Hindsight is 20/20: Early Signs of Dementia in Older Adults

Subtle signs of dementia often appear years before it becomes obvious to family members. Looking back, my grandmother showed those signs long before anyone recognized them for what they were.

Around 2010, she became convinced she was moving from Tennessee to Virginia. She had moving boxes everywhere, stacked two and three high in every room of her newly built, modest two-bedroom home.

The boxes were filled with the most random items. I remember my mom and I opening one and finding it completely full of takeout silverware. We didn’t dare throw anything away. She kept everything.

There was no concrete plan. No realtor, no house hunting, no timeline. At the time, we chalked it up to stubbornness. She was in her early 70s, physically healthy, and fiercely independent, so we let it go.

Those boxes stayed exactly where they were for nearly a decade, until we moved her in with her sister when it was no longer safe for her to live alone.

Looking back, those boxes were some of the very first clues.

The older population is the fastest-growing segment in the United States.

In 2020, one in six Americans was over the age of 65. By 2050, nearly 23 percent of the population will be 65 or older.

As we age, the risk of dementia increases, particularly in the presence of chronic disease.

One of the most significant and often overlooked risk factors for cognitive impairment in older adults is cardiovascular disease. Between 75 and 90 percent of adults over the age of 65 have some form of cardiovascular disease.

Cardiovascular disease worsens cognitive function through hypertension, reduced cerebral blood flow, chronic inflammation, embolic events, and medication side effects.

A 2023 journal article found that one in three cardiology clinic patients had measurable cognitive impairment.

Are We Screening Cardiac Patients for Cognitive Impairment?

If you, your parent, or a loved one has cardiovascular disease, an important question to ask is whether cognitive screening is being done.

Routine cognitive screening is recommended for patients with cardiac disease, yet it is often overlooked.

There are several validated, quick screening tools that can identify subtle cognitive changes long before symptoms are obvious to families. These include the Montreal Cognitive Assessment, the Trail Making Test, and the Stroop Test.

These brief exams can detect impairments that directly affect medication management, decision-making, follow-up care, and overall safety.

When cardiovascular disease and cognitive impairment coexist, the risks multiply.

Cognitive changes can lead to poor medication adherence, missed appointments, difficulty understanding care plans, and unsafe decision-making. These issues are often dismissed as normal aging, allowing preventable complications to occur.

There is growing evidence that targeted interventions can reduce risk. Maintaining a systolic blood pressure below 120 may lower the risk of cognitive decline. Oral anticoagulants have been associated with up to a 29 percent reduction in cognitive impairment in appropriate patients. Lifestyle interventions such as a Mediterranean diet, cognitive training, and social engagement also play a meaningful role.

However, none of these strategies work if they are not implemented, monitored, and followed consistently.

Why Patient Advocacy Is Essential for Older Adults

This is where patient advocacy becomes critical, especially for older adults navigating both cardiovascular disease and cognitive impairment.

An expert nurse patient advocate helps ensure that cognitive screening is not overlooked, treatment plans are realistic and being followed, medications are managed safely, and early warning signs are recognized before crises occur.

Patient advocacy bridges the gap between what should happen in healthcare and what actually does.

For families, advocacy provides peace of mind. It means knowing someone is asking the right questions, coordinating care, and protecting a loved one who may not be able to fully advocate for themselves.

Dementia rarely arrives suddenly. It whispers long before it shouts.

Recognizing the early clues, and having someone in your corner to act on them, can make all the difference.