The Overlooked Signs of Dementia (and What to Do About Them)

You might think of dementia as memory loss in old age. But what if the first signs are as subtle as a messy kitchen, a mismatched outfit, or a loved one repeating themselves in strange new ways?

On this episode of Sofia Unfiltered, we sit down with Dr. Macie Smith, a nationally recognized Licensed Gerontology Social Worker and dementia educator with over 25 years of experience helping families understand and navigate dementia care. Dr. Smith has made it her mission to cut through the myths and confusion surrounding dementia—and help caregivers feel more confident, equipped, and empowered.

What Is Dementia—and What Isn't?

Dementia isn’t a disease—it’s a syndrome, a group of symptoms, such as loss of cognitive functioning, and other underlying conditions like Alzheimer’s disease.

Dr. Smith emphasizes, “Dementia is an umbrella term… Alzheimer's is the most common cause. But there are reversible and irreversible forms.” She stresses this crucial distinction: Some types of dementia are progressive (they worsen over time), while several treatable conditions can mimic or cause dementia-like symptoms

This is why it’s essential not to self-diagnose or jump to conclusions.

What Can Look Like Dementia—But Isn’t?

Conditions like depression, chronic illness, or even a urinary tract infection (UTI) can cause dementia-like symptoms.

Dr. Smith calls these “pseudo-dementias.” Here are a few common culprits that mimic cognitive decline:

Depression or anxiety
Vitamin deficiencies (especially B12)
Thyroid dysfunction
Sleep deprivation
UTIs (especially in older adults)
Polypharmacy (taking multiple medications that interact)

If you or a loved one notice memory or behavior changes, your first step should be a thorough medical evaluation.

What Are the Early Signs of Dementia?

Changes often begin subtly—in speech, decision-making, daily tasks, or even wardrobe choices. It’s rarely about memory loss alone. The Alzheimer’s Association highlights 10 early warning signs, but many of the most telling indicators are subtle. Dr. Smith underscores that individuals can mask symptoms for years, a stage called Subjective Cognitive Impairment (SCI).

Dementia doesn’t announce itself with a flashing neon sign. Instead, it often tiptoes in quietly, showing up as small shifts in routine, behavior, or personality that are easy to dismiss as “just aging” or “a bad day.” But according to Dr. Macie Smith, it’s these early, seemingly insignificant changes that can reveal the most.

Here are key early signs to watch for—and why they matter:

1. Trouble with Daily Tasks

Routine tasks—like cooking a familiar meal, paying bills, or following a recipe—may suddenly become confusing or overwhelming. It’s not just forgetfulness; it’s a disruption in the brain’s executive functioning.

2. Decision-Making Difficulties

People may begin making poor financial choices, fall for scams more easily, or act out of character with impulsive purchases or risky behaviors. This is especially common with frontotemporal or vascular dementia.

3. Repetition with Variation

Telling the same story multiple times isn’t unusual with aging. But with early dementia, a person may retell the same event with subtle changes—altered timelines, characters, or facts—because their memory is reconstructing rather than recalling.

4. Changes in Language

You may notice your loved one struggling to find the right word, substituting incorrect words, or losing the thread of a conversation. This can make social interactions more frustrating or lead to social withdrawal.

“We have to also look at language changes. That could be an early sign. They may no longer be using the words they used to use,” she says.

5. Disorganized or Inappropriate Clothing

Early dementia may show up in how someone dresses. Wearing the same clothes multiple days in a row, layering mismatched items, or dressing inappropriately for the weather may indicate confusion or executive dysfunction.

“If you notice someone you care about and now they're dressing down a lot. They're wearing jeans. They're wearing sweatsuits and they've never done that…there's something happening cognitively that's affecting their decision making,” Dr. Smith shares.

6. Increased Clutter or Mess

A once-tidy home may become disorganized. Bills pile up. Dishes are left in odd places. Food expires in the fridge. These signs often reflect a diminished ability to plan, organize, and maintain routines.

“You may see more clutter because…now if they don't see it, then they won't remember it. So they got to put it out where they can see it,” she says.

7. Changes in Social Engagement

Some individuals pull back from hobbies, groups, or friends, not out of depression, but because they sense something is wrong and feel embarrassed or overwhelmed by it.

