Normal Aging vs. Dementia: When Should You Be Concerned?
This morning you approached your vehicle to meet up with some friends for brunch, then realized you forgot your car keys in the house. During brunch, you lost your train of thought while having a conversation with your friends—not something that’s terribly unusual, but it nevertheless feels embarrassing as they wait for you to remember what you were going to say. When you get home, you walk into the kitchen then realize you forgot why you went there in the first place. You think of a family member who had dementia—a parent, an aunt or uncle, a sibling—and you start to sweat a little as you wonder whether you’re showing early signs of dementia yourself.
The above is a common story; one I’ve heard many times from patients in my office. Often, this leads to the question: “Is this normal or a sign of dementia?”
During my work as a neuropsychologist at a VA hospital in Missouri, I signed up for a special week-long course on geriatrics. One of the lectures I found most intriguing was about the different ways organ systems change with aging (provided by a physician board-certified in geriatrics). As the body ages, very normal and predictable changes take place across all aspects of the body. The liver and metabolic processes slow down. The kidneys aren’t as efficient. Sensory organs like the eyes, ears, and nose do not work as well as they used to. The skin is no longer as elastic. Nails get thicker and harder. And memory isn’t what it used to be.
While these changes can be difficult to adjust to, understanding the body’s natural changes with age can provide some reassurance. And although walking into a room and forgetting why can feel unsettling, this is not an uncommon symptom of normal aging.
What’s Normal with Aging?
Cognition is a word that describes your brain’s thinking abilities: the ability to learn and remember new information, to process information efficiently, to pay attention, to be able to solve problems, and so forth. As the brain ages, normal cognitive changes include slower processing speed (slowed thinking), which can mean that it takes longer to recall information. Importantly, taking a longer time to recall information is much different than completely failing to learn/retain information in the first place. In addition to slowed processing speed, most individuals experience less efficiency with attention. It may be harder to manage several tasks at once (multitasking). And, of course, individuals experience more forgetfulness. Walking into a room and forgetting why involves trouble remembering an intention, a very common change with aging. Individuals may misplace items, forget the name of an acquaintance, or forget a word they wanted to say. Often, with time, individuals will remember where they misplaced the item, what the name or word was, or why they went into that room.
When Should You Be Concerned About Memory Loss?
So what sort of memory changes merit more concern? It is generally a good idea to speak with your doctor if you find that you are forgetting how to do things that should be quite familiar to you; for example, repeatedly forgetting to take medications or manage finances when this was something you managed fine before[1]. It is also more concerning when a person repeatedly forgets recent conversations or asks the same question over and over again within a relatively short period. Another concerning symptom is when the difficulties appear to be progressively worsening over time or when multiple family members start to notice problems and express their concerns.
Although I have said much about memory, it is also important to remember that not all types of dementia are characterized by memory loss alone[2]. For example, some types of dementia affect speech, and although occasionally forgetting a word is normal, it is more concerning when an individual is having significant difficulty expressing themselves or is frequently misnaming or mixing up the correct words they are trying to say.
Other Causes of Memory Problems
By the same token, it is also noteworthy that not all memory problems are caused by Alzheimer’s disease (a common type of dementia characterized by memory loss) [3]. For example, there are certain medical conditions such as thyroid dysfunction and/or certain nutritional deficiencies that can measurably cause memory dysfunction (but which may improve with the right treatment). In other situations, hearing/vision loss can impact memory when the individual is not hearing/seeing the information well enough to retain it in the first place. Certain medications can slow thinking and impact memory, while certain behavioral health factors (e.g., anxiety, depression, prolonged stress, chronically disrupted sleep) can interfere with optimal memory functioning as well.
In all, the presence of memory loss can have many different causes and may not have a single, simple explanation. And when symptoms of memory loss are suspected of being greater than what aging alone would explain, your doctor may refer you for a comprehensive assessment. A memory evaluation might also be considered when memory problems are clearly worsening over time, or when a person’s memory loss is interfering with their ability to complete everyday tasks that allow them to live independently (e.g., forgetting to take medications or pay bills, forgetting how to get to familiar places while driving, forgetting to eat). When such concerns arise, a reasonable first step is to speak about them to your primary care provider, who might review medications or order relevant labs. If such a preliminary assessment does not reveal the cause of the problem, or memory dysfunction continues to persist, that is often the point where your doctor may refer you for neuropsychological assessment. That is my specialty.
