What to Do When You Notice a Sudden Worsening of Dementia Symptoms

When you have a loved one with dementia, life can be devastating—and challenging. And what can make dementia particularly difficult is its unpredictable timeline. Although the most common form of dementia, Alzheimer’s disease, typically advances gradually and progression can be described in stages (there are different models—for example the three- [early, middle, and late] or seven-stage models), the speed with which symptoms progress can vary widely from person to person.

But if your loved one’s dementia symptoms start to worsen within days or weeks, it’s important to note what’s happening so you can immediately seek medical advice. “While dementia is a progressive illness, it’s important to rule out underlying medical causes that may be worsening the condition,” says Gary Small, MD, Chair of Psychiatry at Hackensack University Medical Center, in Hackensack, New Jersey, and a member of TheKey’s Scientific Advisory Board.

Other times, worsening symptoms may have been present for a while, but you only notice after your loved one begins to lose day-to-day function, adds Frank M. Longo, MD, PhD, Professor and Chair of the Department of Neurology and Neurological Sciences at Stanford University School of Medicine in Stanford, California. “For example, maybe your loved one used to prepare meals and now they can’t, or they lose their way in a familiar place. Knowing what’s happening helps determine what needs to come next in terms of treatment,” says Dr. Longo, who’s also a member of TheKey’s Scientific Advisory Board.

It’s always a good idea to consult with your loved one’s primary care doctor first. That said, here’s how to tell what might be going on when you become aware of worsening dementia symptoms as well as what to look out for.

How Do Different Types of Dementia Typically Progress?

Dementia can be caused by many different conditions that affect brain health. Different causes have different treatment approaches and outcomes, so it’s important to know which type your loved one has, Dr. Small says. This way, you’re in a better position to track symptoms and note if they are suddenly worsening.

Here are the most common types of dementia along with their symptoms:

Alzheimer’s Disease

The most common type of dementia in the U.S., its symptoms initially present as short-term memory problems, Dr. Small says. “Alzheimer’s has a gradual onset and a gradual cognitive decline,” he explains.

In the early to middle stages, you may see your loved one having trouble handling money and paying bills, or show forgetfulness and mood and personality changes. In later stages, symptoms can include:

• Increased memory loss and confusion
• Difficulty with language
• Trouble carrying out multistep tasks like getting dressed
• Inability to recognize family and friends
• Impulsive behavior like undressing in public
• Angry outbursts
• Restlessness and agitation, especially in the late afternoon or evening

Vascular Dementia

This is one of themost common forms of dementia and occurs due to blood vessel damage and/or injured brain tissue resulting from the brain not receiving enough blood, oxygen, or nutrients. It may cause symptoms of memory loss similar to Alzheimer’s disease, Dr. Small notes.

Other signs of vascular dementia can include:

• Difficulty planning
• Problems paying attention
• Difficulty concentrating
• Impaired judgment
• Impaired functioning in social situations
• Trouble finding the right words
• Changes in personality, like aggression or anger
• Hallucinations

Unlike other forms of dementia, vascular dementia can have a stepwise structure, says Shadi Gholizadeh, PhD, MPH, Director of Memory Care at TheKey. “The decline in functioning can be steep compared to other dementias, which have a much slower progression if the symptoms follow a stroke or transient ischemic attack (mini-stroke),” she notes.

Frontotemporal Dementia

Another form of dementia, it typically affects people at younger ages, such as those in their 40s, 50s, or early 60s. “We don’t see as many memory issues initially; it’s usually trouble with language and personality changes,” Dr. Small says.

In the advanced stages of frontotemporal dementia (FTD), patients can develop muscle weakness and coordination problems that can make it difficult to swallow, chew, move around, and control their bladder and bowels.

Dementia with Lewy Bodies

Like most other forms of dementia, the symptoms are subtle at first and become more pronounced over time. But unlike Alzheimer’s, for example, early-stage symptoms typically include:

• Movement problems such as a changes in handwriting, muscle rigidity or stiffness, a shuffling walk, and loss of coordination
• Hallucinations and misidentification of familiar people
• REM sleep behavior disorder
• Blood pressure drops upon standing
• Dizziness
• Falls

Parkinson’s Disease Dementia

Up to 80 percent of people with Parkinson’s disease will eventually develop dementia. Parkinson’s-related dementia symptoms are similar to those of Lewy body dementia and can include cognitive impairment, sleep disorders, and hallucinations.

