The moment, ten years ago, when my colleague Sarah told me she realised something was very wrong with her father, then in his mid-70s, is one I still vividly remember.
It was Boxing Day and she was sitting at her parents' kitchen table watching him try to make a pot of tea – something he'd done countless times before.
He filled the kettle, switched it on, then stood there looking at the teapot as though he'd never seen one in his life.
'I just stood there frozen,' she told me, tears welling. 'He looked so confused. And I thought: how long has this been going on?'
The answer, it turned out, was probably more than a year. Her father had been living alone since her mother's death, and while Sarah phoned him regularly, she hadn't spent more than a few hours with him since the previous Christmas.
In those brief phone calls, he had seemed fine. A bit forgetful perhaps, but nothing alarming. It was only when she sat with him for several days that the full picture emerged.
Sarah's story is heartbreakingly common. Christmas brings families together in ways that the rest of the year simply doesn't. You might see elderly parents or grandparents for extended periods for the first time in months.
You'll watch them navigate familiar tasks such as cooking the turkey and following conversations. And crucially, you'll have time to observe.
Dementia often develops slowly and insidiously. Its early signs can be masked during a quick phone call or a hurried visit. But spend several days with someone and the picture becomes clearer.
That's why, this festive season, the NHS is urging families to use gatherings as an opportunity to look out for the signs of dementia in elderly loved ones.
I trained in old-age psychiatry and have spent years working in dementia services, so it's a message I wholeheartedly support, because early detection changes outcomes.
While we don't yet have drugs that can cure dementia, there are treatments that slow its progression, and a wealth of support that can help someone live well with the condition for longer.
Around one million people in the UK live with dementia, yet Alzheimer's Society says one in three don't have a diagnosis.
That means hundreds of thousands are struggling alone, without access to the support, treatment and practical help that could make their lives considerably better.
The NHS Christmas campaign is part of the effort to ensure people come forward.
WHAT TO WATCH FOR
The signs can vary depending on the type of dementia someone has – 'dementia' is actually an umbrella term for a collection of conditions that affect memory, thinking and the ability to perform everyday activities.
Understanding this is important because different types progress differently and respond to different treatments.
The different types include Alzheimer's disease (the most common); vascular dementia (often related to problems with blood supply to the brain); Lewy body dementia (caused by abnormal protein deposits in the brain); and frontotemporal dementia (which typically affects younger people).
The symptoms depend on which areas of the brain are affected. Some people may have significant memory problems but no personality changes; others might struggle with spatial awareness and navigation while their memory remains relatively intact. Here are some of the common signs that might suggest a loved one has early dementia:
REPEATING THE SAME STORIES OR QUESTIONS WITHIN MINUTES: We all tell the same anecdotes, but if Granny asks you the same question three times during Christmas dinner, or tells you the same story as though she's never mentioned it before, that's different.
STRUGGLING WITH FAMILIAR TASKS: Has the person who's made the same Christmas pudding for 40 years suddenly forgotten how to do it? Are they confused by the oven they've used for decades? Difficulty with tasks that were once second nature – e.g. doing shoelaces – is a key warning sign.
PROBLEMS WITH FOLLOWING CONVERSATIONS: Watch how they cope with group chats around the dinner table. Are they struggling to find the right words? Appearing confused or withdrawn when multiple people are talking? It's worth noting that hearing loss (itself a risk factor for dementia) can mask these difficulties or be mistaken for them. If someone seems to be struggling to follow conversations, it's worth considering whether their hearing has been checked recently, too.
CONFUSION ABOUT TIME AND PLACE: Being uncertain about what day it is, or becoming disoriented in unfamiliar surroundings, can be an early indicator, particularly if they seem confused about where they are when staying at a relative's house.
PERSONALITY OR MOOD CHANGES: Has someone who was always sociable become withdrawn? Is a previously calm person now irritable or anxious? Emotional changes – including increased agitation or suspicion of others – can be early signs.
MISPLACING THINGS IN ODD PLACES: We all lose our keys, but putting the car keys in the fridge or the TV remote in the oven is different. This happens because dementia affects the brain's ability to make logical connections and sequence everyday actions.
POOR JUDGMENT: The frontal lobes of the brain, which control reasoning and decision-making, are often affected by dementia.
This can make someone unusually susceptible to scams, lead to uncharacteristic purchases, or cause poor judgment in situations where they'd normally be sensible.
