Dementia is common.
The World Health Organization reports that currently, more than 55 million people worldwide are living with dementia and 10 million new cases are diagnosed every year.
Here in the United States, the Centers for Disease Control and Prevention estimates that 6.5 million adults are living with Alzheimer’s disease. That number is projected to rise to about 14 million by 2060.
What exactly is dementia?
“There are many conditions that result from brain diseases,” says Dr. Douglas Scharre, director of the division of cognitive neurology at the Ohio State University Wexner Medical Center in Columbus. If these conditions “are to such a degree that they lead to interference in day-to-day functioning, they’re called dementia conditions.”
Dr. Susan Wehry, chief of geriatrics and associate clinical professor at the University of New England College of Osteopathic Medicine in Biddeford, Maine, describes dementia as “a syndrome with many causes, and the signs vary with the type of dementia.”
The most common form of dementia is a condition called Alzheimer’s disease. In this disease, specific proteins called beta-amyloid build up and form plaques that interfere with normal brain functioning. Alzheimer’s accounts for about 60% to 80% of all dementia cases, according to the CDC.
But there are several other types of dementia, including:
— Vascular dementia, caused by damage to blood vessels in the brain.
— Frontotemporal dementia, which affects the nerve cells in the frontal and temporal lobes of the brain.
— Lewy body dementia, a condition in which proteins clump together and interfere with normal brain functioning.
— Mixed dementia, in which more than one type of dementia is present.
Across these various types of dementia, symptoms don’t develop overnight. Instead, dementia symptoms tend to show up long after the disease process has started, when damage has already occurred in the brain. Dementia is typically diagnosed only after significant cognitive decline has resulted.
Dementia symptoms can be hard to spot early on.
Dana Taylor, a social worker and senior regional manager for Veterans Home Care based in St. Louis, says that while dementia can be challenging to spot in its early stage, it’s different from everyday forgetfulness.
Confusion, difficulty recalling words and poor decision-making skills can all be signs. “Some may play these symptoms off as ‘old-timer’s disease’ or relate the issues to just being ‘senior moments’ in general, so it’s important to be vigilant as to the frequency of the incidents,” Taylor says.
Because these symptoms can be subtle, “most people are not diagnosed with Alzheimer’s or one of the other many brain diseases that cause dementia until they’ve already progressed into their mid-stage,” adds Lisa Skinner, a Napa, California-based behavioral expert in the field of Alzheimer’s disease and related dementias.
In some cases, an individual may notice their own decline before anyone else does, a stage called subjective cognitive impairment. In other cases, a loved one is the first to notice dementia symptoms.
This checklist for early signs of dementia may help you determine whether you’re dealing with garden-variety absentmindedness or something more challenging that warrants a conversation with a doctor.
1. A decline in memory, thinking or attention
Perhaps the most recognizable sign of Alzheimer’s disease or dementia is a downturn in the ability to remember, make new memories or engage in more complex thought processes.
Dr. Susan Stone, medical director of care management services with L.A. Care Health Plan, the largest publicly operated health plan in the country, notes that the type of memory loss associated with dementia is different from the gradual decline in memory and attention that’s common with aging.
“Most of us have forgotten where we placed an item, but this doesn’t mean that there’s a risk of dementia,” she says. “Memory changes happen and can be quite gradual as we age.”
The frequency of such episodes and whether they disrupt daily life are the key factors. “Sometimes you can find things in odd places, such as the TV remote in the refrigerator, or the senior might develop a failure to follow through with simple tasks,” Taylor notes. “These are warning signs and should be acknowledged.”
2. Changes in mood or behavior
Dementia is “not just memory loss or confusion,” Skinner says. “This disease ravages a lot of the parts of the brain, and as a result of that, family members or caregivers will see behavioral changes or changes in mood.” For example, increased irritability is a hallmark of Alzheimer’s and some other forms of dementia.
In patients who have frontotemporal dementia — a disease that hits especially hard in the front of the brain where your personality and emotions are housed — aggressive outbursts, erratic or overly sexualized behaviors or mood changes may signal something’s wrong.
Taylor adds that physical changes, such as weight loss, can also be red flags because they can indicate the senior is struggling to prepare meals or eat normally.
3. Decline in functional abilities
“Another obvious symptom is that thinking abilities become so impaired (as) to actually interfere with daily functions,” Skinner says.
For example, as the disease progresses, some may have trouble taking care of household tasks like laundry, cooking and cleaning. Financial management, driving to a new location and other tasks that involve preplanning or complex thinking also typically become more challenging for someone living with dementia.
