We tend to associate dementia with memory loss—your mother starts asking the same questions repeatedly, or your father struggles for the right words to say in a conversation. We all know memory issues can be a warning sign for dementia, a general term used to describe difficulty thinking, remembering, or making decisions that interfere with everyday life. (Alzheimer’s disease is the most common form of dementia, but not all dementia is caused by Alzheimer’s.) While memory loss is generally the most obvious and well-known symptom, it isn’t the only red flag. Here are eight other warning signs to be on the alert for in your older loved one—and what to do if your loved one exhibits this behavior.
Red Flag #1: Trouble Concentrating, Planning, or Following Instructions
Does this scenario seem familiar? A wife asks her 75-year-old husband to run to the store for eggs, milk, and bread. The husband gets to the store and picks up the eggs and the milk but can’t remember the third item. “I know she told me to get three things,” he thinks. “What is the third one?” That tiny blip in attention could be an early warning sign of impending dementia, says William Mobley, MD, PhD, Distinguished Professor in the Department of Neurosciences at the University of California, San Diego. “Very early on, there can be periods of a little confusion, a little uncertainty about what the next step should be,” says Dr. Mobley, who’s also a member of TheKey’s Scientific Advisory Board. “Other examples include changes in an older person’s ability to follow a recipe, compute numbers, pay monthly bills, or play a familiar board game.”
Normal, healthy aging can include occasional lapses in the ability to follow directions or recall lists, but these lapses are eventually resolved. Dr. Mobley notes that “if the husband were to call his wife and she says, ‘It was the milk!’ and then he remembers, ‘Oh, yes, the milk,’ that’s not as much of a worry, but if it becomes part of a pattern where there is difficulty completing tasks and in concentrating on and remembering them, that would be cause for concern.”
Red Flag #2: Surprising Changes in Mood, Personality, or Behavior
Has your normally outgoing and optimistic aunt suddenly become withdrawn and pessimistic? Or maybe your mom, a lifelong fan of poker, mystery novels, and volunteering, has stopped engaging in these formerly beloved activities. These sorts of baffling changes in personality, mood, or behavior may be a warning sign of developing dementia.
“If a person has lost some cognitive ability, the enjoyable aspects of an activity such as tennis, golf, bridge, or taking walks might not be as satisfying,” says 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, and a member of TheKey’s Scientific Advisory Board. That’s because depression frequently accompanies a decline in short-term memory function, and might be a contributing factor to the memory loss or a result of it as a person struggles to remember things they used to have no issue remembering. “One sign of depression is decreased enjoyment of activities that, for the patient, were previously enjoyable,” Dr. Longo explains. “In some cases, a loss of cognitive ability can also affect one’s ability to enjoy activities that require short-term memory, such as keeping score [in a game] or spatial orientation,” like what’s required when taking a walk in a new place.
Besides loss of interest in previously enjoyed activities, the Alzheimer’s Association lists social withdrawal; insensitive behavior, such as saying something unkind or inappropriate; and apathy (lacking initiative in terms of planning or participating in activities) as some of the more common personality changes that may signal a loss of cognitive function.
Red Flag #3: Getting Lost—Even in One’s Own Neighborhood
Your loved one used to have a keen sense of direction but suddenly starts getting lost, even in familiar areas. This kind of deteriorating navigational ability has been linked by numerous studies to future dementia. In a 2020 study published in Alzheimer’s & Dementia, 95 subjects between the ages of 50 and 90 were asked to complete a computerized task that involved navigating a new environment. After four to five years of follow-up, those who performed poorly on the task were three times more likely to have developed dementia.
According to Dr. Longo, this symptom may first present itself when a person is out of town and away from their usual environment. “Patients often do well at home in their day-to-day routine but when they go on a trip, like to an adult child’s wedding, their family or spouse notices more struggles with navigating new areas,” he says.
Red Flag #4: Confusion About Time and Place
Everyone forgets what day of the week it is from time to time. This isn’t a problem if it eventually clicks: “Oh right, it’s Thursday!” But for people with undiagnosed dementia, confusion about the day, time, or season of the year can signal trouble. For instance, they might forget where they are (at a friend’s house, say) or how they got there. This confusion can also manifest as difficulty remembering appointments, even if those appointments are on the calendar.
As cognitive impairment progresses, some people might start adding every little detail to their calendar, and then spend time trying to make sense of their schedule, becoming increasingly agitated and confused.
Red Flag #5: Experiencing Disruptive Sleep Patterns
When a team of European researchers examined data collected from nearly 8,000 British adults, they found that people in their 50s and 60s who got six hours of sleep a night or less had a 30 percent higher risk of developing dementia later in life compared to those who slept seven hours a night. The results, published in 2021 in Nature Communications, echo what Dr. Longo (who was not involved with this research) says is a correlation between sleep issues and dementia, usually in the form of frequent awakenings throughout the night or waking up very early in the morning.
