Alzheimer’s May Begin Years Before Memory Fades: How Doctors Spot The Signs

For many families, an elderly parent becoming forgetful is easy to dismiss as a normal part of ageing. “Forgetting a name, missing a conversation or asking the same question repeatedly may not seem alarming at first. But when such changes begin to interfere with everyday life — or are accompanied by changes in behaviour, judgement, language or the ability to perform familiar tasks — they warrant medical attention,” warned Dr Vinit Banga, Director and HOD, Neurology, Fortis Escorts Faridabad.

Talking to The Health Outlook on the sidelines of a World Alzheimer’s Day awareness programme held recently in collaboration with pharmaceutical company Eli Lilly and Company (India) in New Delhi, he said the degenerative disease can begin years before its symptoms become obvious, making early recognition and medical evaluation important.

The distinction between normal ageing and cognitive decline, however, is important.

“Normal forgetfulness does not affect your quality of life or daily routine. But when forgetfulness becomes repetitive and starts affecting daily life, it is a cause for concern,” Dr Banga said.

Alzheimer’s disease is the most common form of dementia and is a progressive neurodegenerative condition.

“Memory is obviously a very important part of it, but Alzheimer’s can also affect judgement, executive functions, language and visuospatial abilities,” Dr Banga said, adding that the changes may initially be subtle.

“For instance, a person who was socially active may gradually stop meeting friends. Someone who takes pride in personal appearance may stop grooming. Food preferences may change. Familiar interests may fade."

“Activities such as reading the newspaper, watching a favourite programme or meeting friends may no longer interest them,” he said, explaining in detail about the signs of Alzehmier’s gripping elderly people.

Problems with judgement and everyday functioning may also emerge. A person may struggle with familiar tasks, dress inappropriately for the occasion, have difficulty preparing a cup of tea or repeatedly use the wrong word while speaking.

These changes do not automatically mean Alzheimer’s. But persistent or progressive symptoms should not simply be dismissed as ageing.

“Once you cross 60, you should be relatively more careful about any cognitive, memory or behavioural symptoms,” Dr Banga said.

However, he cautioned that sometimes what the family thinks is dementia is actually a hearing problem. “A family may feel that an elderly person does not remember what was said when the person may simply not have heard it,” Dr Banga pointed out.

“If you have not even heard what somebody has said, you cannot remember it later. So hearing also needs to be checked and taken care of.”

Vision problems can similarly affect how an older person understands and responds to the environment. This is why hearing and vision assessments can be important when an elderly person begins having communication or cognitive difficulties.

A medical evaluation can help distinguish normal age-related changes from mild cognitive impairment, dementia and other conditions that may affect memory and concentration. Depending on the individual, doctors may use a clinical assessment, blood tests and, where indicated, brain imaging.

The need for early assessment has become more important as newer treatments have emerged. For years, medicines for Alzheimer’s primarily helped manage symptoms. “Newer disease-modifying therapies target amyloid pathology and can slow the rate of decline in appropriately selected people with early Alzheimer’s disease.”

Maintaining vascular and overall brain health is another important part of reducing dementia risk. High blood pressure, diabetes, smoking, excessive alcohol use, physical inactivity and social isolation are among factors associated with dementia risk. The WHO’s updated 2026 guidance says a substantial proportion of dementia risk may be prevented or delayed by addressing modifiable risk factors across the life course.

Dr Banga stressed the importance of everyday habits.

“If you want to slow down your brain’s degeneration, the best thing that you can do is three: one is to avoid stress as much as you can. Number two, have good quality six to eight hours of sleep. Number three, eat healthy food and do exercise.”

He also cautioned against excessive passive screen consumption. While watching an endless stream of short videos may keep a person occupied, activities requiring active participation — such as conversation, playing cards, Sudoku and other problem-solving activities — can provide greater cognitive engagement.

The scale of the problem is significant. Dementia is already affecting millions of people in India, placing a substantial burden not only on patients but also on families and carers. As the population ages, the number of people living with dementia is expected to rise.

At the event, Dr Sahil Kohli, Additional Director – Neurology, Fortis Memorial Research Institute, Gurugram, stressed that recognising changes early can help families understand what they are dealing with and prepare for the road ahead.

“Recognising early signs of Alzheimer’s disease and speaking to a doctor can help patients and families better understand the condition and make informed decisions about the road ahead. It can help families plan care, access appropriate support and have meaningful conversations about the individual’s needs and preferences.”

The need for awareness extends beyond diagnosis and treatment, added Dr Rahul Kapur, Senior Director, Medical, Eli Lilly and Company (India).

“Addressing this challenge requires greater awareness of cognitive changes associated with the disease, timely engagement with healthcare professionals, and stronger collaboration across the healthcare ecosystem. We are committed to working closely with healthcare professionals, hospitals, policymakers, patient groups and industry to support a more informed and responsive Alzheimer’s care environment in India.”

Former Miss Universe and actor Lara Dutta, whose 80-year-old mother has been living with Alzheimer’s and dementia for about a decade, also shared her experience as a carer. “Seeing Alzheimer’s disease up close changes the way you think about memory, independence and the everyday moments that make life meaningful."

“As a carer, I have seen how deeply it can affect not just the person living with the disease but the entire family around them. It has made me realise how important it is to pay attention to changes in memory or cognitive health rather than dismissing them as a normal part of ageing,” she said.