Early dementia signs can be confusing, and many people dismiss them as just part of aging. Neurologists say that while memory issues are widely recognized, other symptoms may appear first. These early signs often fly under the radar, making diagnosis more difficult. Recognizing them sooner could help patients and families seek medical advice earlier.
Doctors explain that not all dementia symptoms are dramatic or tied to forgetting important details. Some begin quietly, showing up as changes in energy or motivation. Because they don’t always look alarming, these signals are often overlooked. Yet, paying attention to them can make a difference in understanding what’s really happening.
What symptom do neurologists warn about?
Neurologists highlight apathy as one of the most overlooked early signs of dementia. Dr. Adel Aziz, MD, a neurologist at JFK University Medical Center, explains that apathy refers to a loss of goal-directed thought and behavior. Unlike memory lapses, this symptom may appear as a gradual decline in initiative, where someone no longer makes plans or seeks out activities they once enjoyed.
Dr. Aziz points out that apathy can be mistaken for simple fatigue, shyness, or even a preference for quiet time. Loved ones may feel hurt, assuming the person no longer cares, when in reality this change stems from a neurological shift. Dr. Katherine D. Amodeo, MD, an assistant professor of neurology at New York Medical College, notes that it can sometimes resemble depression, though it has a different root cause.
Apathy is especially connected to certain types of dementia, including frontotemporal dementia. This condition often affects people earlier in life, between ages 45 and 65, and personality changes are a common first clue. A 2020 study published in Alzheimer’s & Dementia found that apathy could predict frontotemporal dementia years before other cognitive problems began. Researchers also discovered that apathy tends to accelerate overall decline, as it limits engagement in activities that support brain health.
Dr. Daniel Lesley, MD, a board-certified neurologist at Remo Health, adds that apathy may arise not only from chemical and structural brain changes but also from situational factors. As daily tasks become more difficult, individuals may feel discouraged, deciding that things are “not worth the effort.” Some also struggle with feelings of uselessness or being a burden, which reinforces withdrawal.
How to recognize and address apathy in dementia
Experts emphasize that apathy is not a diagnosis itself but rather a description of diminished drive or interest. Dr. Lesley lists common signs such as loss of enthusiasm for hobbies, reduced motivation for essential tasks like paying bills or eating, and neglect of self-care routines. While these changes may seem subtle, their persistence can indicate something more than natural aging.
Importantly, apathy does not always mean dementia. Dr. Amodeo clarifies that it can also appear in conditions like depression, which is why medical evaluation is critical. What sets dementia-related apathy apart is its gradual and progressive course, often accompanied by other cognitive changes such as memory issues, confusion, sleep disturbances, or shifts in personality.
Facing a potential dementia diagnosis can be overwhelming, both for the individual and their loved ones. Experts recommend starting with a primary care doctor, who can order cognitive testing and guide next steps. Mental health support may also be necessary, especially since apathy itself can worsen emotional well-being.