Note, one isolated incident isn't necessarily cause for alarm – but if you're noticing a pattern of several of these signs, or if any single symptom is markedly worse than before and affecting daily life, it's worth seeking advice.
WHAT'S NORMAL
Now let me offer some reassurance. I don't want you spending Christmas in a state of paranoid vigilance, analysing every forgotten word as evidence of cognitive decline.
Normal ageing does affect memory from as early as our 50s. I once had a patient in her early 80s convinced she had dementia.
Her son had noticed that she sometimes forgot names or words and started pointing this out to her. She got more and more upset and worried and her difficulties with words and names got worse and worse. But her memory tests and brain scans were normal.
It became clear it wasn't dementia – she had anxiety caused by her worry about dementia.
Reassuring her that forgetting the odd word or name was normal for her age was actually all that was needed.
The following should not cause concern:
Occasionally forgetting names: especially of people they don't see often. If it comes back to them later, or with a prompt, that's normal ageing.
Needing to write things down more: using lists, calendars, and reminders is a sensible adaptation to normal age-related memory changes.
Taking longer to learn new things: struggling with a new smartphone or unfamiliar technology is not dementia. Processing speed naturally slows with age.
Searching for a word occasionally: having a word 'on the tip of your tongue' but getting there eventually is normal. It's only concerning when this becomes frequent and significantly disrupts conversation.
Being a bit muddled after too much sherry: don't 'diagnose' dementia when the culprit is Grandad's enthusiasm for port.
Misplacing things occasionally: losing your glasses but being able to retrace your steps and find them is normal. Equally, realising they were on your head the whole time is normal.
The crucial distinction is this: normal age-related forgetfulness is mild and doesn't significantly interfere with daily life. Dementia, by contrast, progressively affects the ability to carry out everyday activities.
WHAT TO DO IF YOU'RE CONCERNED
If Christmas does raise concerns, what then? I've met too many families who noticed something but didn't want to 'upset' their loved one by mentioning it, only to wish later they'd acted sooner.
The first step is simple: encourage them to see their GP. This doesn't mean announcing dramatically over Christmas dinner you think they have dementia. Instead, find a quiet moment after the festivities, express your concern gently –and suggest it might be worth getting a check-up.
You might say something like: 'I've noticed you've seemed a bit more forgetful lately and I want to make sure everything's okay. Would you be willing to have a chat with your doctor?'
The GP can then refer them to a memory clinic for proper assessment, which typically involves memory tests and sometimes brain scans.
WHY EARLY DIAGNOSIS MATTERS
I want to end on a genuinely positive note, because I know that dementia is frightening to contemplate and many people avoid seeking diagnosis because of this. But the truth is that early diagnosis is empowering.
It means time – time to plan, to make decisions about the future while you're still able to, and time to access treatments that can help manage symptoms.
Medications can help: for Alzheimer's, cholinesterase inhibitors – drugs such as donepezil, rivastigmine and galantamine – can help maintain memory and thinking skills for longer. They work best when started early.
For vascular dementia, the focus is on preventing further damage to the brain by treating underlying cardiovascular risk factors – so medications for high blood pressure, high cholesterol and diabetes become crucial.
There are also support services, such as local memory cafés where people can connect with others in similar situations, and therapies such as cognitive stimulation –structured group sessions involving word games, puzzles, music and reminiscence – that can help maintain quality of life.
You can make practical adaptations – labels on cupboards, simplified daily routines and making the home environment safer – as well as financial protections and legal arrangements, which are much easier to put in place earlier rather than later.
Most importantly, a diagnosis often brings relief, both to the person affected and to their family. The confusion and fear of not knowing what's wrong is replaced with understanding and a clear path forward.
Families can rally around, support can be organised and the person with dementia can be helped to live well for as long as possible.
Sarah's father was eventually diagnosed with Alzheimer's. 'The diagnosis was devastating,' she told me. 'But it was also the beginning of something better. We finally understood what was happening. We could get help.'
He lived for another six years, with good support and family around him.
So this Christmas, enjoy the mince pies and the cracker jokes. But if, amid the celebrations, you notice something that concerns you, have the courage to act on it. It could be the most important gift you offer your loved one this year.
Worried you or a loved one may have dementia? Use Alzheimer's Society's symptoms checklist by logging in to alzheimers.org.uk/symptoms.
For confidential advice, call Alzheimer's Society's Dementia Support Line on 0333 150 3456.
