Dementia is common.
The World Health Organization reports that currently, more than 55 million people worldwide are living with dementia, and 10 million news cases are diagnosed every year.
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.”
The most common form of dementia is a condition called Alzheimer’s disease. Alzheimer’s develops when proteins called beta amyloid build up into plaques that interfere with normal brain functioning. Alzheimer’s accounts for about 60% to 70% of all dementia cases.
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 started, when damage has already occurred in the brain.
Dementia symptoms can be hard to spot early on.
Symptoms may only surface after years of the changes taking place in the brain.
With Alzheimer’s disease, these changes involve the development of beta amyloid plaques — misfolded proteins that interfere with normal brain functioning. These plaques take years to build up before symptoms arise, and dementia is typically diagnosed only after significant cognitive decline has resulted.
In some cases, there’s a period when the individual notices their own decline before anyone else does, a stage is called subjective cognitive impairment. In other cases, a loved one is the first to notice symptoms of dementia.
Symptoms of dementia are different from typical aging.
“One of the things that’s really difficult with making an Alzheimer’s or dementia diagnosis is that in the very early stages, it’s very difficult to discern between just normal aging or forgetfulness and the signs of something much more serious happening,” says Lisa Skinner, a Napa, California-based behavioral expert in the field of Alzheimer’s disease and related dementias.
“The symptoms are very subtle in the beginning and almost unnoticeable. For that reason, 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.”
However, there are some warning signs that may indicate it might be time to talk with your doctor. This early signs of dementia checklist may help you determine whether you’re dealing with garden-variety forgetfulness or something more challenging.
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. Memory changes happen, and can be quite gradual as we age.”
The difference here is when memory loss disrupts daily life and leads to difficulty in planning and solving problems.
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 and erratic or overly sexualized behaviors or mood changes may signal something’s wrong.
3. Decline in functional abilities
“Another obvious symptom is that thinking abilities become so impaired to actually interfere with daily functions,” Skinner says. More than just general forgetfulness, this shift affects the patient’s ability to complete daily tasks in ways that “don’t happen with normal aging.”
For example, as the disease progresses, some may experience difficulty taking care of household tasks like laundry, cooking and cleaning. Financial management, driving to a new location and other complex tasks that involve pre-planning or complex thinking also typically become very difficult for someone living with dementia as the disease progresses.
4. An increase in confusion
Everyone experiences confusion from time to time, and garden variety forgetfulness, such as occurs when you’re preoccupied or under stress, is normal. But people experiencing cognitive decline related to dementia may 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 when you find them, 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 one. 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 adds. This can lead some people to withdraw from social settings, which only further compounds the problem and could increase risk for loneliness and depression. Depression can exacerbate the situation, but it can also be a sign of dementia in its own right.
“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.”
7. Changes in language use
In addition to the typical word-finding difficulties, people experiencing cognitive decline may display, in more advanced cases and in folks who speak more than one language, there may be a reversion to the native language, Skinner says. In addition to typical word-finding difficulties, please experiencing cognitive decline may insert new words.
“Some people, when they’re experiencing damage to the brain due to brain disease, they actually will revert back to their first language. So, 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.”
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.
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, 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 two to one, 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.
She adds that one possible explanation suggests that brain cells die faster in women’s brains than in men’s. “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.”
Signs of dementia in women are essentially the same as signs of dementia in men.
Early detection is important.
When screening tests finally are able to pick up the cognitive changes, this stage is called mild cognitive impairment, or MCI. MCI may eventually progress to dementia as the disease process continues.
Because MCI can progress to dementia, it’s important to seek help as early as possible when treatment can be more effective in slowing the progress of the disease.
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.”
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.
A new, controversial drug called aducanumab (Aduhelm) was recently approved by the Food and Drug Administration and offers hope that treatment may 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.
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 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.
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.
— Changes in language use.
More from U.S. News
Update 04/13/22: This story was previously published at an earlier date and has been updated with new information.