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 — a colleague, an actor, an old friend — simply won’t arrive. And somewhere in the back of your mind, a nagging thought: “is this how it starts?”
If you’re in your midlife, the anxiety related to developing dementia is one of the most common worries. This article explains what normal memory change in midlife actually looks like, when it’s worth speaking to your GP, and — perhaps most importantly — what the research tells us you can do to protect your brain across the decades ahead.
Why do worries about dementia often peak in midlife?
Fear of developing dementia is widespread and well-documented. A 2022 survey by Alzheimer’s Research UK found that dementia ranked as the most feared health condition among adults — above cancer, stroke, and heart disease. More recently, in Australia, a peer-reviewed survey found that dementia and cancer were the most feared conditions among Australian health service consumers, with adults aged 65 and over fearing dementia the most (Watson et al., 2023).
For people in midlife, this fear often intensifies for specific reasons. You may have watched a parent or grandparent live with dementia. And you’re at an age when the brain begins making changes that are noticeable — even when those changes are entirely normal.
The problem is that it’s difficult for most of us to tell the difference between normal age-related memory change, anxiety-driven forgetfulness, and something that warrants attention.
What actually happens to memory in midlife
The brain is not static. It changes throughout life — in ways that are adaptive or reflective of decline. Some of those changes become more noticeable from our forties onward.
Research published in Nature tracked cognitive performance across the lifespan in over 1.2 million people and found that processing speed — how quickly the brain handles information — begins to decline gradually from around age 20, while other capacities, including vocabulary, general knowledge, and what researchers call crystallised intelligence otherwise known as accumulated knowledge, continue to grow well into later life (Hartshorne & Germine, 2015). The picture is not one of uniform decline; it is one of change, trade-off, and in many areas, continued adaptation and growth.
What this means in everyday terms: in midlife, you may notice that it takes a little longer to retrieve a name or a word, that you are more easily distracted when trying to hold several things in mind at once, and that learning something entirely new requires more effort than it once did. While these experiences are worrying, they are also, in most cases, a normal part of how the brain ages — not early signs of dementia.
A 2024 review from the Lancet on dementia prevention, intervention, and care — one of the most comprehensive reviews of the evidence to date — distinguished clearly between normal cognitive ageing, mild cognitive impairment (where changes are noticeable but do not significantly interfere with daily life), and dementia (Livingston et al., 2024). These are meaningfully different things, and the boundaries between them are not as blurred as anxiety would suggest.
What’s normal and what’s worth checking
This is the question most people actually want answered. Here is 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 disrupts communication
The key clinical distinction is between normal forgetting — where you know you’ve forgotten something and can often retrieve it later — and memory change, where information appears to be lost rather than temporarily misplaced, 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 initial screening, rule out treatable causes of cognitive change (including thyroid issues, vitamin deficiencies, sleep disorders, depression, and medication side-effects, all of which can affect memory), and refer you to a specialist if needed.
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. A 2021 review found that anxiety impairs working memory which holds and manipulates information in the short term, through a process involving attentional disruption (Moran, 2021). As such, when the mind is preoccupied with anxious threat monitoring, it has less capacity for the task at hand.
In other words: worrying about your memory can genuinely make your memory worse. This does not mean the worry is irrational — but it does mean that addressing the anxiety is a meaningful intervention.
Depression similarly affects memory and concentration, often in ways that can be mistaken for early cognitive decline. A 2023 study found that depressive symptoms were associated with self-reported cognitive complaints in midlife, independent of tested cognitive performance (Lam et al., 2023). Feeling like your mind isn’t working properly is sometimes a signal about mood, not cognitive decline — and mood is something that responds well to psychological therapy (Ji et al., 2023; Laidlaw et al., 2022).
Our article Late-Life Depression: What It Looks Like, Why It's Missed, and What Actually Helps explores this in depth — including how depression can mimic cognitive decline and why treating it is also a brain health intervention.
What the evidence says about protecting your brain
This is where the story shifts — because there is good news here, and it is not the kind of vague reassurance that is easy to dismiss.
The 2020 Lancet Commission identified twelve modifiable risk factors that together account for around 40% of dementia cases worldwide — meaning that a significant proportion of dementia may be preventable or delayed through changes that are available to most people (Livingston et al., 2020). A 2024 updated analysis added two further factors, reinforcing the strength of this evidence (Livingston et al., 2024).