Others may start relying heavily on “safe zones” or routines, avoiding anything that requires mental flexibility or new learning.

8. Loss of Initiative or Interest

This can appear as apathy: sleeping more, watching TV all day, or seeming “checked out.” Unlike depression, this isn’t always linked to sadness. Instead, it can reflect the brain’s waning ability to initiate action.

9. Getting Lost in Familiar Places

Navigational trouble, even in well-known areas like a grocery store or neighborhood, can be a serious warning sign—especially if the person gets disoriented and has trouble retracing their steps.

“They're having trouble finding the right way to get home. So now they're getting lost in familiar places. That's how you know that something is happening,” says Dr. Smith.

10. Mood or Personality Changes

You might notice sudden irritability, anxiety, suspicion, or even bursts of aggression—especially when the person is challenged or confused. They may also show decreased empathy or emotional detachment.

It’s not just about memory. Early dementia often shows up as a cluster of cognitive, behavioral, and functional changes that impact everyday life.

These signs may appear slowly and inconsistently. But if you notice two or more of these patterns emerging—and especially if they’re interfering with independence—it’s time to talk to a healthcare professional.

Per a 2019 study, behavioral and emotional changes, such as anxiety, irritability, or withdrawal, often appear before noticeable memory issues. “[The dementia patient] begins to experience the symptoms 15 to 20 years before anybody else does,” Dr. Smith says. “If you see somebody become very upset and very agitated over losing something…simple like a pen or a piece of paper…that is an indication.”

This is why caregivers and family members often detect changes before the person themselves acknowledges anything is wrong.

Should I Get Genetic Testing for Dementia?

Dr. Smith notes that most Alzheimer’s cases are not genetically inherited. Only 1–5% of cases fall under Familial Alzheimer’s Disease, which is caused by mutations in genes like APP, PSEN1, or PSEN2. She recommends genetic testing only if you have a strong family history of early-onset Alzheimer’s. While most dementias are not strictly hereditary, Dr. Smith explains that some people carry risk markers, such as:

Presenilin 1 and 2 (PSEN1/PSEN2)
Amyloid precursor protein (APP)
Apolipoprotein E (APOE), especially APOE-4

More common is the presence of the APOE-e4 allele, which increases risk but does not guarantee disease onset. However, she cautions against blanket testing unless you have a history of Alzheimer’s under age 60 in your family. “I only recommend that someone get a blood test for progressive type of dementia..only if they see a direct lineage [in their family] related to the disease process.” says Dr. Macie. “But talk with [your] doctor about what those risks look like for you.”

If you’re concerned about brain health, start with something more actionable: regular labs.

What Blood Tests Support Brain Health?

Routine blood work can catch treatable causes of cognitive decline and help you stay ahead of early dementia symptoms before they progress.

Dr. Macie Smith emphasizes that one of the first and most overlooked steps when memory or mood changes begin is to get your labs checked. Why? Because cognitive issues aren’t always about the brain itself, they’re often symptoms of imbalance elsewhere in the body.

The following are some of the most important blood tests to ask your doctor about:

Vitamin B12 (low levels linked to memory issues)
Vitamin D (critical for mood and brain function)
Vitamin C and E (antioxidants that protect brain cells)
Thyroid panel (thyroid dysfunction mimics cognitive decline)
Blood sugar and insulin resistance (metabolic health impacts brain health)

Looking to improve cognitive health naturally? Browse for functional medicine experts and nutritionists who specialize in chronic inflammation and cognitive wellness.

These tests provide a window into what’s going on beneath the surface. For example, catching a B12 deficiency or thyroid problem early might completely reverse symptoms that otherwise could be misdiagnosed as dementia. What to do next:

Ask your primary care doctor to order a comprehensive lab panel
Keep copies of your lab results and monitor trends over time
Pair your labs with a full medical and cognitive evaluation, especially if symptoms change

Get help interpreting labs or addressing vitamin and nutrient deficiencies? Discover nutritionists specialize in identifying root causes and creating personalized wellness plans to support brain health.

How Does Diet Affect Dementia Risk?

