Shuffling feet, restless nights and a fading sense of smell can surface long before memory slips. Catching them early may change everything.

Misplacing your sunglasses or blanking on an old acquaintance’s name can spark a moment of panic as the years pile up. Usually, those hiccups are a normal part of aging. But doctors say ordinary forgetfulness and dementia are not the same, and some of the earliest clues have nothing to do with memory.

About 7 million Americans live with dementia, a number expected to double by 2060.

Where forgetfulness ends and dementia begins

Dr. Stephanie Nothelle, a geriatrician and associate professor at Johns Hopkins School of Medicine in Baltimore, said the line between mild cognitive impairment and dementia is crossed when a cognitive problem begins disrupting daily function. That could mean giving up driving, getting lost on a familiar route or suddenly being unable to file taxes after decades of doing them. If thinking changes make an ordinary day hard to manage, she said, that’s a red flag.

Dementia is an umbrella term for several forms of cognitive decline. They include Alzheimer’s disease, the most common type, as well as vascular dementia and Parkinson’s-related dementia. Symptoms vary by diagnosis, but certain physical signs tend to surface.

The body’s quiet warning signs of dementia

1. Trouble walking and keeping balance. Most physical symptoms emerge later, Nothelle said, but walking and balance problems often appear early and worsen over time. Moving smoothly takes serious brainpower because the brain must rapidly process signals from the feet, the eyes and the surroundings. Frequent falls can point to dementia, though arthritis or plain clumsiness can also be the culprit.
2. Shuffling feet and posture changes. Lewy body dementia, the second most common form, is closely tied to Parkinson’s disease, said Dr. Jori Fleisher, an associate professor of neurological sciences at Rush University in Chicago. It can bring stooped posture, shuffling or a slower gait. It’s easy to blame age or arthritis, Fleisher said, but a consistent pattern deserves attention.
3. A fading sense of taste or smell. COVID-19 and sinus trouble can dull these senses, but unexplained changes may be linked to Lewy body dementia. Often a loved one notices first, Fleisher said. For example, food might be burning on the stove and the person doesn’t smell it. That alone warrants a doctor’s visit.
4. Difficulty swallowing. Food and drinks can slip into the windpipe, Nothelle said. Because the mouth harbors bacteria, some of it harmful, anything that reaches the lungs can cause an infection. This condition is known as aspiration pneumonia, and it is relatively common in later-stage dementia.
5. Bladder and bowel changes. The nerves that control the bladder degenerate as dementia progresses, Nothelle said, which can lead to incontinence. New constipation later in life can also signal Parkinson’s and related conditions, sometimes years ahead of other symptoms, according to Fleisher.
6. Restless, disrupted sleep. People rarely catch this in themselves. But if someone you live with thrashes, punches, shouts or talks in their sleep, Fleisher said, tell their health care team. It could be REM sleep behavior disorder, which can precede Parkinson’s or Lewy body dementia by years.

Why an early diagnosis is worth the hard conversation

Admitting to cognitive changes is hard, but both doctors stressed that it matters. Fleisher called this an era of real innovation in dementia treatment, and Nothelle noted that research into new medications is underway. Doctors can now test biomarkers in blood or spinal fluid to identify the type of dementia and guide treatment.

Current therapies aren’t cures, but they can help manage the disease, and both experts said they work best when started early. An early diagnosis also gives people a say in their future, Nothelle said, including decisions about their care, where they will live and their finances.

Everyday habits that may lower your risk

Whether or not these symptoms sound familiar, a healthy lifestyle remains a strong defense. Both experts recommend:

• a nutritious diet (Fleisher favors the MIND diet)
• regular exercise
• time with loved ones
• managing chronic conditions such as diabetes, high blood pressure and sleep apnea

Experts predict that 42% of Americans older than 55 will develop dementia. Paying attention to the body’s quieter signals could make all the difference.