Dementia - early signs

The early signs of dementia are very subtle and vague, and may not be immediately obvious. They depend on the type of dementia and vary a great deal from person to person. Common early symptoms include memory problems, increasing confusion, reduced concentration, changes in personality or behavior, apathy, withdrawal, and a gradual loss of the ability to do everyday tasks.

Sometimes people fail to recognize that these symptoms mean something is wrong, mistakenly assuming the behavior is a normal part of ageing. Symptoms may develop gradually and go unnoticed for a long time, and some people may be reluctant to act even when they know something is wrong.

A checklist of common symptoms#

If the person affected has several of the following signs, consult a doctor for a complete assessment.

• Memory loss. It is normal to occasionally forget appointments and remember them later. A person with dementia may forget things more often, or not remember them at all.
• Difficulty with everyday tasks. Anyone can get distracted and forget part of a meal. A person with dementia may have trouble with all the steps involved in preparing one.
• Disorientation. They may have difficulty finding their way to a familiar place, feel confused about where they are, or think they are back in some past time of their life.
• Language problems. Everyone has trouble finding the right word sometimes, but a person with dementia may forget simple words or substitute inappropriate ones, making sentences hard to understand. They may also have trouble understanding others.
• Problems with abstract thinking. Managing finances is difficult for anyone, but a person with dementia may have trouble knowing what numbers mean or what to do with them.
• Poor judgement. They may have difficulty making appropriate decisions, such as what to wear in cold weather, or judging distance and direction when driving.
• Poor spatial skills and misplacing things. Anyone can temporarily misplace a wallet or keys, but a person with dementia may not know what the keys are for.
• Changes in mood, personality or behavior. Everyone becomes sad or moody from time to time. Someone with dementia can have rapid mood swings for no apparent reason, becoming confused, suspicious or withdrawn. Some may become disinhibited or more outgoing.
• Loss of interest. It is normal to tire of some activities, but dementia may cause a person to lose interest in things they used to enjoy, or to need prompting to take part.

Other conditions can look like dementia#

Many conditions have symptoms similar to dementia, so it is important not to assume someone has dementia just because some of these symptoms are present. Strokes, depression, excessive long-term alcohol consumption, infections, hormonal disorders, nutritional deficiencies and brain tumors can all cause dementia-like symptoms. Many of these conditions can be treated.

The best place to start is by talking with the person’s doctor. Getting a diagnosis at an early stage is critical.

Only a doctor can diagnose dementia#

A correct diagnosis at an early stage is important for early treatment, support and planning for the future. A complete medical assessment may identify a treatable condition and ensure it is treated correctly, or it may confirm the presence of dementia and whether it is Alzheimer’s disease or another type.

Several kinds of assessment can help to confirm or exclude a diagnosis:

• Medical history. The doctor will ask about past and current medical problems, family medical history, any medications being taken, and the problems with memory, thinking or behavior that are causing concern. They may also wish to speak with a close family member who can help provide the necessary information.
• Physical examination. To help rule out other conditions, this may include tests of the senses, movement, and heart and lung function.
• Laboratory tests. A variety of blood and urine tests can identify any illness that could be responsible for the symptoms. In some cases, a small sample of spinal fluid may be collected for testing.
• Tests of thinking abilities. These assess memory, language, attention and problem-solving, helping to identify specific problem areas and, in turn, the underlying cause or type of dementia.
• Brain scans. Some scans look at the structure of the brain and are used to rule out brain tumors or blood clots as the cause of symptoms; some can detect patterns of brain tissue loss that distinguish between types of dementia. Other scans look at how active certain parts of the brain are, which can also help determine the type.
• Psychiatric assessment. This helps identify treatable disorders such as depression and to manage symptoms such as anxiety or delusions that may occur alongside dementia.

After considering the symptoms and ordering screening tests, the doctor may offer a preliminary diagnosis or refer the person to a specialist such as a neurologist, geriatrician or psychiatrist.

When someone is reluctant to see a doctor#

Some people resist the idea of visiting a doctor. In some cases they do not realize, or they deny, that anything is wrong. This can be due to the brain changes of dementia, which interfere with the ability to recognize the changes taking place. Others are aware of the changes but are afraid of having their fears confirmed.

One of the most effective ways to overcome this is to find another reason for the visit. You could suggest a check-up for a symptom the person is willing to acknowledge, such as blood pressure, or a review of a long-term condition or medication. You might also suggest that it is time for both of you to have a physical check-up. Any anxiety the person expresses is a good opportunity to suggest seeing the doctor.

Be sure to provide plenty of reassurance. A calm, caring attitude can help overcome the person’s very real worries and fears. If your friend or family member still refuses to go, a dementia support organization can advise you on what to do next.

Key Points#

• Early symptoms depend on the type of dementia and vary a great deal from person to person.
• Common early symptoms include memory loss and a gradual loss of the ability to do everyday tasks.
• People sometimes fail to recognize that these symptoms indicate something is wrong.
• Symptoms may develop gradually and go unnoticed for a long time.
• Work through a checklist of common symptoms, and see a doctor if several are present.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).