Early Signs of Cognitive Impairment

A Psychiatric and Neuroscientist’s Perspective on Aging Parents:


Going home for a visit can sometimes bring unexpected surprises, especially if you haven’t seen loved ones in a while. As we all know, time can be tricky and seem to move at warp speed as we age. The problem with this is that sometimes, aging loved ones seem to change rapidly, even though memory loss and physical health decline are relatively gradual.

Clinical Professor of Psychiatry and Behavioral Sciences, Wes Ashford, MD, PhD, provides insight into why awareness and early detection of cognitive impairment can be beneficial to your family. Visits with family are a prime time to evaluate senior loved ones, do screenings and discuss options for the future.

“You need to be aware that there is an issue. How is your loved one acting? Do they seem themselves? People have a way of compensating and covering up for memory loss, so it helps if you know them really well and can discern a change. It’s the subtle changes or problems that might give you a clue, and consulting an expert is always helpful in these instances.”


Dr. Ashford discusses that the Alzheimer’s Association has published their 10 Warning Signs of Alzheimer’s and cognitive impairment. The problem with this is that once someone reaches these stages, they are often fairly far along. “Ten percent of people over 60 have significant memory problems. Look at the family’s genetics for an indication of when problems may arise. There are screenings that can be done these days, and 65 is a pretty good age to have a loved one screened. Also, having a family member who is very supportive and understanding attend doctor’s visits can be helpful.”

Here are a few signs Dr. Ashford discusses may be indicators that your loved one may be suffering from cognitive impairment:

  • Difficulty doing the more familiar things in their life. Having problems with activities of daily living (ADLs), or any activity that is part of your loved ones’ normal routine, such as cooking, cleaning, or performing regular job skills, could signal an issue.
  • Difficulty remembering things that happened in the last day. Alzheimer’s and dementia affects recent memory, so memory problems within the past 24 hours could be a red flag.
  • Sudden behavioral changes. If your loved one is suddenly depressed, quiet, agitated, or acting out of the norm, this could be a problem.
  • Having trouble keeping a conversation. The following problems in conversation could be an indication of memory impairment:
    • Asking the same questions repeatedly, without remembering the answer
    • Not referring to people by name
    • Vagueness and lack of details in conversation

People have a way of compensating for memory loss. Some people may realize they have a problem and try to cover it up, and others may not even recognize there is a problem. Dr. Ashford provides insight:

“I’ve seen over 1,000 patients, and only one came in by himself because he was worried about his memory. Usually when asked, ‘Have you been having any difficulty with memory lately?’ – Half the people say, ‘no’ and the other half say, ‘no more than anyone else my age.’ This is exactly why early detection is important.”

Sometimes it may be difficult to notice when there is a problem, but spending quality time with your loved one, having conversations and doing screenings can all help determine whether they suffer from memory loss, or may be at risk for Alzheimer’s or dementia.


Ashford has spent his career researching the process of memory loss associated with aging. He and the other members of the group at the Stanford Aging Clinical Research Center are involved in a variety of studies to measure the effectiveness of medications, mood, sleep and other factors on disease progression. He has developed a simple memory test that can help track changes over time, using colorful images to detect early signs of memory loss.

The test, MemTrax, is an online memory test that helps to measure and monitor the memory, and can be very helpful for families to determine whether their loved one is suffering from a cognitive problem. Dr. Ashford discusses:

“The problem is that it is difficult to recognize when people have a problem. People with a memory problem often try to cover it up, and as much as 90% of patients are misdiagnosed early in the disease course. After a certain point they don’t recognize that they have a memory problem and by then they need to be in a nursing home. Screening and tests can provide insight into memory problems.”

MemTrax is meant to be a fun way to test memory, without causing unease. “My family played MemTrax one Thanksgiving, and it was actually fun. We were in rural Kentucky and we decided to test our memory. It was meant to be fun, so it was not anxiety provoking. This simple game is a great way to give families insight into measuring memory and cognitive awareness.”


While mild forgetfulness affects most people as they age, serious memory problems affect peoples’ ability to participate in everyday activities. This is another reason it’s so important to be in tune to and observe your loved in their activities of daily living (ADLs), in addition to memory screening and/or attending a doctor’s visit. When you’re home, observe how your elderly loved one is doing the following:

  • Walking and getting around
  • Dressing
  • Bathing
  • Using the toilet
  • Grooming
  • Feeding

Dr. Ashford stresses that the cognitive decline associated with dementia and Alzheimer’s disease is an issue not only for affected individuals, but also for society. New understanding, improved treatments, and viable preventive strategies are becoming more crucial since more than 5 million Americans are already living with Alzheimer’s disease, and its prevalence is expected to double by 2020. Ashford notes the two most important things to pay attention to as people get older are:

  • Exercise
  • Cognitive Engagement

In other words, how is your loved one ‘walking and talking’ and are they doing well enough to live in their home without help? Ashford comments, “There is genetic testing available and families need to be proactive about getting tested and understanding their genotype. For one common genotype, which equates to about 20% of the population, there is a 40% chance of developing Alzheimer’s by age 76. Another genotype – one that affects only 2% of the population – has 10 times greater chance of having the disease by age 67; and another group appears to develop Alzheimer’s only after age 95. Looking at your family genetics and getting yourself and loved ones tested can help you determine what you’re up against.”


Whether you notice that your aging family member is in great shape or that he or she may need additional care, it’s never too soon to have a conversation. If your elderly loved one can participate in the discussion and provide you with all the necessary information to execute their retirement and end-of-life wishes when the times comes, your family will be in better shape, both emotionally and financially. Dr. Ashford comments,

“Help your loved one prepare for their future, proactively. Be helpful and supportive, and let them participate in the decision-making, if possible. If needed, get educated. I highly recommend “The 36-Hour Day, by Nancy L. Mace.” The Alzheimer’s Association also has great information, and provides local support groups. It’s also never a bad idea to seek an expert’s help; whether that’s a family doctor, geriatrician, psychologist or eldercare attorney.”

About Wes Ashford, MD, PhD

Dr. J. Wesson Ashford, a psychiatrist and neuroscientist, has dedicated his career to understanding the way Alzheimer’s disease affects memory. Dr. Ashford is Chair of the Memory Screening Advisory Board of the Alzheimer’s Foundation of America as well as a Senior Editor of the Journal of Alzheimer’s Disease. He also holds the positions of Clinical Professor, Psychiatry and Behavioral Sciences; Senior Research Scientist, Stanford; and Director of the War Related Illness and Injury Study Center in the VA Palo Alto Health Care System.

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A Place for Mom Assessing Cognitive Ability Guide
Reprinted from A Place for Mom