Dear Dr. Koepp: Normal Aging or Dementia? How to Know When to Worry About Mom’s Memory

Dear Dr. Koepp,

My mom is 78 and still does her own taxes, but lately she tells me the same story twice in one phone call and can’t find her keys most mornings. My brother says I’m overreacting and that everyone forgets things. I can’t tell if I’m seeing the start of something or just seeing my mom get older.

How do I know when it’s time to worry about my mom’s memory?

In this Dear Dr. Koepp episode, I answer a letter from a daughter who’s noticing changes in her 78-year-old mom’s memory. 

In This Episode, You’ll Learn:

• Why some forgetfulness can be normal with aging, but dementia is not
• What “neurodegenerative disorder” actually means, in plain language
• The difference between mild cognitive impairment and dementia
• Treatable causes of memory changes that have nothing to do with dementia
• How depression, anxiety, substance use, and insomnia can look like memory loss
• How to bring up your concerns with your parent with care, concern, and curiosity
• Your role at the doctor’s appointment (and why you shouldn’t take it over)
• What to do when a sibling sees things differently
• How the 2024 Lancet Commission’s 14 modifiable risk factors can help protect brain health at any age

 

Why This Matters

It’s easy to assume that memory loss comes with getting older. It doesn’t have to. Among adults 65 and older in the US, about 1 in 10 has dementia (Manly et al., 2022). The risk rises with age, but it is not a foregone conclusion.

 

Dementia is a neurodegenerative disorder. Neuro means brain, degenerative means it gets worse over time, and disorder means it gets in the way of daily functioning. It’s also a chronic and terminal illness, which is why it’s not a label to hand out casually. Before anyone reaches that conclusion, there are many other possible causes to rule out, and a lot of them are treatable.

 

Key Takeaways

1. Look at what’s preserved and what’s changed

In this letter, two things are happening at once. Her mom still does her own taxes, and if they’re accurate, that’s a good sign. At the same time, repeating stories and misplacing keys sound like new changes. The questions I ask: Are these changes new? Did they come on slowly or all of a sudden? Are they getting in the way of daily life, like getting lost while driving?

 

2. Write down what you observe, not what you sense

“She told the same story twice in one call” is an objective sign. “She just seems different” is a hunch. Write down specific examples, when they started, and what was going on around that time: a medication change, a big move, a new diagnosis, or an infection.

 

3. Don’t jump to conclusions

Memory changes can come from vitamin deficiencies, metabolic issues like potassium or hydration levels, infections, insomnia, chronic pain, pain medications, and medication interactions. Current clinical guidelines recommend an evaluation that looks for these causes, because many of them respond to medical care (Dickerson et al., 2025).

 

4. Mental health conditions can mimic dementia

Depression, anxiety, substance use disorders, and insomnia can all produce symptoms that look like a dementia disorder. A primary care provider, or a mental health provider who specializes in older adults, can help sort out what’s going on.

 

5. Bring it up with care, concern, and curiosity

Try something like: “Hey Mom, I’ve noticed you’ve been repeating yourself more in our conversations. What do you think is happening?” Listen to her answer. If you’re still concerned, you might share that memory changes can come from many things, like vitamin deficiencies, medications, or infections, and ask if she’d be willing to see her primary care provider. Offer to go with her.

 

6. Support the appointment. Don’t take it over.

If your mom invites you, share what you’ve observed when asked, and let her lead. She and her doctor need a trusting relationship, especially if she’s facing a dementia disorder or another medical problem. This is her appointment, and you’re there with her permission.

 

7. Expect to step in and step back

I call this ambiguous caregiving. Sometimes you’re stepping in, sometimes you’re pulling back, sometimes you’re asked for help, and sometimes you’re hands-off. If you’re truly worried about your parent’s safety, reach out to their primary care provider and share your concerns.

 

8. When siblings disagree, stay objective

It’s very common for one family member to notice changes in an aging parent while another doesn’t. You and your brother are each entitled to your own perspective. Take your concern seriously, keep it objective, write down what you’re seeing, and help your mom get connected to care.

 

9. Brain health is worth investing in at every age

The 2024 Lancet Commission identified 14 modifiable risk factors that, together, may account for nearly half of dementia cases worldwide (Livingston et al., 2024). They include depression, social isolation, alcohol use, untreated hearing and vision loss, and access to early education. Whether you’re 78 or in your 50s like me, it’s a good time to protect your brain. And even for someone living with mild cognitive impairment, there’s a lot they can do to support brain health.

