10 Unusual Signs of Dementia That Most Older Adults Miss
In my first professional career, I worked as a social worker in a continuum of care facility that included independent living condominiums, assisted living apartments, a memory care facility, and nursing home beds. As part of my job, I continuously assessed residents and met with countless seniors and their families to help them live high-quality lives. A diagnosis of dementia impacted the quality of life, but early diagnosis helped to preserve dignity and hope. Early assessment by a physician and resulting diagnosis were difficult when many didn’t recognize the early signs of dementia. Family caregivers and seniors often expect the big red flags—forgetting names, getting lost in familiar places, wandering—but dementia can start with subtle, unusual symptoms that are easy to write off. Here are ten unusual signs of dementia that many older adults and their loved ones miss.
Changes in Sense of Humor
I fondly remember a gentleman who lived in one of the assisted living apartments. He was witty, and his humor was on-point, sophisticated, and creative. One day, I started to notice that his sense of humor was changing. He suddenly found silly, simple, slapstick, and somewhat inappropriate comedy hilarious. He was missing the punchline when telling more sophisticated jokes. Shifts in what someone finds funny—especially if they start laughing at inappropriate things—can be related to a lot of things, but they’re sometimes an early sign of cognitive decline.
Unexplained Apathy or Loss of Interest
One of my favorite residents in our facility was a woman with an incredible green thumb. I would bring her plants that were black, wilted, and dry, and she would somehow find a way to bring them back to life. I went to visit her one week, and it was as if she’d lost all interest in tending to plants. There was a genuine disinterest (that came on quite suddenly) in her beloved hobby that she had long taken pride in. A loss of interest like this can be an early sign of dementia, especially when there’s no clear reason for the change.
Difficulty Understanding Sarcasm or Jokes
Another assisted living resident was a woman who always “got” dry humor and was a lot of fun to joke around with. The residents all loved her, and there was a playful banter that took place as they seemingly competed to tell her the ‘best’ jokes. During one weekly visit, I noticed that her comprehension of the other resident’s jokes changed. Sarcasm was lost to her, and she was easily offended, taking all of the jokes too literally. I recognized that this could indicate changes in the brain and talked to her and her family caregiver about seeing a doctor for an evaluation. Dementia can affect the ability to process complex language and social cues, and a sudden failure to understand sarcasm is sometimes an initial indicator that this is taking place.
Subtle Changes in Walking and Balance
In addition to impacting memory and cognitive functioning, dementia can cause physical functional changes to happen. Many of my residents and their family caregivers didn’t realize this or the impact that dementia has on motor function, including walking, balance, and gait. Small changes, like shuffling feet, a more persistent, slowed walking pace, or the senior seeming increasingly unsteady, can be early indicators of Lewy body dementia or another form of dementia. When residents exhibited these types of changes, I often recommended they meet with a healthcare professional. A physical assessment and diagnostic testing, as ordered by a senior’s physician, can help to rule out other issues and determine if dementia might be the cause of balance or mobility challenges.
Trouble Managing Finances
A perfectly organized retiree in one of our independent living condos suddenly started missing bills and making unusual purchases online. His daughter brought this to my attention and asked if we could help. I met with him to rule out some possible concerns, and we created a plan for him to follow to better manage his finances. However, the problems persisted. Problems with numbers, budgeting, and decision-making are often early signs of cognitive decline, so I asked his daughter to arrange a visit with his physician and have him evaluated. The assessment revealed early Alzheimer’s and provided the family with options to start medications and slow the decline.
Difficulty Following a Story or Conversation
There was a social group in our assisted living facility with four women who were always spending time together. They enjoyed tea, played cards, crafted, and spent time in the swimming pool. I was checking in with this group one day and discovered that one of the ladies who always enjoyed lively discussions was struggling to keep up. It was as if she lost track of the conversation, and she seemed to be asking the same questions repeatedly. Behavior like this sometimes indicates that the brain is having trouble processing and retaining information. It can be an early indicator of dementia.
Changes in Personal Hygiene
One of the more overlooked unusual signs of dementia that I saw in our senior living facility was a sudden shift in grooming habits. The man who always shaved started to wear a scruffy beard, or the woman who showered daily was going days or weeks without washing herself. If someone who has always been particular about their appearance starts forgetting to bathe themself, groom their hair or nails, or otherwise maintain their hygiene it may be a warning sign of cognitive decline. Aside from this, it might be an indication that these tasks are physically challenging because of changes in mobility, so have a doctor assess to accurately determine the root cause.
Increased Irritability or Mood Swings
I’ve seen family caregivers chalk up a senior loved one’s depression or irritability to stress, anger over a change in their living situation, or aging. Mood swings can be related to some of these things, but that’s not always the case—especially if the changes seemingly come out of nowhere. This can signal the early stages of dementia. The frustration of not being able to process thoughts as before or remember things as easily often manifests as anger, irritability, depression, or anxiety.
Uncharacteristic Hoarding or Paranoia
I remember a gentleman who suddenly started hoarding newspapers and tiny bottles of shampoo and soap and accusing the staff at the facility of stealing them. This was uncharacteristic behavior for a man who had once been neat, tidy, and quite trustworthy. Holding onto random objects or acting paranoid about and suspicious of people you once trusted can be an early warning sign of cognitive changes and dementia.
Struggling with Familiar Tasks in New Environments
Sometimes, I saw residents whose ability to complete small, seemingly tasks would shift in different environments. They might do just fine tying their shoelaces or remembering simple instructions in their apartment but get confused when visiting the dining hall or going to spend the night with a family member. I also sometimes noticed these changes for a new resident. Their family would tell me they were fine at home, but memory challenges increased once they moved into the facility. This is known as transfer trauma, and it can occur before, during, or months after a move. If an aging loved one starts to exhibit these symptoms in a new or unfamiliar setting, have them assessed for cognitive decline.
Closing Thoughts About Early Detection of Dementia
Unusual behaviors might indicate cognitive decline. They offer us an opening into a small window of opportunity to have senior loved ones evaluated for dementia. Early detection is key to helping seniors better manage their symptoms, increase their level of care (if necessary), and start medications that can slow the progression of Alzheimer’s and other forms of dementia. If you or your aging loved one exhibits any of these changes, don’t ignore them. Instead, have a conversation with a doctor. A simple assessment could lead to early support, better symptom management, a higher quality of life, and more time to prepare for the future.
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Originally published April 17, 2025
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