Early signs of dementia and depression in older adults: caring for your parents

Normal aging, dementia or Alzheimer's: what is the difference?

Forgetting things now and then is a normal part of getting older, but dementia is not. As the US National Institute on Aging (NIA) explains, an older person may simply need more time to remember something or to learn something new. Dementia, by contrast, is a decline in memory and thinking that goes far enough to disrupt everyday life, and knowing the early signs of dementia helps you tell the two apart. Many people call any kind of dementia "Alzheimer's", but the two are not the same thing: Alzheimer's disease is not another name for dementia, it is its most common cause.

Here are some of the comparisons the NIA offers:

• Normal: losing things from time to time. Sign of dementia: misplacing things often and being unable to find them.
• Normal: forgetting which day it is, then remembering later. Sign of dementia: losing track of the date or the time of year.
• Normal: sometimes not finding the right word. Sign of dementia: struggling to keep up a conversation at all.
• Normal: forgetting to pay a bill once. Sign of dementia: being unable to manage the monthly bills.

In a fact sheet updated in 2026, the World Health Organization (WHO) estimates that about 57 million people worldwide were living with dementia in 2021, and that Alzheimer's disease accounts for 60–70% of cases. Dementia is more common after the age of 65, but it is not an inevitable result of aging.

Early signs of dementia you should not ignore

These signs, described by the WHO and the NIA, are a good reason to take your mother or father to see a doctor, especially if they are new and getting worse over time:

• Forgetting recent events, and asking the same question over and over
• Getting lost in a place or on a route they know well
• Becoming confused about time, people and places
• Difficulty with familiar tasks or with making decisions
• Trouble finding words or following a conversation
• Neglecting themselves, such as eating poorly or not washing, or behaving in unsafe ways

The WHO points out that changes in mood and behavior, such as anxiety, sadness, a change in personality or withdrawing from people, sometimes appear even before memory problems do.

Depression in the elderly: when it looks like memory loss

The NIA stresses that depression is common in older adults but is not a normal part of aging. In some older people sadness is not the clearest symptom; instead they may seem emotionally flat or lose interest in things. In some cultures, depression shows up mainly as physical complaints such as aches, headaches and digestive problems. Signs the NIA describes in older adults include:

• Losing interest in things they used to enjoy, and neglecting their role and responsibilities in the family
• Tiredness and low energy, and moving or speaking more slowly
• Difficulty concentrating, remembering and making decisions
• Changes in sleep, appetite and weight
• Irritability, feelings of hopelessness or guilt, or thoughts of death

MedlinePlus, the US National Library of Medicine's health encyclopedia, notes that tiredness, poor appetite and sleep problems can be put down to age or to a physical illness, so the early signs of depression often go unnoticed, and that severe depression can look like dementia. The NIA adds that depression can be an early warning sign of dementia and that the two can occur together, which is why only a specialist assessment can tell them apart. The reassuring news is that depression, even severe depression, can be treated. Read more about the symptoms of depression.

Forgetfulness that follows retirement or the death of a husband or wife often improves as the emotions settle, the NIA explains. If it lasts for weeks, have it checked by a doctor.

Treatable medical causes to rule out first

Not all forgetfulness in older age is dementia. The NIA lists other causes, many of which improve with treatment:

• Thyroid problems, or kidney or liver problems
• Low vitamin B12 or poor nutrition
• Medicine side effects, including common medicines with an "anticholinergic" effect, which the UK's National Institute for Health and Care Excellence (NICE) warns can impair thinking
• Infections, including urinary tract infections, which the NHS describes as a common cause of sudden confusion in older people
• Depression, anxiety and sleep problems, as well as poor hearing or eyesight, which NICE lists among the causes that should be checked
• Head injuries, and alcohol or drug use

That is why NICE guidelines published in 2018 recommend a physical examination and blood and urine tests to rule out treatable causes, along with a memory test, before dementia is diagnosed. Bring a list of all your parent's medicines and supplements with you, because, as the NIA notes, the body's changes with age raise the risk of medicines interacting with each other.

Confusion, suspicion and hallucinations in older adults: when is it an emergency?

The NHS draws a line between forgetfulness or confusion that builds up gradually, which needs a doctor's appointment soon, and confusion that comes on suddenly, known as delirium, which needs help straight away because some of its causes can be life-threatening, such as infections, a stroke, low blood sugar and some medicines. Signs of delirium include unclear speech, not knowing where they are, poor attention, and seeing or hearing things that are not there.