Mixed Dementia

This type of dementia is usually seen in people aged 80 or over. Most commonly, people have both the abnormal protein deposits associated with Alzheimer’s as well as the blood vessel problems linked to vascular dementia, according to the Alzheimer’s Association. As a result, they may have features of both diseases.

Sudden Worsening of Symptoms: Is It Dementia—or Something Else?

Dementia can manifest in a number of ways, but if you notice that your loved one suddenly seems more confused than usual, or is unexpectedly agitated, they may be experiencing delirium.

“Both delirium and dementia can cause cognitive impairment, but delirium is usually due to a more acute problem. There’s often an underlying physical cause–for example, an infection or dehydration,” explains Dr. Small.

Studies show that people with dementia are up to five times more likely to develop delirium. In fact, two-thirds of delirium cases occur in people who already have dementia, according to the American Geriatrics Society.

While it’s not quite clear why people with dementia are at higher risk of developing delirium, “dementia causes brain shrinkage and neuronal dysfunction, which makes the brain more sensitive to any kind of medical insult,” explains Dr. Small.

Delirium can also be caused by an imbalance in brain chemicals, which can occur more commonly among people with dementia. Such imbalances may be due to an infection, medication side effects, or abnormal blood sugar levels. That’s why, if there’s a sudden change in your loved one’s behavior—meaning within hours to days—it’s important to get it checked out right away, stresses Dr. Longo.

Common symptoms of delirium to watch for include:

• Slurred or incoherent speech
• Loss of consciousness
• Changes in movement such as slowness
• Changes in sleep patterns, like reversed sleep-wake cycles
• Confusion and disorientation–for example, not knowing where they are
• Memory loss, especially with short-term memory
• Sudden and dramatic personality changes such as extreme anger or agitation
• Sudden incontinence
• Hallucinations
• Fever or chills

If your loved one with dementia shows any signs of delirium, you should have them evaluated by their doctor right away to try to pinpoint the underlying cause, says Dr. Small. Once it’s identified—for example, a new medication or an infection—there’s a good chance the delirium can be resolved.

Other Potential Causes of Worsening Dementia Symptoms

“If I haven’t seen someone in a year and they’re a little worse in terms of symptoms, that’s an expected pace for dementia progression,” Dr. Longo explains. “But if they’re worse from when I saw them a few weeks ago, or a few days ago, that’s way too fast and something else is probably going on.”

When dementia changes are rapid, particularly within a few days, it’s important to check in with your loved one’s medical team right away. Some common causes include:

Mini-stroke: If your loved one has a form of dementia, such as Alzheimer’s or dementia with Lewy bodies, another potential cause of sudden worsening of cognition or other function is a small stroke due to vascular disease. In addition, vascular disease itself can be a cause of dementia. “With vascular dementia, the brain has a series of small strokes, which affect cognition,” says Dr. Longo. In some cases, older adults have a combination of Alzheimer’s disease and vascular dementia.

A recent hospitalization: If your loved one was hospitalized for an infection such as pneumonia, research suggests they are at greater risk to develop cognitive impairment.

Medication changes: It’s important to review all the drugs your loved one is taking, even over-the-counter medications. “Many medications can cause cognitive side effects, and people with dementia are more susceptible to them,” Dr. Longo says. Other potential culprits include opioids for pain management, anti-anxiety pills, oral steroids, and cholesterol-lowering statins.

Poor kidney function: A 2022 study published in the journal Age and Aging, for example, found an association between declining kidney function in older adults and dementia risk.

Nutritional deficiencies: People who have low vitamin B12 or folate levels may present with symptoms of dementia, notes Dr. Small.

Dehydration: Those with dementia may not be able to recognize or communicate that they’re thirsty—making them more susceptible to dehydration, which can make someone seem tired or confused.