What this means practically is that midlife is not a time to wait and see. It is one of the most important periods in which to act.
The evidence-based lifestyle factors most consistently associated with reduced dementia risk include:
Physical activity. Regular aerobic exercise is one of the most robustly supported factors in brain health research. A 2022 meta-analysis found that physical activity was significantly associated with reduced risk of cognitive decline and dementia across multiple study designs (Iso-Markku et al., 2022). Such positive outcomes, involve increased blood flow to the brain, reduced inflammation, and the promotion of neuroplasticity (or the brain’s capacity to form new connections and adapt).
Sleep. Sleep is when the brain performs essential maintenance, including clearing metabolic waste products associated with Alzheimer’s disease. A 2021 study found that sleeping six hours or fewer per night in midlife was associated with a 30% higher risk of dementia in later life compared with sleeping seven hours (Sabia et al., 2021). Sleep quality matters too, not just duration.
Social connection. Loneliness and social isolation are both risk factors for dementia, with a 2022 study estimating that loneliness increases dementia risk by approximately 40% (Livingston et al., 2024). Meaningful connection with others is not so much a nice thing to have, but instead a brain health intervention.
For more on loneliness and connection in midlife and later life, read When Did Everyone Become So Disconnected? Loneliness in Midlife and Beyond. For LGBTQIA+ readers — for whom social connection in later life often carries the additional weight of minority stress, historical marginalisation, and the particular losses of the HIV/AIDS era — The Loneliness Few People Talk About: Building Belonging in the LGBTQIA+ Community at Midlife and Beyond speaks directly to that experience.
Managing depression and anxiety. Both depression and chronic anxiety are associated with increased dementia risk (Gulpers et al., 2016; Becker et al., 2021). Treating these conditions is therefore not only about quality of life in the present — it is an investment in cognitive health across the decades ahead.
Because depression is both a risk factor for dementia and characterised by cognitive difficulties with attention and concentration, treating it matters twice over. Our article Late-Life Depression: What It Looks Like, Why It's Missed, and What Actually Helps is worth reading alongside.
Mental stimulation. Learning new skills, engaging with complex ideas, and maintaining intellectual curiosity are all associated with cognitive reserve, which is a kind of brain-buffer that allows the brain to function well, even as changes occur (Stern et al., 2020). There is no single activity that is uniquely protective; what matters is sustained engagement with things that challenge you.
Hearing. Hearing loss is one of the largest modifiable dementia risk factors identified by the Lancet Commission — larger than smoking or physical inactivity. Treating hearing loss with aids is associated with reduced cognitive decline in people at higher risk (Livingston et al., 2020). This is worth knowing, and often overlooked.
What psychology can offer
A clinical psychologist is not a neuropsychologist or a diagnostician of dementia — that pathway runs through your GP and specialist medical teams. But psychology has a meaningful and often underutilised role to play in this area.
If you are living with significant worry about your memory or your future brain health, a psychologist can help you:
Understand the difference between anxiety-driven cognitive symptoms and changes that warrant medical attention
Address the anxiety itself, which can be directly impairing your memory and concentration
Treat depression, which is both a risk factor for dementia and a cause of cognitive symptoms in its own right
Build and sustain the lifestyle habits — sleep, social connection, physical activity, purpose — that the research most consistently supports
Work through the emotional weight of a family history of dementia, which is a particular kind of anticipatory grief that deserves its own space
At Upside Stories, our clinical psychologist Bruce, works with people in midlife and later life who are navigating these kinds of questions — including those who are caring for a parent with dementia and are more aware that their own brain health story is still being written. This work sits at the intersection of the Healthy Brain Happy Heart program and broader online therapy at Upside Stories.
What this means if you have a family history of dementia
Having a parent or sibling with dementia does increase your statistical risk — but the absolute increase is more modest than most people fear. A large international study pooling data from over 17,000 older adults found that a parental history of dementia was associated with approximately 47% higher odds of developing dementia in offspring (Cations et al., 2023). In practical terms, this means moving from roughly 20 cases per 1,000 people to around 26 to 29 per 1,000 — a real increase, but far from a predetermined outcome. The majority of dementia risk is explained by lifestyle and modifiable factors rather than genetics alone (Livingston et al., 2024) — which means that what you do across your life course matters considerably, regardless of family history.
