Concerns About Dementia in Midlife: What’s Normal, What’s Not, and What You Can Do
You walk into a room and forget why you’re there. You lose your train of thought mid-sentence. A name that should come easily, whether it’s a colleague, a celebrity, someone’s partner, but it’s still on the tip of your tongue. And somewhere in the back of your mind, a nagging question: “what if this is dementia?”
If you’re in your midlife, fears about developing dementia are common, especially because it is still unfortunately a stigmatised condition and many people have a family history of dementia too. This article explains what normal memory change in midlife looks like, when it’s worth speaking to your GP, and what the research tells us about future brain health.
Why do worries about dementia often peak in midlife?
It has long been recognised that developing dementia is a common fear. In Australia, peer-reviewed surveys indicate that dementia and cancer are the two most feared conditions among Australians, particularly for people aged 65 and over (Watson et al., 2023). In part, this explains why people put off asking their GP for dementia testing; on average waiting for 3 years after they suspected early signs of dementia (Ambikairajah et al., 2025; Watson et al., 2023).
The stigma that surrounds a dementia diagnosis, only makes this situation worse. For Australians living with dementia, experiences of discrimination, judgement, and being underestimated are frequent (Kim et al. 2019). However, the views and responses of others aren’t the only source of stigma. Dementia-related stigma can also be internalised over decades, through negative media and cultural views, until it starts to become self-referential from midlife (Alzheimer's Disease International, 2024). And when occasional memory lapses or misplacing things starts to remind a person of a parent or grandparent who lived with dementia, midlife worries about dementia are only compounded (Farina et al., 2024; Fenstermacher et al., 2020).
The problem is that it’s difficult to tell the difference between normal age-related memory change, anxiety-related forgetfulness, and a cognitive change that needs screening.
What happens to memory in midlife?
The brain is not static. It changes throughout life, adapting in some ways, declining in others, with many of those changes becoming more noticeable from early midlife.
Research published in Nature tracked cognitive performance across the lifespan in over 1.2 million people and found that the brain starts to process information more slowly, gradually declining in speed from around age 20, while other capacities, including vocabulary, general knowledge, and accumulated knowledge, keep growing well into later life (Hartshorne & Germine, 2015). As such, the picture is not one of uniform decline; it is one of change, trade-off, and in many areas, ongoing adaptation and growth.
So what does this look like, in day-to-day midlife? You may notice that it takes slightly longer to retrieve a name or a word, that you’re more easily distracted when trying to hold several things in your mind at once, and that learning something entirely new requires more effort than it used to. While these experiences are worrying, they may also be in many cases, a normal part of how the brain changes as we age, rather than early signs of dementia.
One of the most comprehensive reviews of the dementia treatment intervention and care to date, was able to clearly distinguish between normal cognitive ageing versus mild cognitive impairment (which are noticeable changes but changes that do not interrupt daily life), and dementia itself (Livingston et al., 2024). This indicates that these three things are typically distinct and recognisable. For many of us, it may be that what we’re noticing is our anxious “what if’s” taking over.
What’s normal and what’s worth checking?
This is a common question, and here’s a straightforward guide based on current clinical evidence (American Psychiatric Association, 2022; Livingston et al., 2020).
Generally normal in midlife:
Occasionally forgetting a name or word, but recalling it later
Momentarily forgetting why you walked into a room
Feeling more mentally fatigued after sustained concentration
Taking longer to learn new skills than you once did
Losing the thread of a conversation when distracted
Worth mentioning to your GP:
Forgetting recent conversations or events entirely, not just the details
Asking the same questions repeatedly without realising it
Getting lost in familiar places
Difficulties managing finances, medications, or tasks that were previously routine
Noticeable changes in personality, mood, or behaviour that others have commented on
Frequent difficulty finding words, in a way that breaks the flow of communication
On one hand, there is normal forgetting, where you know you’ve forgotten something and can often retrieve it later. On the other hand, there is memory change, where information appears to be lost and where the person themselves may not be aware of the gaps.
If you’re uncertain, a conversation with your GP is always the right first step. A GP can conduct dementia screening, rule out treatable causes of cognitive change, and refer you to a clinical neuropsychologist and geriatrician for further assessment, and a clinical psychologist for support.
The anxiety-memory loop: when worry makes forgetting worse
There is a particularly unhelpful cycle that many people in midlife find themselves in. They notice a memory slip, worry it signals dementia, the worry itself uses up cognitive resources and disrupts concentration, which leads to more forgetting, which increases anxiety, and so on.
This is not imagined. The relationship between anxiety and memory is well-established in the research literature. Anxiety has been found to impair working memory by disrupting your attention when you’re trying to hold and manipulates information in the moment (Moran, 2021). When the mind is caught up anxiously monitoring for signs of dementia, it has less capacity for the task at hand. In other words: worrying about your memory can genuinely make your memory worse.
