Let’s start with some good news: Older adults today maintain their brainpower longer than they did in previous generations.

Over the past 25 years, a person’s odds of developing dementia have fallen by 13%, according to a study published in the journal Neurology. That’s something to celebrate. But it’s also no comfort if you or a loved one begins showing signs of cognitive decline.

Alzheimer’s disease, the leading cause of dementia, affects 6.2 million Americans, according to the Centers for Disease Control and Prevention. And it’s the fifth-leading cause of death for people age 65 and older.

While dementia can feel like it comes on quickly, the signs may appear years — or possibly decades — before a diagnosis. Researchers from Rush University Medical Center in Chicago found that poor results on a cognitive exam could predict an Alzheimer’s diagnosis as much as 18 years ahead of time. That’s as far as the researchers looked, so the signs may appear even earlier.

That means the clues are there. You just need to know what you’re looking for. And according to the Alzheimer’s Association, spotting dementia before it’s serious can help you manage symptoms and reduce anxiety about the changes that will likely come.

So whether you’re worried about yourself or a loved one or you just want to be informed, here are the warning signs you should watch for.

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Early dementia sign #1: Forgetting recent conversations

“The most common early sign of dementia is simply forgetting,” says Jo Cleveland, MD. She’s a geriatric medicine specialist focused on dementia at Wake Forest Baptist Health in Winston-Salem, North Carolina.

A memory that’s slipping often leads to a person forgetting something that was recently said, says Dr. Cleveland. They might ask the same question multiple times per day, for example.

But don’t we all struggle with forgetfulness sometimes? Of course, says Thomas Gill, MD. He’s the Humana Foundation Professor of Geriatric Medicine at Yale University in New Haven, Connecticut. “Occasional forgetfulness is a common problem that increases with age,” he says. “In healthy brains, that memory will come back, even if it takes a while. With dementia, the information cannot be retrieved, and memories are lost.”

Early dementia sign #2: Struggling to find the right word

Forgetfulness can also lead to an inability to access basic vocabulary. That can turn everyday conversations into puzzles that need to be solved.

For example, a person might describe something as “the thing that tells you what day it is,” says Dr. Cleveland. “But they cannot come up with the word ‘calendar.’”

Early dementia sign #3: Falling behind on routine tasks

People with early dementia often begin to struggle to manage what Dr. Cleveland calls the 4 M’s. These are:

  • Medications
  • Meals
  • Money
  • Mobility (driving, public transportation, etc.)

“All of these skills rely on our executive function — our ability to plan, organize and strategize,” she says. “And this ability is lost early on in dementia.”

Early dementia sign #4: Trouble with relative time

Anybody can forget what day of the week it is. But healthy brains can often figure it out based on context. For instance, you went to church yesterday, so today is Monday.

But that’s not so easy for someone who’s slipping. “People with dementia cannot follow that kind of logic,” says Dr. Cleveland. They might turn to a loved one and say, “I haven’t seen you in weeks,” even if their last visit was yesterday.

Early dementia sign #5: Unusual changes in personality

As a person begins to show early signs of dementia, they may start to experience the world differently. They may not feel like themselves, and as a result, they may begin acting differently.

One common change is that previously outgoing people can become more reserved, says Dr. Cleveland. They might even stop doing hobbies they once loved. “Social withdrawal is especially common, probably because people with dementia have difficulty following conversations,” she explains.

These changes are often subtle early in the disease. But you will probably be able to recognize them in a close loved one.

What should you do if you see signs of dementia?

There’s no cure for dementia. But there are steps you can take to delay or prevent it from developing.

1. Schedule an appointment with your doctor

If you see signs of cognitive decline, the first thing you should do is check in with your provider, says Dr. Cleveland. In some cases, the problem might not be what it seems. “There are medical problems that masquerade as dementia that need to be ruled out, such as hypothyroidism and obstructive sleep apnea,” Dr. Cleveland explains.

Many medications can also have dementia-like side effects, she says. (They can also throw off your balance and increase your risk of falling.) Your doctor will be able to help you find solutions. And mental health conditions such as depression can also sometimes seem like dementia.

You want to either rule out cognitive decline or spot it early. If you have Medicare, your cognitive exam will be covered as part of your annual wellness visit. Just be sure you tell your doctor you want one. A study from the journal Health Affairs found that fewer than one-third of patients received a formal cognitive assessment.

Related reading: How time with friends keeps your brain sharp

2. Consider medication

While no medication can reverse dementia, there are some that can help manage symptoms. For instance, certain medications may help you find forgotten words or follow through on daily tasks. These include:

(Here’s what you should know about medication for memory loss.)

There’s also a new medication called aducanumab (Aduhelm®), which was recently approved by the Food and Drug Administration. It removes amyloid protein plaques, which build up in the brains of people with Alzheimer’s disease. But many dementia-care specialists say that Aduhelm may not be effective and may even cause harm, says Dr. Cleveland. “There is currently considerable controversy about the use of this medication, and many health systems are choosing not to make it available to patients.”

Plus, Aduhelm costs $28,200 a year. So Medicare and other insurers have signaled a reluctance to cover it.

3. Exercise every day

Beyond medication, routine workouts may help protect your brain from deterioration. They offer “not just physical benefits but also cognitive benefits,” Dr. Gill says. “Even in later life, if someone becomes more physically active, that can still be an effective strategy for stalling cognitive problems.”

A study published in the journal Alzheimer’s Research & Therapy supports his point. It found that people who consistently worked out before and after developing mild cognitive impairment were 18% less likely to develop dementia than were people who did not regularly engage in physical activity.

The research also found that it’s never too late to start exercising. People who didn’t work out until they had developed mild cognitive impairment still saw benefits. They were 11% less likely to develop dementia.

If you need a benchmark, aim for 2.5 to 5 hours of moderate-intensity exercise per week. That’s the recommendation for active older adults set by U.S. Health and Human Services.

Even without a miracle drug, there are steps you can take to protect your brain right now. And if you also want to protect your wallet, download the Optum Perks discount card. It can save you up to 80% on your prescription medications.

Additional sources

Dementia rates are falling: Neurology (2020). “Twenty-seven-year time trends in dementia incidence in Europe and the United States

Signs of Alzheimer’s show up as far as 18 years in advance: Neurology (2015). “Cognitive impairment 18 years before clinical diagnosis of Alzheimer disease dementia

Alzheimer’s overview: Centers for Disease Control and Prevention

Benefits of early dementia detection: The Alzheimer’s Association

Medicare’s annual wellness visit: Medicare.com

Frequency of cognitive assessments with annual wellness visits: Health Affairs (2020). “Cognitive Assessment at Medicare’s Annual Wellness Visit in Fee-for-Service and Medicare Advantage Plans

Aduhelm controversy: Cureus (2021). “Aducanumab as a Novel Treatment for Alzheimer’s Disease: A Decade of Hope, Controversies, and the Future

Aduhelm price: Biogen investor relations (2021). “Biogen Announces Reduced Price for Aduhelm to Improve Access for Patients with Early Alzheimer’s Disease

Exercise can prevent dementia: Alzheimer’s Research & Therapy (2020). “Association between physical activity and conversion from mild cognitive impairment to dementia

Exercise recommendations: Physical Activity Guidelines for Americans