association can help families navigate the uncertainty and challenges that may arise.
Resources for Families
Wondering whether the changes may be more than normal aging?
Learn about [Mild Cognitive Impairment] and [Dementia] from UCI MIND.
Need caregiver guidance or services in your community?
Explore [Local Resources]
Want to hear directly from experts and other caregivers?
Visit [UCI MINDcast] for Ask the Doc discussions and Spotlight on Care caregiver conversations.
Seeking an appointment with an expert?
UCI Neurology Memory Disorders Program [Click Here]
UCI Senior Health [Click Here]