Suspicion and accusations of theft

In dementia itself, hallucinations and delusions can appear in the later stages, the NHS notes. The NIA explains that suspicion is often linked to memory loss: someone who forgets where they put something may believe that somebody has stolen it. So:

• Don't argue about what they see or hear, and don't respond to an accusation with anger
• Reassure them that they are safe, then gently distract them with an old photo or a short walk
• Turn off the TV during violent scenes, as they may think these things are happening in front of them
• Tell their doctor, because another illness or a medicine may be behind it

And remember that some suspicion is justified: as the NIA points out, older people can genuinely be victims of abuse or financial exploitation.

Caring for a parent with dementia at home: what helps?

These practical tips come from the NHS, the NIA and the WHO:

A steady daily routine

• Keep regular times for meals, walks and sleep, and encourage the activities they enjoy and time sitting with the family
• Get them out into daylight, cut down on tea and coffee in the evening, and use a soft night light if it helps them sleep
• Put up a large, easy-to-read clock if they often ask what time it is

Communication that protects their dignity

• Be patient when they repeat a question; they are not trying to annoy you, they have simply forgotten that they asked
• If they ask about someone who died years ago, don't break the news to them all over again; talk with them about that time in their life instead
• If they ask to "go home" while they are already at home, reassure them that they are safe
• Choose small visits rather than big gatherings

A safer home

• Lock away medicines, cleaning products and sharp objects
• If you can, fit an automatic shut-off for the stove and use gas and smoke detectors, because they may not be able to smell gas or smoke
• Light hallways at night, mark the edges of stairs with brightly colored tape, and fit grab bars in the bathroom
• Write emergency numbers and the home address next to the phone, and go out with them if they get lost or often wander out of the house

Dementia medicines: what they can and cannot do

There is still no cure for dementia, the WHO says, but medicines do have a specific role, which the WHO and the NHS explain:

• Medicines that ease symptoms for a while: a doctor may prescribe donepezil, rivastigmine, galantamine or memantine. They are used mainly in Alzheimer's disease, but they do not cure it.
• Treating other conditions: keeping blood pressure, blood sugar and cholesterol under control, and treating depression, are an essential part of the plan.
• Antidepressants: a doctor may prescribe them for depression in an older person. When someone has mild or moderate dementia, though, NICE recommends talking therapy for mild to moderate depression and advises against giving antidepressants for it as a matter of routine, while the WHO says they may help with severe depression when changes to lifestyle and social life have not worked. If a doctor prescribes one for your parent, read about antidepressant side effects.
• Medicines for agitation and aggression: antipsychotics are only used once non-drug approaches have been tried and there is a clear need, with caution and under a psychiatrist's supervision. NICE warns that they can cause severe reactions in people with Lewy body dementia.

The WHO also stresses that non-drug approaches, such as physical activity, social contact, memory-stimulating activities and support for the family, improve quality of life.

Looking after yourself as a carer: how to avoid burnout

In its estimate of the global cost of dementia in 2019, the WHO notes that relatives and friends who care for someone with dementia provide on average about 5 hours of care and supervision a day. NICE guidelines also point out that carers are at higher risk of depression. So:

• Share the responsibility with your brothers, sisters and other relatives using a clear schedule, and don't carry the load alone.
• Take regular breaks, and ask a relative to stay with your parent for a while.
• Learn about the illness and how to handle it: NICE recommends education and skills training for carers, and notes that it often works best in groups.
• Watch your own health: if your sadness, exhaustion or poor sleep lasts more than two weeks, ask for help.

The NHS advises carers who feel frustrated to see a doctor, as talking therapy may help, and you can start with a therapy session for yourself. Asking for help is not letting your parents down; it is what allows you to keep caring for them.

When to seek help, and how assessment and treatment begin

Take your mother or father to see a doctor soon if:

• Forgetfulness is getting in the way of daily life or getting worse over time
• Signs of depression last more than two weeks
• Their personality changes, or suspicion, hallucinations or aggression appear
• They neglect themselves or get lost outside the home

Get help immediately if confusion or hallucinations come on suddenly, or if they become a danger to themselves or to others.

An assessment usually begins by listening to your parent and to a family member who knows them well, followed by the tests mentioned above. Brain imaging or referral to a specialist service may be needed, as NICE recommends, so go with them yourself and write down what you have noticed.

At Oxygen, you can start with an appointment with a psychiatrist to assess mood, memory and behavior and decide what tests or follow-up with other specialties are needed, then agree on a plan that includes treating depression if it is present and involves the family in care. If your father refuses to come, the family can come on their own first. Contact us at any time.