Sleep disruptions: People with dementia are more prone to interrupted sleep, which can worsen the condition, points out Dr. Small.

Depression: “Depression is a risk factor for dementia, and dementia is also a risk factor for depression,” says Dr. Gholizadeh. While people living with dementia do experience depression at higher rates, it often goes undiagnosed because the person isn’t able to communicate how they are feeling. “The symptoms, such as social withdrawal or isolation and apathy, are sometimes written off as dementia,” Dr. Gholizadeh explains.

7 Warning Signs a Loved One’s Dementia May Be Worsening

Since dementia symptoms can vary by type, it’s important to know the general symptoms associated with your loved one’s form of dementia to gauge if it is suddenly worsening, advises Dr. Gholizadeh. For example, hallucinations tend to be a typical symptom for a person living with Lewy body dementia, but are rare in the earlier stages of Alzheimer’s, she notes. In this situation, any potential worsening may be a sign of an underlying medical issue, such as an infection.

If you notice any of these seven signs suddenly cropping up, have your loved one checked by a medical professional as soon as possible.

1. Incontinence: This symptom is common in middle- and late-stage dementia. If it pops up out of the blue, it could indicate another issue, such as an untreated urinary tract infection.

2. Trouble with language: Your loved one is unable to find the right word, or forgets what they are saying mid-sentence much more frequently than they did in the recent past. They also suddenly find it difficult to follow a conversation.

3. Aggression or agitation: They seem restless and do things like pace or seem unable to sit still, or they shout or scream, whereas they didn’t before.

4. Losing inhibitions: Your loved one starts saying or doing inappropriate things (like undressing in public or making rude comments), and this is out of character for them.

5. Confusion: They get confused about the time of day. For example, they get up and get dressed in the middle of the night. They suddenly appear perplexed about where they are, even if at home, or suddenly stop recognizing familiar people.

6. Delusions: Your loved one may suddenly worry that others will harm them, or can’t be trusted. For example, they might accuse someone of stealing from them or trying to harm them.

7. Hallucinations: They see and hear things that aren’t there, whereas this hasn’t been an issue previously.

What to Do If Worsening Symptoms Occur

If you suddenly see any of the above symptoms in your loved one, your first step should be to make an appointment with their neurologist, or, if you can’t get in quickly, their primary care physician, advises Dr. Small.

Bring the following information to your loved one’s medical visit:

• A detailed symptom journal: List any concerning symptoms, including when it started (or worsened), and if it’s constant or only seen at certain times. Be as specific as possible when relaying information, too. For example, note if your loved one has always been able to walk the dog along the same route, but over the last week, you’ve noticed they’ve gotten lost or can’t remember where to go.
• A list of medications: Make a detailed list of all the drugs your loved one is taking, including prescriptions, over-the-counter drugs, and any vitamins or other supplements.
• Any health or lifestyle factors: Jot down anything you can think of that could influence your loved one’s symptoms. For example, note a recent diagnosis of diabetes, depression, or family stress.

Your loved one’s doctor will most likely do a thorough workup, which may include blood work to look for nutrient deficiencies or a chemical or hormonal imbalance, memory and cognitive function tests, and possibly a brain scan.

Getting Your Loved One the Best Care

While it’s important to notice worsening dementia symptoms, it’s just as essential to keep your loved one as happy and comfortable as possible. Maintaining a stable environment is extremely helpful in protecting and caring for your loved one, as change can sometimes exacerbate dementia symptoms.

Working with a home-based care service can help you develop and maintain a long-term care plan—and help your loved one stay in a familiar environment for as long as possible. A professional caregiver may be the most beneficial option, says Dr. Gholizadeh. “For adults living with dementia who don’t have access to regular social interaction, a professional caregiver can provide an important source of companionship and engagement,” she explains.

“The longer people can be in a home that’s functional and safe, the better,” adds Dr. Longo. And remember that you don’t have to go it alone. There are plenty of options to support you and your loved one with dementia to help them receive the best possible care.

Additional reporting by Hallie Levine.