The holidays are a good time to check in with older relatives. Here's how to tell what's normal and what's not.

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Getting together with family is one of the true joys of the holidays, especially if you don’t see each other often. It’s a chance to catch up with cousins, see how much kids have grown, and reminisce about the past.

It can also be a good time to check in on older friends or relatives who may not seem as sharp as they used to be—especially those who live independently and don’t have someone paying close attention to them regularly.

"If you haven’t seen your elderly loved one in a while, you might be more likely to notice changes in their memory and behavior that worries you," says Gregory Jicha, M.D., professor of neurology at the University of Kentucky Sanders-Brown Center on Aging.

Yes, it’s super uncomfortable to question someone’s mental state—especially a parent or another close family member. But if you suspect there’s a problem, it’s important to encourage them to see a doctor. One reason? About one-third of the time, says Dr. Jicha, memory or cognition problems are caused by something other than Alzheimer’s disease.

“Sometimes we find out that a patient simply needs thyroid medicine or has a vitamin deficiency, and we can treat those conditions easily,” he says. “Other times we find that a patient has had a stroke, which needs to be addressed in a totally different way.”

Even if tests do reveal that your loved one is in the early stages of dementia, having confirmation can make a big difference: Your loved one may have to make adjustments to better cope with their memory issues—like putting daily medications in a seven-day pill box to ensure they don’t miss a dose, or hiring a health aide to help with basic tasks.

Getting a dementia diagnosis can also mean exploring medication options. “The earlier we start people on medicines for memory problems, the better they do in the long run,” says Dr. Jicha. “They won’t cure the disease or change a person’s lifespan, but they do keep people functioning at a much higher level for a much longer period of time.”

Of course, early cognitive decline isn’t always obvious, and it can be difficult to tell what’s really a warning sign of dementia and what is a normal sign of aging. Here are some red flags to watch and listen for this holiday season.

Repeating themselves. It’s normal for a person’s recall to slow with aging, says Dr. Jicha, and it may be normal for someone to tell a story or ask a question over again—if they catch themselves and acknowledge the mistake. “When they repeat something and seem totally unaware that it’s been discussed before, that’s when you know to ask, ‘Have you been having problems with your memory?’” he says.

Trouble with recipes. Problem-solving skills can deteriorate in someone with Alzheimer’s disease. Following step-by-step instructions or doing simple calculations may become confusing.

Getting lost in familiar places. It’s normal for an older adult to feel disoriented or confused when they’re in a new place—but if they are having difficultly completing familiar tasks or navigating around familiar locations, it might be a sign of dementia.

Choosing the wrong words. Healthy people occasionally struggle to find the right word, especially as they age. But using completely wrong words and calling things by the wrong names may be a sign that something more serious is going on.

Poor hygiene. “Changes in appearance are often the first things family members notice when a person has dementia,” says Dr. Jicha, “especially for people who are typically immaculately dressed or meticulous about their makeup.” Certainly, someone who’s retired and doesn’t get out very often may put less emphasis on how they look. “But if they’re showing up to Thanksgiving dinner and they clearly haven’t shaved or showered in a few days, that could signal a problem,” he says.

Household clues. If you’re visiting an older loved one in their home, take note of anything that seems unusual or out of sorts. Are they missing personal care products, like toothpaste or soap and shampoo? Are there old or rotten items in their refrigerator? Is laundry or garbage piling up?

Personality changes. Is your loved one acting irrational, fearful, or suspicious? Are they showing bad judgment—giving money to telemarketers, for example? “The big thing you want to look for is a significant change,” says Dr. Jicha. “If you're unsure, just ask yourself: Is their behavior—or they way they present themselves, or their home—suddenly different than it used to be? If the answer is yes, it's worth talking to a doctor."

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