Other concerns with mood, such as depression also impact memory and concentration, with individuals experiencing depression are more likely to report concerns with memory and thinking, despite contradictory performance on cognitive tests (Szyszkowska et al., 2023). For those in midlife, such changes could be mistaken for early cognitive decline.
As a result, feeling like your mind isn’t working properly is sometimes a signal about mood such as anxiety or depression, rather than cognitive decline. Our article Late-Life Depression: What It Looks Like, Why It's Missed, and What Helps explores this in depth, including how depression can mimic cognitive decline and why treating depression is also a brain-health intervention.
What does the evidence say about modifiable risk factors for dementia?
According to the 2024 Lancet Commission on Dementia Prevention, Intervention, and Care, up to 48% of dementia cases may be linked to modifiable risk factors, including physical inactivity, depression, social isolation, hearing loss, and high blood pressure. Whether you’re noticing normal age-related memory change, anxiety-related forgetfulness, or something more significant, it’s never too early or too late to start looking after your brain health. Learn more in our companion article, about modifiable risk factors for dementia and what you can do about them.
What does it mean if you have a family history of dementia?
Although age is the greatest risk factor for developing dementia, with dementia risk doubling roughly every five years, from around 8% for Australians aged 65 and over to 43% for those aged 90 and over (AIHW, 2024), for most people, the majority of dementia risk is explained by lifestyle and modifiable factors rather than genetics (Livingston et al., 2024).
For those with a first-degree family history of dementia, research indicates a 4–10 times higher risk compared to those without a family history (Cupples et al., 2004). However, environmental and lifestyle factors influence "genetic makeup to eventually allow or deny dementia a foothold" across an individual's lifespan (Chow, 2013, p. 70), meaning that the choices we make day to day have an impact on our brain health and future dementia risk (Livingston et al., 2024; Koulouri & Zannas, 2024).
Frequently asked questions
Is it normal to worry about dementia in your forties and fifties?
Yes. Fear of dementia is one of the most common health concerns in midlife, particularly among people who have watched a parent or grandparent live with the condition (Watson et al., 2023). Some worry is understandable, and having a first-degree family history does increase statistical risk, though the absolute increase is more modest than many people fear (Cupples et al., 2004). When that worry becomes persistent, intrusive, or begins to affect daily life, it is worth speaking to your GP, who can do a dementia screening test and rule out possible physical causes, and refer you to a clinical neuropsychologist or geriatrician for further assessment, or a clinical psychologist for support, as required.
Can anxiety and depression cause memory problems that feel like dementia?
Yes. Anxiety impairs working memory by disrupting your attention (Moran, 2021). Depression similarly affects concentration and memory, and people experiencing depression are more likely to report subjective memory concerns despite this not always being reflected in objective cognitive testing (Szyszkowska et al., 2023). Both conditions can produce cognitive symptoms that are sometimes mistaken for early dementia (American Psychiatric Association, 2022). Your GP can help distinguish between these, and a clinical psychologist can help treat the underlying anxiety or depression.
What are the early signs of dementia I should actually look out for?
The signs most worth discussing with your GP include: forgetting recent conversations or events entirely, not just the details; asking the same questions repeatedly without realising it; getting lost in familiar places; difficulty managing previously routine tasks such as finances or medications; noticeable changes in personality, mood, or behaviour that others have commented on; and frequent difficulty finding words in a way that disrupts the flow of communication. Occasionally forgetting a name or word, momentarily losing your train of thought, or feeling mentally fatigued after sustained concentration are generally not signs of dementia (American Psychiatric Association, 2022; Livingston et al., 2024).
Can I actually reduce my risk of dementia?
Yes, and the evidence for this is stronger than many people realise. According to the 2024 Lancet Commission, up to 45% of dementia cases worldwide may be preventable or delayed by addressing modifiable risk factors across the lifespan (Livingston et al., 2024). The most important of these in midlife include regular physical activity, good sleep, social connection, treating depression and anxiety, managing blood pressure, addressing hearing loss, and maintaining cognitive stimulation. Midlife is one of the most important periods to act. For a detailed look at the evidence, read our companion article on modifiable risk factors for dementia and what you can do about them. For a detailed look at the evidence on each of these factors, read our article Modifiable Risk Factors for Dementia, and What You Can Do About Them.
Do I need a GP referral to see a psychologist at Upside Stories?
No referral is needed to book. Medicare rebates apply if you have a GP referral with a Mental Health Treatment Plan, which reduces the cost of your sessions. Your GP can also screen for dementia and rule out any underlying medical reasons for cognitive changes you’re experiencing.
What the research tells us
Normal memory change in midlife includes slower word retrieval, greater susceptibility to distraction, and increased effort required for new learning; these are not necessarily early signs of dementia (Hartshorne & Germine, 2015; Livingston et al., 2024).
Anxiety impairs working memory by disrupting our attention, and depression affects concentration and memory in ways that can be mistaken for early cognitive decline (Moran, 2021; Szyszkowska et al., 2023).
