6 Dementia Symptoms That Can Show Up Years Before a Diagnosis in Fort Myers

Dementia Doesn't Start With Memory Loss When patients ask me about dementia, they almost always ask about memory. Am I forgetting more than I should? My mother had it — should I be worried? It's a fair question. But it may be the wrong starting point. A recent Washington Post piece by Richard Sima pulled together something researchers have been circling for years: the earliest signs of Alzheimer's and other dementias often aren't cognitive at all. The brain changes quietly for a long time before anyone notices a problem with memory — in many cases 15 to 20 years before a diagnosis is ever made. What shows up first tends to look like something else entirely. Mood. Sleep. How you walk. How you smell your coffee. That's not a scary idea. It's actually a hopeful one, because a 15-year head start is a lot of room to work with. The six early signals New depression or anxiety after 55 or 60. Mood disorders that appear for the first time later in life can reflect changes already underway in the brain's networks. This doesn't mean depression at 60 is dementia — most of the time it isn't. But it's worth taking seriously rather than writing off as "just getting older." Apathy or unusual irritability. Losing interest in things you used to enjoy, pulling back from friends, snapping at people when that isn't your nature. Families often notice this before the patient does, and they usually chalk it up to personality or stress. Disrupted sleep. Sleep apnea, poor sleep quality, and less nighttime sleep overall are linked to greater buildup of amyloid-beta, one of the proteins associated with Alzheimer's. Your brain clears waste while you sleep. Shortchange that process for years and it shows. A fading sense of smell. The olfactory nerve is unusually vulnerable to neurodegeneration. Roughly 85% of people in early-stage Alzheimer's have some decline in their sense of smell, and it can begin up to a decade before any cognitive symptoms. Walking more slowly. Gait speed, and how easily you can turn a full circle, predict cognitive trouble years ahead. Walking is more of a brain task than most people realize. Weakening grip strength. Every 11-pound drop in grip strength is associated with about a 20% higher dementia risk in men and 12% in women. Why we already test some of this That last one probably sounds familiar if you're a member of our concierge program, because grip strength is part of your extended wellness testing here. I've had patients laugh when we bring out the dynamometer. It's a small device you squeeze, it takes thirty seconds, and it feels like the least sophisticated thing we do all visit. But grip strength is one of the best single predictors we have for overall mortality, disability, and hospitalization — and now, increasingly, for brain health. It reflects total muscle quality and the health of the nerves driving those muscles. When it drops, something systemic is usually going on. The McCance Brain Care Score is the other piece. It scores 21 modifiable factors — blood pressure, blood sugar, cholesterol, weight, nutrition, alcohol, tobacco, exercise, sleep, stress, relationships, and sense of purpose. Notice how many of those overlap with the six signals above. Sleep is on both lists. So is mood. So is the vascular health that determines how well blood reaches your brain in the first place. That overlap isn't a coincidence. What protects your heart protects your brain, and up to 40% of dementia risk is tied to factors you can actually change. Where this is heading Testing in this area is moving fast. Blood-based markers that were research-only a few years ago are now available to us in the office, and we've added an Alzheimer's biomarker panel to our prevention program for patients where it makes sense. Smell testing, gait speed measurement, and better sleep assessment are all reasonable additions as the evidence firms up. I want to be honest about the limits. None of these tests diagnose dementia. A single low grip strength reading doesn't mean anything on its own. New depression at 58 is usually depression. The value is in tracking your numbers over years and watching for patterns — which is exactly what a small panel practice lets me do, and what a rushed 15-minute annual physical cannot. What you can do, starting this week Treat sleep as medical, not optional. Aim for 7–9 hours. If you snore, wake unrefreshed, or feel sleepy during the day, ask me about a sleep study. Untreated apnea is one of the most fixable risks on this whole list. Lift something heavy, twice a week. Resistance training is the only reliable way to build grip and muscle back. Two or three sessions a week is enough to change your trajectory. Walk every day, and walk with purpose. Thirty minutes at a pace that makes conversation slightly harder. Both your legs and your brain benefit. Get blood pressure, blood sugar, and cholesterol to target. These are brain numbers, not just heart numbers. Say something about mood changes. If you or your family notice new irritability, withdrawal, low motivation, or anxiety, bring it up. Don't wait for your next physical. Notice your sense of smell. If food has tasted flat for months, mention it. Protect your connections. Isolation is a genuine risk factor. So is losing a sense of purpose. Limit alcohol, skip tobacco. Both accelerate the vascular damage underneath cognitive decline. The theme here is that nearly everything on that list is something you have leverage over. We measure it so we can see it early — and early is where the leverage lives.

Questions about your health? Contact Fort Myers Primary Care & Wellness at (239) 922-0909.

This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting any new wellness routine.

To your health,

Dr. Sabha