It's always great to see Grandma or Uncle Ralph at the holidays.

But sometimes when we visit with an older loved one, we notice they don't seem like themselves – confused about which relative you are, upset they can't locate the special tablecloth they use every year, embarrassed because they forgot to go to a doctor's appointment last week.

How do you know if what you are seeing is normal aging or if there is something more serious going on?

WellSpan geriatrician Dr. Faina Caplan says that holiday visits are often a time when families will notice that an older relative is experiencing a significant cognitive decline.

"Family members are often the first to notice if a loved one is changing and should take it seriously to make sure that older person is evaluated before their safety is endangered," Dr. Caplan said. "If a person lives alone, this can be very important."

Dementia and aging

Dementia is a general term for decline in intellectual ability. It is an impaired ability to remember, think, or make decisions that leads to functional decline, or a decreased ability to manage your affairs and remain independent.

Alzheimer's disease is the most common type of dementia seen in older people. About one in nine people age 65 and older (almost 11%) has Alzheimer's. About two-thirds of them are women.

Common risk factors for dementia include a family history, high blood pressure, high cholesterol, smoking, hearing loss, and loneliness. Some risk factors are modifiable, meaning that if they are properly treated, the onset of dementia and progression can be delayed or prevented. However, the prevention must start in mid-life to provide maximum benefit, Dr. Caplan said.

"It is a good reminder that we should eat well, exercise, seek social interactions, and take medications to manage any medical issues," Dr. Caplan said. "It is never too early to practice these habits."

Common dementia symptoms

Here are some common symptoms you may see in your older relative that are not part of normal aging. Be aware if the person:  

• Asks the same questions over and over.
• Gets lost in a place the person knows well, like the neighborhood or a familiar store.
• Is unable to follow directions, like in a recipe.
• Becomes confused about people, time, and places.
• Shows signs of poor self-care: not bathing, eating poorly, wearing dirty clothes.
• Struggles to hold a conversation.

"If you notice these symptoms, don't ignore them," Dr. Caplan said. "Talk to your relative and contact their primary care provider to start an evaluation. Early diagnosis is important."

An accurate diagnosis also is important because sometimes cognitive changes can be due to medications or other conditions that are reversible. It may allow for interventions that can slow the progression of the disease.

"The best thing is to get an accurate assessment of your loved one," Dr. Caplan says. "There are things we can do to treat people if they are in the early or middle stages of Alzheimer's disease."

Normal memory changes associated with aging

Not all forgetfulness is a sign of dementia or Alzheimer's disease.

Normal memory changes, associated with aging, can include when a person:

• Occasionally misses a monthly payment or appointment.
• Forgets a person's name but remembers it later.
• Occasionally struggles to find the right word during a conversation.
• Misplaces things from time to time.

"As we get older, our bodies change, and so do our brains," Dr. Caplan says. "However, normal memory changes do not disrupt our daily lives."

Our expert team of geriatricians can help evaluate and prepare a care plan for your loved ones who may be facing memory challenges. Learn more about our services here.