Up to 45% of dementia cases worldwide may be preventable or delayed by addressing modifiable risk factors across the lifespan (Livingston et al., 2024).
Midlife physical activity, sleep quality, social connection, hearing care, and treatment of depression and anxiety are among the most evidence-supported protective factors for brain health (Livingston et al., 2024).
A lack of meaningful, supportive relationships increases dementia risk, especially if you live alone or feel disconnected (Livingston et al., 2024). If this resonates, read our articles on loneliness in midlife and later life and, for LGBTQIA+ readers, building meaningful friendships and belonging.
For those with a first-degree family history of dementia, research indicates a 4–10 times higher relative risk compared to those without a family history (Cupples et al., 2004). However, environmental and lifestyle factors also influence our brain health and future dementia risk (Chow, 2013; Livingston et al., 2024; Koulouri & Zannas, 2024).
Your brain’s next chapter is still being written
At Upside Stories, our clinical psychologist Bruce, works with people in midlife and later life who are navigating these kinds of questions, including those caring for a parent with dementia, and are more aware that their own brain health story is still being written. This work includes online therapy and individualised 10-week programs such as Healthy Brain Happy Heart which explores modifiable risk factors and how you can turn good intentions into meaningful, healthy lifestyle habits.
To explore your next chapter, book a free 20-minute consult today.
References & reading
Alzheimer's Disease International. (2024). World Alzheimer report 2024: Global changes in attitudes to dementia. London, England: Author. https://www.alzint.org/resource/world-alzheimer-report-2024
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425787
Ambikairajah A, Foxe D, deLange A-M, et al. (2025). A Bayesian analysis of diagnostic timelines across Alzheimer's disease, frontotemporal dementia, and other neurodegenerative conditions. Alzheimer's Dementia, 17:e70184. https://doi.org/10.1002/dad2.70184
Australian Institute of Health and Welfare (2024). Dementia in Australia. AIHW, Australian Government. https://www.aihw.gov.au/reports/dementia/dementia-in-aus
Cations, M., Radford, K., Laver, K., Draper, B., Low, L.-F., Gresham, M., Brodaty, H., & Gonçalves-Bradley, D. (2023). Parental history of dementia and the risk of dementia: A cross-sectional analysis of a global collaborative study. Psychiatry and Clinical Neurosciences, 77(8), 449–456. https://doi.org/10.1111/pcn.13561
Chow, T. (2013). The Memory Clinic: Stories of hope and healing for Alzheimer's patients and their families. Toronto, Canada: Penguin.
Cupples, L. A., Farrer, L. A., Sadovnick, A. D., Relkin, N., Whitehouse, P., & Green, R. C. (2004). Estimating risk curves for first-degree relatives of patients with Alzheimer's disease: The REVEAL study. Genetics in Medicine, 6(4), 192–196. https://doi.org/10.1097/01.GIM.0000132690.10042.6E
Farina, F.R., Bennett, M.P. and Griffith, J.W. (2024), Fear of Alzheimer’s disease in older women with a family history of dementia and what we can do about it: results from an observational study and randomized controlled trial. Alzheimer's Dement., 20: e090823. https://doi.org/10.1002/alz.090823
Fenstermacher, E., Ebert, A., Shook, N., Lee, J., Wilson, J., Haliwa, I. (2020). Dementia-Related Anxiety and General Illness Anxiety Differ Based on Familial Exposure to Persons With Dementia, Innovation in Aging, 4(1) 283–284. https://doi.org/10.1093/geroni/igaa057.907
Hartshorne, J. K., & Germine, L. T. (2015). When does cognitive functioning peak? The asynchronous rise and fall of different cognitive abilities across the life span. Psychological Science, 26(4), 433–443. https://doi.org/10.1177/0956797614567339
Koulouri, A., & Zannas, A. S. (2024). Epigenetics as a link between environmental factors and dementia risk. Journal of Alzheimer's Disease Reports, 8(1), 1372–1380. https://doi.org/10.1177/25424823241284227
Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., … & Mukadam, N. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 404(10452), 572–628. https://doi.org/10.1016/S0140-6736(24)01296-0
Moran, T. P. (2021). Anxiety and working memory capacity: A meta-analysis and narrative review. Psychological Bulletin, 142(8), 831–864. https://doi.org/10.1037/bul0000051
Szyszkowska, J., Kundro, P., & Wróbel, J. (2023). The impact of depressive symptomology, rumination and objective memory performance on subjective cognitive complaints. International Journal of Psychophysiology, 190, 1–7. https://doi.org/10.1016/j.ijpsycho.2023.05.351
Watson, R., Sanson-Fisher, R., Bryant, J., & Mansfield, E. (2023). Dementia is the second most feared condition among Australian health service consumers: Results of a cross-sectional survey. BMC Public Health, 23(1), Article 876. https://doi.org/10.1186/s12889-023-15772-y