“Trouble handling money, following a recipe or completing familiar tasks” can all be signs of growing difficulty with problem-solving and decision-making, adds Dr. Shoshana Ungerleider, a practicing internal medicine physician at Crossover Health in California and host of the TED Health Podcast.
4. An increase in confusion
Everyone experiences confusion from time to time, and garden-variety forgetfulness, like when you’re preoccupied or under stress, is normal. But people experiencing cognitive decline related to dementia may show more severe confusion, especially with regard to time and place.
“An individual may become disoriented about where they are or what day it is and may have trouble following a schedule,” Ungerleider says.
As the disease progresses, some people begin to lose the ability to recognize common objects. “That’s a sign of a more serious disease happening” rather than just general aging, Skinner says. She gives the example that forgetting where you’ve put your keys isn’t that big a deal — everyone does it sometimes. But if you find them and you’re not able to remember what you’re supposed to do with them, “that’s a huge red flag.”
5. Decline in social cognition
Many adults who are experiencing cognitive decline also notice a decline in their ability to recognize faces or remember the names of friends or loved ones. Responding appropriately to social cues also becomes more difficult as dementia develops.
“You’ll notice signs that the person’s social skills are changing, and they tend to avoid or withdraw from social situations or isolate themselves,” Skinner says. This can lead some people to withdraw from social settings, which only further compounds the problem and could increase the risk of developing loneliness and depression. Depression can exacerbate the situation, but it can also be a sign of dementia in its own right.
The decline in social cognition can also appear as a loss of initiative, Ungerleider says. “An individual may become less interested in things they previously enjoyed or may need to be prompted to start activities.”
6. Repetition
“This is a really common sign,” Skinner says. “A lot of people with dementia will repeat the same questions over and over and over again in the same conversation, or they’ll repeat the same story. They’ll tell it to you over and over and over again.”
Wehry, who’s also a board member of Dementia Action Alliance in Charlottesville, Virginia, says that “repeating the same story or asking the same question that’s just been answered and being unaware of having done so is a classic example” of Alzheimer’s disease.
7. Changes in language use
In addition to the typical word-finding difficulties, people experiencing cognitive decline may display other language changes. For example, in more advanced cases and in folks who speak more than one language, there may be a reversion to the native language, Skinner says.
“If your mother came from Italy and Italian was her first language, she might just all of a sudden start speaking in Italian without even realizing it,” she explains.
In other cases, when word-finding issues arise, the person might sub in a made-up word. “They might say, ‘I put my laundry away in the thingamajig,’ because they can’t find the word for dresser drawer,” Skinner says.
As the disease progresses, these language issues become more pronounced, Ungerleider adds. “They may experience significant changes in their ability to communicate and understand language.”
What to do if dementia symptoms arise
If you notice any of the above symptoms, it’s worth talking with your primary care provider. Scharre says this clinician will “take a history, perform a pen-and-paper test (that evaluates cognitive function), do a physical examination, order lab tests and order a brain scan to help identify what the cause may be.”
Scharre adds that “you can also assess your cognitive abilities free of charge at your doctor’s office or at home by downloading and taking the Self-Administered Gerocognitive Examination, known as the SAGE test, to get a baseline level and then check again every six to 12 months. If you see a decline, let your doctor know.”
Women may be at higher risk.
Women are affected by Alzheimer’s disease more than men, by a margin of about 2 to 1, according to data from the Alzheimer’s Association.
“There is research underway to understand these differences and how biological mechanisms such as hormonal factors and lifestyle may impact this difference,” Stone says.
Wehry adds that the higher incidence of Alzheimer’s in women “has been mostly attributed to the fact that women live longer. Developing Alzheimer’s disease is not inevitable, but increasing age does increase the risk to a point.”
Another possible explanation suggests that brain cells die faster in women’s brains than in men’s, Stone says. “Women in their 60s are twice as likely to develop dementia than they are breast cancer, and given that women take on more caregiving roles, the impact is significant.”
Symptoms might manifest differently, depending on gender.
Signs of dementia in women are essentially the same as signs of dementia in men, though Ungerleider notes there can be some differences.
“Men may be more likely to experience frontotemporal dementia, which is characterized by changes in behavior, personality and language,” says Ungerleider, “while women are more likely to develop Alzheimer’s disease, which primarily affects memory.”
