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How to recognize symptoms of cognitive decline in older adults

By Elyse Notarianni


It’s something most people don’t think to worry about up until the moment they start to notice it — how do you know when the older adults in your life are just showing normal signs of aging, and how do you know when it’s progressive cognitive decline? It’s a tricky situation, and one that many people don’t take action on soon enough.


“A lot of people don’t fully understand what cognitive decline looks like,” says Rachel Chalmer, MD, a geriatrician affiliated with Montefiore Medical Center and a member of the COHME Board of Directors. “Sometimes, people aren’t able to recognize the early signs and symptoms of dementia in older adults, and they don’t know that an older adult needs assistance until they’re already pretty far gone.”


It’s a tricky situation, she says. The warning signs, especially at the beginning, can be very subtle. Misplacing things, forgetting parts of conversations, losing keys — these are things that happen to everybody at every stage of life. And because they don’t want to offend the older adult, people tend to write it off. But when these changes become more consistent, it may be cause for concern — and time to have that difficult conversation.


“In about 3/4 of the families I meet, the patient knows why I’m there and is aware that they’re having memory changes,” says Chalmer. “They are often having a hard time with it, and they may have feelings about the way their children are handling it, but ultimately, they see that something is changing.”


More advanced signs are easier to see — things like forgetting to pay bills for months, forgetting to schedule regular appointments, or repeatedly missing appointments that have been scheduled. Other signs include routinely forgetting to turn off the stove when cooking, becoming more socially withdrawn, and not taking medications reliably. Even something as simple as going to the grocery store with a list and yet buying duplicates of something you already have plenty of at home can be an indicator.


“You’re looking for a sustained pattern of accumulation of changes,” says Chalmer. “What the changes are is going to vary person to person. You may not have to worry about things like being disorganized if the person has always been known to lose things. But if someone has a standing hair appointment that they never miss, and all of a sudden they can’t keep track, that’s a sign. The earlier you intercede, the better.”


This has always been a difficult conversation, but all of this has only become more complicated since Covid.


“Covid has impacted all of our brains, not just older adults’ brains, in ways we still don’t fully understand,” says Chalmer. “A lot of people have experienced higher rates of anxiety, depression, stress and trauma responses. We’ve seen a trend in older adults who’ve had Covid; they seem to have acceleration of any prior cognitive decline.”


The social isolation caused by Covid lockdowns, too, could have contributed to cognitive decline — worse, there was sometimes no one around consistently enough to notice. But, on the other hand: Now that we can be with our families, people are spending more time together than they otherwise may have before.


“Now that so many people are working from home and spending more time with older loved ones, there’s an uptick in people coming in with earlier stages of cognitive decline than they might otherwise have,” says Chalmer.


If someone does see signs of cognitive decline, it’s important to talk to a family medicine doctor, internist, or geriatrician to explore what’s going on.


“Doctors have standard tests to help diagnose cognitive decline, and from there they can refer the patient to a neurologist for further testing if needed,” says Chalmer.


Regardless of testing, there are ways to slow or help prevent cognitive decline in older adults.


“Keep your mind active at every age,” says Chalmer. “Do puzzles, play word games, keep learning, stay socially active, exercise and eat a healthy diet.”


Looking for resources for Alzheimers and Dementia? Visit the Alzheimer’s Association, Caring Kind, and Senior Guidance for more information.