However, a family history of dementia deserves more than a risk-factor checklist. Supporting someone you love who lives with dementia, deserves a space where it can be explored.
For more on navigating the emotional experience of supporting a family member with dementia, see Holding On While Letting Go and From Guilty Failure to Moral Courage in the Upside Stories Library.
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. Some worry is understandable — having a family history of dementia does modestly increase statistical risk, though in absolute terms the increase is smaller than most people fear (Cations et al., 2023). When that worry becomes persistent, intrusive, or begins to affect daily life, it is worth speaking to your GP and clinical psychologist — because anxiety is treatable, and because unaddressed anxiety can itself impair memory and concentration.
Can anxiety cause memory problems that feel like dementia?
Yes. Anxiety impairs working memory — the system that holds information in mind during a task — through attentional disruption (Moran, 2021). Depression similarly affects concentration and memory; and both anxiety and depression can produce cognitive symptoms that are sometimes mistaken for early dementia (American Psychiatric Association, 2022; Lam et al., 2023). Your GP can help distinguish between these, and your 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 rather than just the details; asking the same questions repeatedly without realising it; getting lost in familiar places; difficulty managing previously routine tasks like finances or medications; and personality or behaviour changes that others have noticed. Occasionally forgetting a word or a name, or feeling mentally fatigued, are generally not signs of dementia.
Can I actually reduce my risk of dementia?
Yes. And the evidence for this is stronger than many people realise. Around 40% of dementia cases worldwide may be preventable or delayed through modifiable factors (Livingston et al., 2020, 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 on each of these factors, read our article Modifiable Risk Factors for Dementia — and What You Can Do About Them.
How can a psychologist help with dementia worry?
A clinical psychologist cannot diagnose dementia — that pathway to a geriatrician or clinical neuropsychologist runs through your GP. But clinical psychology can address the anxiety and depression that mimic cognitive symptoms and increase dementia risk, help you build and sustain lifestyle habits that are brain-protective, and provide a space to process the emotional impact of a family history of dementia.
Do I need a GP referral to see a psychologist at Upside Stories?
No referral is needed to book. Medicare rebates do apply if you have a GP referral with a Mental Health Treatment Plan, which reduces the cost of sessions significantly. Your GP can also help rule out treatable medical causes of memory change at the same time — so a GP visit is often a useful first step even if you are primarily seeking psychological support.
What the research tells us
Normal memory change in midlife includes slower word retrieval and greater susceptibility to distraction — these are not early dementia (Hartshorne & Germine, 2015).
Anxiety and depression both impair memory and concentration, and can be mistaken for cognitive decline (Moran, 2021; Lam et al., 2023).
Around 40% of dementia cases may be preventable or delayed through modifiable lifestyle factors (Livingston et al., 2020, 2024).
Midlife physical activity, sleep, social connection, hearing care, and treatment of depression and anxiety are among the most evidence-supported protective factors (Livingston et al., 2020, 2024).
Loneliness increases dementia risk by approximately 40% — meaningful connection is a brain health intervention, not just a nice to have (Livingston et al., 2022).
A parental history of dementia is associated with approximately 47% higher odds of developing dementia — a real but modest increase in absolute terms that does not determine outcome. Modifiable lifestyle factors matter regardless of family history (Cations et al., 2023; Livingston et al., 2024).
Your brain’s next chapter is still being written
Concern about dementia is understandable. For many people in midlife, it sits in the background — surfacing every time a word won’t come, every time a room is entered and forgotten. That worry deserves to be taken seriously, but it also doesn’t need to leave you feeling unusually anxious. Because the research is clear: what you do in midlife matters for your brain in later life. The daily lifestyle habits, the social connections, the sleep, the treatment of anxiety and depression — they are the conditions under which your brain continues to write its story.
At Upside Stories, we believe a longer life should mean more joy, not more resignation. That includes the story of your brain health.
To explore your next chapter, book a free 20-minute consult.
Every article starts and ends with me. I conduct a literature search, review the evidence, and apply critical thinking to form a balanced clinical perspective. My draft notes go into Claude, an AI assistant made by Anthropic, which recommends an article structure. Then it’s back to me, for consideration, writing, and editing until it’s finished. Every article is grounded in recent peer-reviewed research and scientific reports, cited throughout. Dr Bruce Walmsley, Clinical Psychologist.
References & reading
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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
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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
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