A diet high in processed foods, sugar, and additives can increase inflammation and contribute to brain fog, memory loss, and long-term cognitive decline. Whole, nutrient-rich foods are key to protecting your brain.

Food plays a crucial role in dementia prevention, every bite sends signals to your brain, either helping or harming its long-term function. Dr. Macie Smith makes it clear: what you eat directly impacts your brain health.

The Inflammation Connection

Chronic, low-grade inflammation is one of the leading contributors to neurodegeneration. Diets high in added sugars, refined carbohydrates, hydrogenated oils, and ultra-processed foods have been shown to trigger systemic inflammation that reaches the brain. Over time, this inflammation damages blood vessels, impairs glucose metabolism, and contributes to memory issues, brain fog, and eventual neurodegeneration.

“Artificial sweetener has been linked to developing progressive types of dementia,” says Dr. Smith. “You want to ingest things that are made from a plant that are, but not made in a plant.”

Looking to reset your diet for brain health? Explore a nutrition consult or browse our holistic healing sessions.

The Brain-Boosting Power of the Mediterranean Diet

According to JAMA Network Open and the Mayo Clinic, anti-inflammatory diets such as the Mediterranean diet are linked to reduced cognitive decline and Dr. Smith is a strong advocate for adopting its main components into every meal:

Omega-3 fats (from fish, olive oil, and nuts)
Leafy greens (like spinach, kale, and arugula)
Colorful vegetables and fruits (packed with antioxidants)
Whole grains (like farro, quinoa, and oats)
Legumes and beans (for plant-based fiber and protein)

This type of diet helps reduce inflammation, improve vascular health, and provide the nutrients your brain needs to function optimally.

Foods That Harm Cognitive Health

Unfortunately, the typical Western diet is packed with ingredients that do the opposite. Dr. Smith cautions against artificial ingredients and ultra-processed foods, “Food is the biggest culprit for inflammation in the body and that means inflammation in the brain.”

Highly processed packaged foods
Artificial sweeteners and food dyes
Trans fats and hydrogenated oils
Sugary (and artificially sweetened) beverages

She urges everyone to be conscious of where they shop in the grocery store. “Avoid the middle aisles as much as you can,” she says.

Eat to Fuel the Brain

There are a number of foods that are recommended for a brain-friendly plate:

Dark berries (like blueberries, blackberries, and raspberries) for their high antioxidant content
Cruciferous vegetables (broccoli, Brussels sprouts, cauliflower) to detoxify and reduce inflammation
Fatty fish (salmon, sardines, mackerel) for omega-3s that support brain cell membranes
Nuts and seeds (especially walnuts and flaxseeds) for healthy fats and minerals
Herbs and spices (like turmeric, rosemary, and cinnamon) to fight inflammation and support memory

Meal Timing and Brain Health

It’s not just what you eat, it’s when. Recently, there has been emerging research around intermittent fasting and cognitive function, which suggests that giving the brain a break from constant digestion may improve mental clarity and reduce oxidative stress.

One simple strategy? Avoid late-night eating and allow at least 12 hours between dinner and breakfast to support brain recovery overnight.

Book a session with a nutritionist or functional medicine expert for sustainable, anti-inflammatory meal plans.

What Are the Best Lifestyle Changes for Brain Health?

Move daily, learn often, and stay socially engaged. Dementia prevention is not just about diet or supplements, it’s about your daily rhythm. Dr. Smith shares her top brain health habits:

Regular physical activity improves cognition and blood flow
Sunlight exposure boosts vitamin D and mood
Social engagement protects against isolation-linked decline
Learning new skills helps build cognitive reserve, a buffer that slows the effects of dementia
Practicing mindfulness and stillness

While a 2021 study found that lifelong learning significantly correlates with delayed onset of Alzheimer's symptoms, Dr. Smith also reminds us that, “You are always on. And when you are always on, you are never off… You have to schedule rest for your mind.”

Reset the nervous system with meditation classes to support mind-body wellness.

What Systemic Issues Impact Brain Health?

Access to clean water, quality healthcare, and nutritious food are foundational but not always available. Dr. Smith doesn't shy away from bigger-picture issues: “It's always going to be a battle in a fight when it comes to the marginalized communities and people who are still living in communities that don't even have clean water. How in the world are they going to reduce their risk of developing chronic illness?”

