Family Members Often See First Signs of Dementia

It’s true that family members often see first signs of dementia, long before a doctor makes a diagnosis.

There are the moments before the doctor confirms it, before the tests and brain scans, before the word itself is ever said aloud. Small, almost forgettable.

A father who suddenly forgets how to use the coffee maker he’s owned for twenty years. A mother who drives to the store comes home without the milk she left to buy.

A husband who asks the same question twice, his voice calm, unaware of the repetition. The early signs don’t arrive with sirens or flashing lights. They slip in quietly, one misstep at a time.

Most families don’t see it at first. Or they see it but explain it away. It might start with stress, aging, and a horrible night’s sleep. The excuses make sense—until they don’t.

Then, one day, it clicks: something is wrong. And when that realization comes, it doesn’t arrive in a doctor’s office. It happens at the dinner table, in a conversation that doesn’t flow as it used to, in a familiar face that suddenly looks lost.

The People Who Notice First

Doctors rely on exams and scans. Family members rely on something else—knowing how their loved one used to be.

They know the sound of their voice when they’re lying to cover up a forgotten detail. They notice the pause before an answer and the hesitation before picking the right word.

They see how they pull back from conversations they used to lead and how they suddenly let others make the decisions.

The medical world has tried to capture this awareness in tests. The AD8 questionnaire is one of them—a simple, two-minute assessment that asks family members if they’ve seen changes in thinking and memory.

Did they once handle complex tasks easily but now struggle? Have they started forgetting the month or year? The answers, yes or no, add up to something bigger.

Research shows that AD8 often catches problems before formal office screenings do.

Then there’s the Mini-Mental State Exam (MMSE)—the standard test many doctors use. It’s familiar, but it’s flawed. It measures memory and cognition, but it can miss the earliest changes.

A person may score well on the test but still struggle to manage daily life. Experts recommend using informant-based assessments like the AD8 alongside traditional testing.

The real story isn’t in a doctor’s office—it’s in the home, where the small failures build up over time.

Other Ways Dementia is Diagnosed

Doctors don’t rely on a single test. There isn’t one. Instead, they piece together what they can from different tools—some old, some new, none perfect on their own.

Cognitive and neurological tests

- Two-finger test – Doctors ask patients to copy a hand gesture. It seems simple. It isn’t always.
  
  Brain scans

- CT scan – X-ray imaging that looks for strokes, tumors, or brain shrinkage.

- MRI scan – Uses magnets and radio waves to create sharper images of brain structure.

- PET scan – Shows how the brain uses energy, detecting changes in activity before structural damage appears.

- SPECT scan – Measures blood flow in the brain, sometimes revealing patterns of decline.
  
  Psychiatric evaluations

- Doctors ask about mood, behavior, and emotional shifts. They listen to what families say.

- They may test for depression since its symptoms can mimic early dementia.
  
  Other tests that sometimes help

- Blood tests – Rule out vitamin deficiencies, infections, or thyroid problems that might look like dementia.

- EEG – A test of brain waves, occasionally used when seizures or other neurological issues are suspected.

- Genetic tests – Rarely conclusive but sometimes helpful in identifying inherited risk.

- Cornell Scale for Depression in Dementia (CSDD) – Measures how much of what’s happening is dementia and how much might be treatable depression.

There is no single answer. No perfect tool. It’s just a series of questions, images, and educated guesses, trying to catch what’s happening before it’s too far gone.

The First Signs, The First Doubts

Memory slips are expected with age. Forgetting where you put your keys isn’t a red flag. Forgetting what they’re for—that’s different.

A father forgets the month, then the year.
A wife starts making strange choices—leaving the oven on and sending money to scam artists.
A brother stops following his favorite TV show because the plot is too complex to track.
A mother suddenly struggles to pay her bills, something she handled effortlessly before.

Then, there are the shifts in personality that make family members question themselves.

A husband, once patient, starts snapping at minor annoyances.
A grandmother forgets birthdays and doesn’t seem to care.
Once warm and affectionate, a father becomes suspicious, convinced people are stealing from him.
A once-sociable woman stops calling friends, avoids gatherings, and sits in silence when she used to fill the room with stories.

These changes don’t happen all at once. They come in waves—good days, bad days, moments of clarity that make the worrying seem foolish.

Then, just as hope builds, another lapse, another mistake, another piece of them slipping away.

What to Do When Worry Becomes Reality

There’s a moment for every family when they stop wondering and start knowing. The question shifts from Is something wrong? What do we do now?

First, trust your instincts. If something feels off, it probably is. Doctors may brush off concerns at first, especially if standard tests don’t show dramatic changes.

But family members see what those tests miss. Push for further evaluation.

A general practitioner may not recognize the warning signs early, so seek a specialist.
Neurologists and geriatricians have more experience diagnosing dementia in its early stages.
Cognitive testing is helpful, but real-world observations matter just as much.

A diagnosis won’t change what’s happening but gives families something to hold onto. It allows them to plan, to prepare, and to stop pretending things will get better.

Caring for Them, Caring for Yourself

There is no cure. That truth is heavy, but it’s not the end of the story. Some medications can slow the disease, but the real work—the hard work—falls on the people left to care.

Routine matters. People with dementia do better with consistency—the same schedule, environment, and habits.
Stimulation helps. Physical activity, puzzles, music—anything that engages the brain can slow the decline.
Patience is key. Arguments won’t work. Facts won’t win. What matters is reassurance, kindness, and meeting them where they are, even when they make no sense.

For caregivers, the weight is immense. Watching someone change in ways you can’t control is a kind of grief. There’s exhaustion, frustration, guilt. There’s love that doesn’t feel like love anymore but obligation. The best advice? Please don’t do it alone.

Support groups exist for a reason.
Therapy can help with the emotional toll.
Respite care can keep burnout from swallowing you whole, even for a few hours.

And the hardest lesson of all: You are still here. Dementia takes from them, but it shouldn’t take from you, too. It’s easy to lose yourself in caregiving, to forget that your life matters as much. Take a break. Go to dinner. See your friends. Let yourself laugh, even when guilt whispers that you shouldn’t.