How to Spot Dementia in Seniors

When it comes to dementia, misperceptions — and fear — abound.

“Many people wrongly believe that all older people will end up with dementia and that all dementia is the same,” says Dr. Ronald D. Adelman, co-chief of the Division of Geriatrics and Palliative Medicine at NewYork-Presbyterian/Weill Cornell Medical Center, and the Emilie Roy Corey Professor of Geriatrics and Gerontology at Weill Cornell Medicine.

For one thing, there are large numbers of people who have normal cognition well into their 80s and 90s, says Dr. Adelman. And while 32 percent of people older than 85 develop Alzheimer’s-related dementia, “it’s crucial to distinguish between mild cognitive impairment and profound or progressive Alzheimer’s disease,” he emphasizes.

“We think of dementia as a single type of disease,” he says, “but there are a large number of diseases that cause dementia.”

When doctors use the term dementia, they are often referring to brain disorders that make it hard to think clearly.

“Typically, dementia is characterized by a chronic, acquired decline in one or more domains, including language, spatial awareness, and executive functioning sufficient to affect a person’s daily life,” says Dr. Adelman.

According to a 2017 report from the Alzheimer’s Association, common symptoms of dementia include:

• Memory loss that disrupts everyday life, including forgetting names, appointments, and conversations (and not recalling them later)
• Difficulty planning, solving problems, concentrating, or reasoning (i.e., forgetting what to do or whom to call in an emergency)
• Trouble remembering how to do once-familiar tasks, like forgetting the rules of a favorite card game or the route to a familiar place
• New problems with language, whether writing or speaking
• Frequently misplacing things and being unable to track them down later
• Withdrawal from social activities
• Changes in mood and personality

When you or a loved one experiences moments of forgetfulness or confusion, it is easy to start worrying that something bigger may be wrong.

“But people have to realize that there’s such a thing as benign forgetfulness, when you don’t remember a word or a name,” says Dr. Adelman. “Those kinds of minimal losses are pretty common in anyone who leads a busy life.”

Just as not all forgetfulness signals dementia, not all dementia is a sign of Alzheimer’s disease. While 60 to 80 percent of dementia cases in the U.S. are Alzheimer’s, according to Dr. Adelman, the rest involve other forms, including vascular dementia (e.g., multiple strokes), frontotemporal lobe dementia, or FTL, which can cause disinhibition as well as cognitive decline in people as young as 40, and dementia with Lewy bodies.

Surprisingly, some patients with symptoms of dementia may not have dementia at all. Instead, the symptoms may be related to a treatable condition such as a thyroid disorder, a subdural hematoma (when blood pools outside the brain, usually caused by trauma), a metabolic problem like low blood sodium, normal pressure hydrocephalus or drug toxicity.

“Many things can trigger cognitive problems in an older person, including depression, certain medications, or various diseases,” says Dr. Adelman.

Indeed, according to a meta-analysis in the Archives of Internal Medicine, 9 percent of patients with dementia actually had some other, reversible condition. The rate of reversible dementias in those older than 65 is about 5 percent, according to a 2015 article in the Journal of Geriatric Mental Health. For those younger than 65, about 18 percent of cases with dementia symptoms involve reversible causes. That’s why it’s important to see a doctor for an evaluation as soon as possible if you notice a change in a loved one’s behavior, such as a normally outgoing, sharp person becoming withdrawn or confused.

The first step is getting a cognitive screening from a physician.

“Often, an older person has such excellent social skills that they can cover up their deficits,” says Dr. Adelman. “But we ask questions and do assessments with various tools that can gauge the quality of a person’s cognitive status.”

It helps for a loved one to come along to weigh in on any changes that may have been observed. The work-up likely will involve neuropsychological testing, imaging of the brain, and blood work.

Steering clear of the doctor because you worry that you or a loved one might have dementia means forgoing the chance to get treatment for a potentially reversible condition. And while there is no cure for Alzheimer’s, FTL, vascular dementia, and many types of dementia, there is much that can be done to improve a person’s quality of life.

“By treating for comorbid conditions like diabetes, hypertension, and hypercholesterolemia (high cholesterol levels), we can help prevent strokes and keep a vascular dementia from progressing,” says Dr. Adelman. “Or discovering that a patient has an underlying cardiac problem, like atrial fibrillation, where little clots are causing brain injury, we can anticoagulate the patient and try to prevent further assaults to the brain.” (Anticoagulation typically involves treatment with blood-thinner medications to prevent clots.)

Lifestyle changes, like getting adequate exercise, doing mentally stimulating activities, and avoiding medications that can cause confusion, such as certain allergy medications, can also make a big difference.

And, ultimately, knowledge, even if it’s painful knowledge, is power.

“If the diagnosis is Alzheimer’s or another dementia-causing disease,” says Dr. Adelman, “you can start to put legal, financial, and advance care plans in place, when the patient can fully participate and determine her or his goals of care. This advance care planning will hopefully help improve a patient’s quality of life and reduce some aspects of family caregiver stress.”