 

Early life matters, too. In a study of more than 6,000 Kaiser Permanente members in Northern California, African American adults born in the US states with the highest infant mortality rates had a higher risk of dementia decades later. The same pattern didn’t show up for White members (Gilsanz et al., 2019). Infant mortality is a marker of hard early-life conditions, and findings like this suggest that the conditions we’re born into can shape brain health across the lifespan, and may help explain racial disparities in dementia.

 

“Some forgetfulness can be normal with aging, but dementia is not a normal part of aging.”

 

 

So When Should You Worry?

When someone asks me, “When should I be concerned about my loved one’s memory?” here’s what I say:

• If the changes are getting in the way of daily functioning, that deserves a workup.
• If the changes are new and concerning, that deserves a workup.
• If the changes are getting worse, that deserves a workup.

 

By workup, I mean connecting your loved one to their primary care provider to figure out what’s causing the changes. That can take time. And while your parent works through the uncertainty, you can offer a steady base and secure footing. I’m so glad you reached out.

 

Watch the Episode

Have a Question for Dear Dr. Koepp?

I’ll be answering more of your questions in future episodes. Leave a voicemail or write in, and your question may air on an upcoming episode: https://www.buzzsprout.com/952579/fan_mail/new

 

Looking for Support?

Looking for a therapist? Check out our national provider directory to find a therapist who specializes in older adults and caregivers.

 

Professionals looking for CEUs? Check out our catalogue of CEU courses on meeting the mental health needs of older adults, including Therapy with Dementia Disorders: Individual Therapy + Caregiver Family Therapy for Each Stage of Dementia (6 CE Credits).

 

Resources Mentioned

• The 2024 Lancet Commission report on dementia prevention, intervention, and care (14 modifiable risk factors)
• CMHA National Provider Directory
• CMHA Continuing Education Courses

 

Related Articles

• Dementia Symptoms Most Challenging for Families
• How to Bring Family Into Therapy with Older Clients
• When a Loved One Refuses a Dementia Evaluation: What Families Can Do
• What Does a Dementia Evaluation Actually Look Like?
• My Loved One Was Just Diagnosed with Dementia: What Do I Need to Know and Do?
• Just Diagnosed with Dementia? Here’s What to Do First
• What Is Mild Cognitive Impairment — And How Can Psychotherapy Help?
• Supporting People with Dementia Who Live Alone: Must Have Resources
• Podcast: Depression Treatment Prevents Dementia- According to Science

 

Subscribe and Leave a Review Wherever You Listen

If you enjoyed this episode, please subscribe, leave a review, and share it with a colleague or friend. Together, we can ensure older adults are included in the mental health conversation.

 

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Share With a Friend

Know someone who’s worried about a parent’s memory? Send them this episode.

 

Remember, it’s only with your help that we can meet the mental health needs of older adults, so thank you for being here, and doing your part.

 

Articles Referenced

• Dickerson, B. C., Atri, A., Clevenger, C., Karlawish, J., Knopman, D., Lin, P.-J., Norman, M., Onyike, C., Sano, M., Scanland, S., & Carrillo, M. (2025). The Alzheimer’s Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer’s Disease and Related Disorders (DETeCD-ADRD): Executive summary of recommendations for specialty care. Alzheimer’s & Dementia, 21(1), Article e14337. https://doi.org/10.1002/alz.14337
• Gilsanz, P., Mayeda, E. R., Glymour, M. M., Quesenberry, C. P., Jr., Mungas, D., DeCarli, C. S., & Whitmer, R. A. (2019). Birth in high infant mortality states and dementia risk in a cohort of elderly African American and White health care members. Alzheimer Disease & Associated Disorders, 33(1), 1–6. https://doi.org/10.1097/WAD.0000000000000270
• Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., Ames, D., Banerjee, S., Burns, A., Brayne, C., Fox, N. C., Ferri, C. P., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Nakasujja, N., Rockwood, K., … Mukadam, N. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 404(10452), 572–628. https://doi.org/10.1016/S0140-6736(24)01296-0
• Manly, J. J., Jones, R. N., Langa, K. M., Ryan, L. H., Levine, D. A., McCammon, R., Heeringa, S. G., & Weir, D. (2022). Estimating the prevalence of dementia and mild cognitive impairment in the US: The 2016 Health and Retirement Study Harmonized Cognitive Assessment Protocol Project. JAMA Neurology, 79(12), 1242–1249. https://doi.org/10.1001/jamaneurol.2022.3543