Pre-clinical Dementia (Stage 1): Risk Factors & Early Awareness

If there are no symptoms yet, this is the stage for awareness and lowering risk — here’s what matters and where to begin.

What is stage 1?

Stage 1 is the pre-clinical stage — no noticeable symptoms and normal day-to-day function.

Most people are here. If you’re reading this out of worry or a family history, the useful work now is lowering risk where you can and learning what to watch for.

Signs at this stage

A few patterns tend to show up — use them to orient, not to diagnose.

• No noticeable memory or thinking changes
• Here out of worry, family history, or wanting to lower risk
• Interested in brain-health habits and early warning signs

What to focus on at this stage

A short list of what matters most now.

• Protect brain health (heart health, sleep, hearing, activity, connection)
• Learn normal aging vs. a genuine warning sign
• If watching a parent, note what you observe over time

Can you lower your risk?

Yes, by a meaningful amount, though not to zero.

The 2024 Lancet Commission on dementia prevention identified 14 risk factors that can be changed. It estimated that nearly half of future dementia cases (45 percent) could potentially be prevented or delayed if all 14 were addressed. Two were new in 2024: high LDL cholesterol in midlife and untreated vision loss in later life. The list also includes hearing loss, high blood pressure, physical inactivity, and social isolation.

Those numbers describe whole populations, not one person. Age and family history still count, and nobody can promise a particular brain will stay healthy. But most of the 14 are things you can act on at any age, and the sooner the better. Our articles on hearing loss, vision loss, and social isolation go through three of them in detail.

What is happening before there are symptoms?

Possibly a lot, quietly.

The Alzheimer’s Association notes that brain changes can begin years before symptoms appear. Stage 1 on the Global Deterioration Scale means no measurable decline, so there is nothing to diagnose. The stage exists as a starting point on the map, and as a reminder that the best time to act on risk is before anything feels wrong.

Normal aging or a warning sign?

Occasional lapses are common. A pattern that disrupts daily life is different.

The Alzheimer’s Association lists ten early warning signs and pairs each with its typical age-related counterpart. A few examples:

• Forgetting a name or appointment and remembering it later is typical aging. Forgetting recent information and relying more and more on reminders or family is not.
• Occasionally needing help with an appliance setting is typical. Trouble with familiar tasks, like driving to a known place, is not.
• Briefly confused about the day of the week, then working it out, is typical. Losing track of dates, seasons, or where you are is not.
• Sometimes struggling for the right word is typical. Difficulty following or joining a conversation is not.

If you notice one or more of the ten signs in yourself or someone else, the Alzheimer’s Association advises scheduling a doctor’s appointment rather than waiting.

If you are watching a parent

Notice, write it down, and stay calm.

A family history makes many people hypervigilant, which is its own kind of strain. A steadier approach is a simple dated note when something stands out: what happened, when, and what they were doing. One slip is just a slip. A pattern over months is worth taking to a doctor, and the notes make that visit far more useful. If it reaches that point, stage 2 covers the next step.