She also raises concerns about environmental factors, disparities in dementia diagnosis, and how some communities are underdiagnosed—or misdiagnosed.

Her advice: advocate early, especially for vulnerable loved ones. Ask providers about all possible causes of symptoms, and keep a log of potential indicators to share with your doctor.

Find supportive integrative health providers and therapists who take a whole-person approach.

What’s the Role of the Caregiver?

You don’t need to be perfect—but you do need to be trained, compassionate, and prepared for a journey that requires flexibility and grace. When a loved one is diagnosed with dementia, it’s not just their life that changes—it’s yours, too. The caregiver becomes the lifeline, the advocate, the emotional anchor, and often the healthcare coordinator. But too often, caregivers are expected to step into this critical role without the tools, training, or emotional support they need.

Dr. Macie Smith provides powerful advice for caregivers, reminding them that good dementia care doesn’t require a medical degree, but it does require education. “You have to know what type of dementia the person has…because they're going to present with different challenges. And so once you know…you're able to…prepare in your mind first and then you prepare environmentally, you're able to manage to care a lot more confidently.”

Start with the Diagnosis

Step one is knowing the specific dementia diagnosis. Is it Alzheimer’s, vascular dementia, Lewy body, or frontotemporal? Each affects the brain differently—and therefore requires different support strategies.

Alzheimer’s may show up first as memory loss or disorientation.
Vascular dementia often involves more sudden changes tied to strokes or poor blood flow.
Lewy body dementia can include hallucinations and movement changes.
Frontotemporal dementia may present as personality shifts or inappropriate social behavior.

This diagnosis shapes everything from safety measures to communication tactics to how you structure the person’s day.

Focus on Communication, Not Correction

A powerful piece of advice is this when dealing with someone with dementia is: Don’t argue with them. If your loved one insists that their long-deceased mother is coming over for dinner, correcting them won’t help. In fact, it may increase agitation or confusion.

“It's no longer about the days, it's no longer about the weeks, the months and the years, but it is about the moment,” she advises. “You have to meet them in their mind and meet them in the moment in their mind to be able to establish that connection.”

Instead of correcting, try these techniques:

Redirect to a comforting topic or activity
Ask questions about how they’re feeling
Validate emotions even if the facts aren’t accurate

This is the heart of person-centered care—seeing the individual beyond the disease.

Create a Safe, Predictable Environment

Routine can reduce stress for both the caregiver and the person living with dementia. Try to:

Keep consistent meal times and bedtime
Use labels or signs on doors and cabinets
Reduce loud noises or visual clutter
Use soft lighting in the evenings to prevent “sundowning” (late-day confusion)

You can also build out a “dementia toolkit” at home, including:

Calendars with large numbers
Whiteboards with daily reminders
Clothing laid out in the order it’s worn
Pill organizers to support medication adherence

A health coach or care planning expert on Sofia Health can help you design routines and tools that fit your loved one’s stage and needs.

Use Non-Pharmacological Support

Medication can play a role, but it’s not the only option. Dr. Smith recommends trying non-drug therapies first to manage behaviors and emotions:

Reminiscence therapy (looking at old photos, listening to familiar music)
Sensory activities (like folding towels, gardening, or using aromatherapy)
Movement and rhythm (gentle exercise, dance, or tapping)
Animal therapy or nature exposure (studies show even short outdoor time can reduce agitation)

These strategies aren’t just calming—they’re also moments of joy, connection, and dignity.

Understand Your Emotional Role

Many caregivers underestimate the emotional toll of this role. Guilt, grief, frustration, and even resentment are common—and normal.

That’s why it’s so important to:

Join a caregiver support group—in person or online
Set boundaries and say “no” when needed
Seek counseling or coaching for emotional resilience
Ask for help from family, friends, or professional respite care

You’re not a failure if you feel overwhelmed. You’re human.

Find therapists and wellness coaches who specialize in caregiver support, burnout prevention, and emotional well-being.