How can a Neuropsychological Evaluation Help?
A neuropsychological evaluation is a comprehensive assessment of cognitive and psychological functioning. During such an evaluation, an individual will complete a series of ‘tests’ designed to assess memory, attention, language, visuospatial abilities, executive functioning, and so on. After, a person’s performance is compared to their own peers’ performance (called normative data); in other words, I can see how much information someone is able to remember and then (using statistical analyses) look to see whether it is normal for age. This type of evaluation is considered by many to be the gold standard when it comes to diagnosing cognitive disorders such as dementia. I have simplified much of what the neuropsychological evaluation actually involves, and perhaps I will expound upon that in another article. For now, know that the neuropsychological evaluation can help determine whether normal aging, dementia, or another factor is the probable cause of a person’s memory problems; in addition, this type of evaluation will provide practical recommendations and suggestions regarding next steps[4].
Interestingly, I have met many individuals who avoided going to a neuropsychological evaluation (in spite of it being suggested by their doctor) for years due to not wanting to know whether they meet criteria for dementia. Others avoid such testing because they are worried I will take their car keys or send them to a nursing home if they ‘fail’ the testing. Some have avoided testing simply due to pride, refusing to acknowledge that there was a problem in the first place. This is unfortunate, because the earlier a real problem is detected, the better it can be addressed. Beyond this, the earlier a baseline can be obtained, the better, as neuropsychological assessment can be repeated over time to monitor change. Of note, I cannot revoke one’s driver’s license, nor can I force them to move into a nursing home. I might make recommendations regarding driving safety or living arrangements, but in most circumstances, these decisions remain with the patient and their family.
Conclusion
All in all, changes in memory are a normal part of aging. Even when more serious memory problems are identified, there are multiple factors that could be a potential cause (not just dementia). When dementia does become a legitimate concern, neuropsychological testing may be recommended. Neuropsychological testing is a comprehensive assessment of cognitive and psychological functioning, and it often can provide direction in terms of what to do next. If you or a loved one is concerned that symptoms of memory loss are beyond what would be reasonably expected for normal aging, let your doctor know. And if neuropsychological assessment is recommended, I hope you feel a little more prepared.
*About Dr. Jared Cline: I am a licensed psychologist and clinical neuropsychologist providing memory and cognitive evaluations for adults experiencing concerns about changes in thinking or memory. My practice, Red Pine Neuropsychology, is located in Farmington, Utah.
References
1. National Institute on Aging. (n.d.). Memory problems, forgetfulness, and aging. National Institutes of Health. https://www.nia.nih.gov/health/memory-loss-and-forgetfulness/memory-forgetfulness-and-aging-whats-normal-and-whats-not
2. National Institute on Aging. (n.d.). What is dementia? Symptoms, types, and diagnosis. National Institutes of Health. https://www.nia.nih.gov/health/alzheimers-and-dementia/what-dementia-symptoms-types-and-diagnosis
3. National Institute on Aging. (n.d.). Assessing cognitive impairment in older patients. National Institutes of Health. https://www.nia.nih.gov/health/health-care-professionals-information/assessing-cognitive-impairment-older-patients
4. Dickerson, B. C., Atri, A., Clevenger, C., Karlawish, J., Knopman, D., Lin, P.-J., Norman, M., Onyike, C., Sano, M., Scanland, S., & Carrillo, M. (2025). The Alzheimer's Association clinical practice guideline for the diagnostic evaluation, testing, counseling, and disclosure of suspected Alzheimer's disease and related disorders (DETeCD-ADRD): Executive summary of recommendations for specialty care. Alzheimer's & Dementia, 21(1), e14337. https://doi.org/10.1002/alz.14337