Some men tend to become more aggressive as dementia progresses, whereas women tend to show more depression and anxiety symptoms. Wehry adds that “in general, women of all ages tend to have better verbal skills and verbal memory than men and so may perform better on some tests designed to detect dementia. One way to look at this is to say the diagnosis may be ‘missed.’ Another way to look at it is to say women may preserve function longer because women have more cognitive reserves in this area of verbal memory.”
In all discussions of differences between how men and women experience dementia, however, “it’s important to keep in mind that gender-specific differences are not always present and can vary widely among individuals,” Ungerleider notes. “Dementia affects individuals differently, and not everyone with dementia will experience the same symptoms.”
Early detection is important.
When screening tests are able to pick up cognitive changes, this stage is called mild cognitive impairment, or MCI. MCI may eventually progress to dementia as the disease process continues. So, it’s important to seek help as early as possible when treatment can be more effective in slowing disease development.
Scharre notes that the longer you wait to address issues related to cognitive decline, the harder it becomes to slow the progression of the disease. “The earlier you detect cognitive decline, the more beneficial are the treatments. Alzheimer’s disease has a course of typically eight to 12 years. Starting treatments earlier can probably slow the decline.”
Wehry says she teaches her students that “staging by strength may be a useful way to think about early vs. later stages. In the early stages, people can carry on conversations, plan common tasks like dinner, navigate familiar surroundings and recognize familiar people and places.”
She continues, “In the middle stages, people living with dementia are more likely to focus on remembered events that happened long ago.” They might recognize people from early in life, for instance. They might rely on commonly used phrases, such as “Hello, how are you?” to preserve a social connection. They may still be able to make simple decisions, read and understand single words.
In the later stages, “people can still interpret and use basic body language to communicate rather than words and enjoy the world through senses — sounds, tastes, smells, sights and touch,” Wehry says.
Treatments are available.
Skinner notes that while there’s currently no cure for Alzheimer’s and other forms of dementia, there are treatments available that can delay the progress of the disease.
These medications aren’t effective for everyone, and there can be a lot of variability in how the disease progresses even after the patient begins treatment. But, she says, there’s hope that early intervention can give you a better quality of life for longer.
One medication, a controversial drug called aducanumab (Aduhelm), was approved by the Food and Drug Administration in July 2021 in hopes that the treatment would offer a better quality of life. However, this medication has to be started as early as possible to be effective, and some providers aren’t using it because they don’t see the benefits as being worth the high price and potential downsides.
Another new medication, lecanemab-irmb, sold under the trade name Leqembi, received accelerated approval from the FDA in January 2023. It has been shown to moderately slow cognitive and functional decline in cases during the early stages of Alzheimer’s disease.
Other new medications for Alzheimer’s and other dementias are on the horizon and receiving a lot of attention, given the vast number of people who need help with these degenerative diseases.
The bottom line, Wehry notes, is that there is help available if you seek it when symptoms arise. “Please, please, please don’t be afraid to have a conversation with your primary care practitioner,” she says. “Primary care physicians and nurse practitioners can do a simple screening test to see if further tests are warranted. Some causes of dementia, like dementia due to certain medications or medication interactions or depression, may be reversible.”
Activity and social engagement can help.
While medications offer some hope, other interventions can also help. Skinner recommends getting and staying as active as possible if you’re dealing with dementia.
“It’s very important for people with Alzheimer’s disease (and other dementias) to be provided with the right type of activities and stimulation and environment to delay the progression,” she says.
She recommends finding activities that engage the body, mind and spirit “that will match the skill level that the person is at. You don’t want to overwhelm them with something that’s too difficult because that also causes agitation and frustration.”
From music therapy to gardening and gentle exercise, getting and staying engaged in ways that use all five senses can help stretch the brain and slow the progression of cognitive decline.
The brain is like any other muscle in the body, Skinner says. If it’s not kept active, it can atrophy and die. But, you can delay brain atrophy with physical and mental activities and social engagement.
Lastly, Wehry encourages you not to ignore symptoms. “The tragedy narrative that has so long dominated our conversations is yesterday’s news. We know so much more about these chronic progressive conditions than at any point in my career. Like with all chronic, progressive diseases, until there’s a cure, there is a way to live and thrive with dementia.”
7 early signs of dementia:
— A decline in memory, thinking or attention.
— Changes in mood or behavior.
— Decline in functional abilities.
— An increase in confusion.
— Decline in social cognition.
— Repetition.
— Changes in language use.
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Recognizing the Early Symptoms of Dementia originally appeared on usnews.com
Update 02/13/23: This story was previously published at an earlier date and has been updated with new information.