Keep Learning as the Disease Progresses

Dementia is progressive—and that means the needs and challenges will evolve over time. Caregivers should seek ongoing education through:

Books and podcasts on dementia care
Workshops at local senior centers or hospitals
Coaching sessions with a dementia specialist
Digital caregiver training programs (some are covered by insurance or free through local agencies)

The more prepared you are, the more confident you’ll feel navigating tough decisions—whether it’s around safety, memory care placement, or end-of-life planning.

Dr. Smith reminds us: “You have to set those boundaries, you have to have those expectations put in place, and you have to follow them.”

By caring for yourself, getting the right support, and understanding what’s really happening in your loved one’s brain, you become not just a caregiver—but a guide, a companion, and a source of comfort during one of life’s most vulnerable journeys.

Don’t do it alone. Look for caregiver classes, dementia support coaches, and personal coaches who specialize in cognitive health and caregiving strategies.

Can You Still Live Well With Dementia?

When care is compassionate, personalized, and rooted in dignity, “People can live well and they do,” Dr. Smith says. “[They] live well with the support of a competent, compassionate, reliable and patient caregiver or team of caregivers.”

She emphasizes the shift from curing to caring: “It's not treatable in terms of the disease itself. So what do you have? You have care, compassion and people to be there to provide the support.”

That includes:

Establishing consistent routines
Building trust through familiar environments
Focusing on strengths and remaining abilities
Offering choices and autonomy when possible

Her philosophy is clear: The goal is not just more years—it’s better years.

What Does Self-Care Look Like for Caregivers?

It’s not indulgent. It’s essential. Dr. Smith knows firsthand that caregiver burnout is real. That’s why her own daily routine includes:

Prayer and faith practices
Exercise and sunlight
Meditation and mental quiet
Scheduled alone time—without devices
Celebrating small wins
Permission to rest

“Ain't nobody going to love you like you,” she stress, “You have to be able to spend time with yourself to decide what it is about you that you want to preserve forever.”

Awareness Is the First Step

Dementia doesn’t have to be scary, but it does require understanding.

Whether you're noticing early signs, navigating a diagnosis, or simply being proactive, Dr. Macie Smith offers a message of empowerment: “You’re not alone, and there are things you can do today to protect your brain and your peace.”

Get Personalized Support for Brain Health and Caregiving

If you or a loved one are facing memory changes, cognitive decline, or the challenges of caregiving, Sofia Health connects you with compassionate, expert support. From brain-healthy nutrition and stress management to dementia care navigation and mental fitness, our practitioners help you take proactive steps tailored to your life stage and needs. You can even shop the Sofia Marketplace for products and services or work with a lifestyle medicine expert to address your needs.

Check out the full episode of the Sofia Unfiltered podcast, "Dementia Decoded: What to Know Before It’s Too Late" for a thoughtful exploration of the early signs of dementia, the difference between age-related forgetfulness and progressive disease, and why caregiving requires both practical tools and emotional support. Available on Apple Podcasts and Spotify.

We’re here to help you meet your wellness goals—physically, mentally, emotionally, and spiritually. Whether you prefer a subscription for ongoing support or want to shop for individual services, classes, or products, Sofia Health provides the tools you need to thrive. Plus, with Sofia Prime, you can access both live classes and an extensive on-demand video library, featuring expert-led content in wellness, nutrition, fitness, and meditation.

Start your two-week trial today and discover the difference that dedication and expert help can make.

Frequently Asked Questions About Dementia

What are the first signs of dementia?

Changes in memory, language, judgment, and daily function. Watch for repetitive stories, misplaced items, and mood changes.

Can dementia be reversed?

Some conditions that mimic dementia (like UTIs or depression) are treatable. Progressive dementia like Alzheimer’s cannot be reversed but can be managed.

What lifestyle changes prevent dementia?

Anti-inflammatory diet, regular movement, sunlight, social connection, cognitive stimulation, and managing chronic conditions like high blood pressure or diabetes.

Is dementia hereditary?

Most types are not, but there are genetic risk markers like APOE-4. Talk to your doctor about your family history before testing.

How can caregivers get support?

Find coaching, therapy, or classes focused on caregiving. Training and emotional support are critical to avoid burnout and improve care quality.

Resources

Disclaimer: The Sofia Unfiltered Podcast by Sofia Health is for general informational and entertainment purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have. For any health concerns, users should seek the assistance of their healthcare professionals.

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