Most families come to us after an incident: a missed medication, a stove left on, a parent found confused at the gate. By then the condition has usually been developing for a year or more. The earliest signs are behavioural, not clinical, and they are easy to explain away as ageing.
1. Withdrawal from routine social life
A parent who once led family gatherings starts avoiding them. Crowded rooms become tiring because following several conversations at once demands working memory. Withdrawal is often mistaken for mood, not memory.
2. Difficulty with familiar sequences
Not forgetting the recipe, but losing the order of steps. Cooking, dressing and prayer routines take noticeably longer. Sequence loss is one of the most reliable early markers we look for during assessment.
“Families rarely notice memory first. They notice that the person has quietly stopped doing things they used to enjoy.”
3. Repeating questions within a short window
Asking the same question twice in an hour matters more than forgetting a name. Keep a simple written log for two weeks before the first appointment: date, time, what was repeated. This record is more useful to a geriatrician than any description given from memory.
What to do before the first visit
Document changes, list every medication including supplements, and bring one family member who sees the person daily. Avoid framing the visit as a test. A calm, ordinary explanation preserves dignity and improves cooperation.
Founder and geriatric physician at Senior Care. Eighteen years working with dementia, palliative and post-surgical care across Dhaka.