Although this particular study did not confirm a cause-and-effect relationship, it is one of several studies suggesting that getting fewer than seven hours of sleep per night is associated with a higher risk of developing dementia, according to Dr. Longo.
There may be a “chicken-or-the-egg” dynamic at work, however, he says. For some people, new difficulties with sleep may be a sign that existing dementia is disrupting their sleep patterns. But for others, decades of poor sleep might actually contribute to the development of dementia, because sleep is a prime-time opportunity for the brain to clear out toxins that can interfere with cognition. “We don’t have the final answer yet, but my sense is that lack of sleep is one causal factor for dementia,” Dr. Longo says. The sleep-dementia link is an ongoing area of study, he adds.
Red Flag #6: Exhibiting Poor Judgment
This doesn’t refer to the relatively minor kind of bad decision-making that leads someone to, say, stay up late when they have to be up early the next morning. Rather, it’s a pattern of unwise judgment calls by your loved one that can ultimately put them in danger. This includes things like wearing a sweater and jeans on an extremely hot day; filling cups of coffee until they are overflowing; leaving the stove on; not keeping up with daily hygiene, or not recognizing a medical problem, such as a bad cut, cough, or other injuries. These are all examples of how dementia can begin to show itself.
Another common sign of this kind of poor judgment is that the older adult suddenly starts making bad financial decisions—something they never did in the past. For instance, a person who used to be financially savvy might stop opening or paying bills, begin spending beyond their means, or write checks to strangers who call them asking for money. (This is why older adults with dementia may end up being victims of financial scammers.)
Red Flag #7: Spatial Disorientation
According to the American Academy of Ophthalmology, changes in vision may accompany certain types of dementia. The retina is made up of brain tissue and is connected directly to the brain via the optic nerve, so it makes sense that changes in cognitive functioning might show up as changes in vision. The person might struggle with depth perception; difficulty reading and/or driving; or trouble following moving objects, distinguishing colors, or contrasts, or judging distances, according to the Alzheimer’s Association.
In addition to these symptoms, there is another visual problem to watch out for, says Dr. Longo. Some studies report somewhere between 5 and 15 percent of people diagnosed with Alzheimer’s have a condition called posterior cortical atrophy (PCA), which affects the visual parts of the brain. “It’s not common, but the very first symptom can be an inability to integrate or process the visual world,” he explains. [These patients] can see perfectly well but they can’t make visual sense of the world. For instance, they’ll open the fridge but can’t find the milk,” even though it’s right in front of them.
Other manifestations can include slowly developing trouble reading, estimating distances, or telling the difference between stationary and moving objects, per the Alzheimer’s Association. Individuals in the early stages of PCA tend not to have obvious memory issues. They also tend to be younger than the average Alzheimer’s patient at the onset of the disease—between ages 50 and 65 versus over 65—though researchers don’t know why.
Red Flag #8: Loss of Smell Over Time
A gradual decline in sense of smell has also been found to be a key early warning sign for dementia and Alzheimer’s disease. If your loved one has trouble smelling things, such as food that went bad in the fridge or the fact that they have body odor from not bathing, don’t assume it may be because they had COVID-19. New research from the National Institute on Aging that followed 364 participants over an average period of about two and a half years found that lower olfactory test scores were associated with a higher chance of developing mild cognitive impairment associated with Alzheimer’s and other types of dementia.
What to Do If Your Loved One Exhibits Any of These Warning Signs
If you recognize any of these potential red flags in an older loved one, your first step is to “call their primary care provider and schedule a visit,” Dr. Mobley advises. In the days or weeks before the appointment, keep a detailed journal of symptoms: what are you seeing, when it occurs (you notice a particular symptom occurring more frequently at night or after a poor night’s sleep, for example), and is the problem worsening?
Ask the doctor to perform a dementia screening. There are a number of such tests available, including one called the Mini-Cog©, which involves word recall and drawing a clock. “These [screenings] are supposed to be done yearly for anyone over 65 on Medicare,” notes Dr. Mobley, who says he just underwent one himself at a routine physical. The doctor will most likely also screen for other health problems that can masquerade as early dementia or contribute to cognitive difficulties, such as anxiety, depression, high blood pressure, a urinary tract infection (UTI), thyroid problems, or vitamin deficiencies.
Consulting a physician will help give you some answers and can lead to early detection of dementia—so that you can get your older loved one the treatment and care they need right away, when it may be most effective.
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